Thursday, March 8, 2012

PACS Administrator certification: CIIP vs PARCA

It's not about the race,
but it's about the journey
As PACS systems were getting more sophisticated and complex, the need for one or more full-time individuals to support these systems, and taking responsibility for the data integrity and availability of the images and related information, became obvious. The profession of a PACS System Administrator (SA) naturally evolved by having both clinical (Radiological Technologists) as well as IT folks taking up the slack to support the PACS. These early SA’s were basically learning on-the-job, because there was initially no dedicated training available. Over the past 20 years, professional organizations, notably SCAR, now called SIIM, have started to include dedicated tracks to educate these folks, and several academic and commercial training institutes started to offer training courses, seminars, and hands-on workshops. Vendors also provide SA training, but it is generally recognized that these vendor specific training sessions do not address any of the basics and rather mostly concentrate on the how-to and specific user interfaces of their equipment. In addition, there are now computer based training courses as well as text books on the subject of PACS, and the essential standards to make these systems work, i.e. DICOM and HL7. As these training classes developed, it also became obvious that there was a need for certification, for two reasons: to provide some indication of acquired skills, and also set a baseline for training: it became evident that there was a need to differentiate the large variety of training programs with varying depth and also spread of knowledge.

When defining the certification requirements, it appeared that almost no-one seemed to agree upon the job requirements of these SA’s, because their jobs vary highly depending on their background, strength of other departments, culture, and history. For example, a SA with a strong IT background might be able to troubleshoot connectivity issues between a modality and the PACS him or herself, potentially even looking at a network sniffer that shows the DICOM protocol data units and TCP/IP packets, while another SA would have to leave this up to their IT counterparts. However, after many meetings and discussions, there seemed to evolve three different tracks with potentially three different career paths, even although in many cases, all these skills could be present in one-and-the same SA. But before we elaborate on this more, it also became clear that there is definitely a common ground and vocabulary, i.e. all SA’s need to be able to communicate on the same level. They need to have a basic set of clinical AND technical vocabulary and understanding. That means, for example, for people with an IT background to know the difference between different positioning such as a PA and LAT chest so they can configure the proper hanging protocol. Similarly, it would mean for the clinical folks to know the difference between a switch and a router in case the network performance was bad. Therefore, every one agreed that basic IT and Clinical skills are a must. After having this foundation, i.e. being able to communicate at the same level, there are those professionals that specialize in standards, so that they could assist in, for example,  mapping HL7 to DICOM Attributes at an interface broker to make sure all appropriate exams show up on a modality worklist. The second group of professionals would concentrate on the PACS workflow issues, so they can re-design a system to become more effective and efficient, and a third group might be mainly involved with the coordination and project management of new modalities, implementation of speech recognition, 3-D, or whatever projects are current. The first and second career path is clearly addressed by the PARCA certifications, while CIIP is covering the 3rd track.

Certification options:
As of today, there are two options for PACS administrators, aka imaging professionals, i.e. PARCA and CIIP. Before going into the many differences between these organization, because they are quite different because of the way they initiated, let’s first concentrate on the different certification requirements. These requirements are posted on-line, both for PARCA at and CIIP at There is enough detail to be able to compare both certifications. Both certifications require clinical and IT credentials. In the case of PARCA, this is achieved by taking the CPAS exam, which tests extensively the clinical and IT skills of a candidate. In the case of CIIP, this is achieved by having certain education requirements, combined with a certain experience. Either one method has its advantages: The PARCA approach does not require experience but rather, current skills and knowledge, the CIIP approach favors experience over current knowledge. This means that professionals who would like to get into this field, and lack the required experience, only have the option to go the PARCA route. Even if you have the required experience, it might be a good choice to take the PARCA CPAS exam regardless, to get your skill at the current level.

PARCA has then two different routes, the DICOM Interface Analyst (CDIP) and the System Administrator (CPSA) track. The CDIP deals with interface standards such as DICOM, the CPSA requires knowledge about PACS components, workflow, integration and security. The CIIP certification also deals with both of these topics but from a very high level perspective, and, in addition also with topics such as project management, procurement, operations, training and education and systems management. One could conclude that PARCA is definitely more technical skill-based as CIIP is more oriented towards organizational and management roles. Again, look at both outlines and it will speak for itself.

Differences between PARCA and CIIP
In addition to the different areas and skills that these certifications are addressing, there are also differences in the approach between these certifications. PARCA is available since early 2005, and CIIP had their first pilot in June of 2007 and as of today candidates for both certifications are exceeding 1000 certificates. Consequently, there are books and study guides available for PARCA as well as for CIIP Also, most training institutions by know have learned how to adjust their training programs to make sure all PARCA and CIIP requirements are covered.
The way the exams are performed is also quite different. PARCA has a anytime-anywhere philosophy, providing the exam on-line. Note that this is still proctored, but instead of being watched in a testing center when taking your CIIP exam, you are being watched taking the PARCA exam using your computer camera remotely. This means that it is available for professionals from remote locations who might not have the travel funds readily available, especially non-US countries. Consequently, PARCA certificates are issued to as far as the Middle East. CIIP exams are conducted a couple of times/year at predetermined testing centers and are proctored making the CIIP a more predominant US certification vs. the global reach of PARCA. In addition, the exam costs also differ significantly, i.e. $100 for the PARCA CPAS exam with a “free” retake capability of two times within a year timeframe. CIIP exam cost is $400 and a $200 retake fee in case you don’t pass. The organizational structure is also different: PARCA (still) being an independent non-profit organization and CIIP under the auspices of ABII, which was founded by SIIM and ARRT.

It’s not about the piece of paper.
Certification is a major effort, and, as many people have said before us: the race is not about the finish but all about the journey. I have first hand experience about races having finished two NYC marathons: it is not about the race itself but about the many months of training and preparation. The same holds true for this certification, it takes many months of studying, reading text books, in many cases tanking classes either face-to-face or using computer based training, attending conferences, or whatever it takes. The effort should not be under estimated, but the good news is that it is an excellent reason to learn about those subjects that you might need now and in the future. It is especially a great opportunity to focus on the weak area’s, which for the clinical folks is the IT sector and for the IT folks the clinical area.
Certification is also about empowerment: How better to empower yourself with more knowledge and skills so you can better manage these complicated and sophisticated systems and ultimately provide better patient care. Managing includes taking care of image quality issues, improve workflow, reconciling studies, exams and patients, and supporting the expedient processing and reporting of patient critical images and related information.

PARCA and CIIP have gotten a lot of momentum witnessed by the fact that the number of combined PARCA and CIIP certified professionals is more then 2000 professionals. The titles are showing up both with signatures and in job requisitions. There is still a long way to go for all those thousands of professionals that are still preparing themselves for this. Initial polls showed that more than 90% of the SA’s found that certification is important, while more than 80% was seriously considering it. Each certification has its own pro’s and con’s both from an organizational perspective as to what is covered as part of the requirements. Each one supports distinctly different career tracks, although many professionals might opt to go for both, making sure they master not only the technical but also the more organizational skills. There will also be retraining needed, just look at the many different specialties that are just becoming reality, such as Optical Coherence Tomography for Ophthalmology, Tomo-synthesis for digital mammography, and just wait till pathology comes on-line with their digitized images. New challenges, requiring additional knowledge and skills; that is what being involved in this high-tech industry is all about, change is the only true predictor. Certification will help to master those skills in a consistent manner to provide excellent career opportunities and also to provide some type of standard so that the people who are hiring these professionals have something to go by.