PACS cannot succeed only as a piece of health IT. Policies, procedures, and support create the required environment for these systems to achieve their full potential.
A recent series of classes I conducted in the Middle East exemplified the challenges with installing, maintaining, and supporting PACS in this region. Although the technology is the same as used throughout Europe and North America, the PACS environment (policies, procedures, and support) is not.
Unfortunately, there is a big training gap on what is required to successfully implement PACS, which has led to a lack of infrastructure and support. In general, the IT staff at many facilities is very weak, or sometimes even non-existent. In these institutions, there are no policies with regard to basic IT good practices such as virus protection, network management tools. Even fundamental activities such as who is making a back-up, and how often this is done can be missing. There is no understanding that a PACS needs a dedicated PACS administrator. In many cases a technologist, or even a department head, will perform double duty to fill this role.
It is very easy for these facilities to buy a piece of technology, such as a PACS, but to change internal procedures, infrastructure, jobs, and workflow to accommodate it is--in many cases--not done. Job descriptions need to be changed and a very clear division of authorities is needed. For example, who is importing images from a CD, where are they kept, for how long, who is merging two patients or studies, checking log files, and so must be defined. Basic QA activities such as dose-creep analysis, reject analysis, calibrating CR systems and monitors have to be performed but are not being done.
Using technology without proper infrastructure and policies and procedures has the potential to create patient harm. The good news is that these countries are eager learners and are quickly picking up the required knowledge needed to successfully implement PACS. For expatriates, there are also some very good opportunities to help start these changes. However, there is still a lot of work to do and awareness of PACS issues, training, and education are critical. If these elements are not put in place soon, there could be some dramatic failures in the near future.