Thursday, August 23, 2012

Will the PACS SA profession be obsolete in 2015? PACS SA Career series Part 1

A PACS administrator is critical to support
healthcare imaging applications
There is no question that the traditional role of PACS System Administrators (SA) has changed over the past 15 years, and there is also no question that it will continue to evolve over the next 5 to 10 years. Instead of “going with the flow,” it might be wise as a PACS SA to actively anticipate the future for as far as possible, and work towards a preferable upwards career path. Remember that even though there are no formal statistics, it is generally assumed that each person has about seven different careers in their lifetimes, which means, assuming 42 years of employment that means one might be on the lookout for a change every six years.
There are plenty of opportunities for PACS SA’s as they have acquired unique multifunctional skills and experiences that are very valuable in managing and supporting healthcare imaging and IT systems. These range from internal career growth to managing multiple imaging departments or electronic records management, working as an independent consultant or for a major consulting firm. One can also transition to the vendor side in sales, project management or as a service and support professional.This series of articles will explore the trends and changes that have occurred over the past few decades with the PACS SA career, and explore each of these career tracks by interviewing established PACS SA’s in a given field. Although I have spoken with quite a few PACS administrators, as many of them have attended our PACS and DICOM, HL7 and IHE training classes, this is limited to an overview and will not try to present a comprehensive examination of all possible PACS careers. Nevertheless, I hope this series will l jump start ongoing regular interactions, not only during our live web-based interview sessions, the first being on September 4 (TIME 7:00 PM CST) on our first OTech Google+Hangoutbut also afterwards.  (Join OTech on Google+ and add us to your circles and tell us your interest while joining our “Hangouts” in order to receive an invitation for the upcoming applicable Hangouts.
PACS administrators are known by many different titles. Based on a survey, there appears to be a wide variation of job titles reported by those filling the role of a PACS or Imaging and Informatics professional. The most frequently reported job title (37%) is “PACS Administrator,” or “PACS System Administrator.” The next most frequently reported job title (11%) is “RIS/PACS administrator.” Only 11% of professionals have the word “imaging” in their job title.

Below is a list of the job titles reported in the survey:

Chief Tech/PACS Administrator
PACS - Clin. Eng.Syst. Integrator
Clinical Applications Analyst
PACS (System) Administrator
Computer Specialist / imaging
PACS Admin/ QM Tech
Digital Imaging Analyst
PACS Analyst
Director of Imaging and IT Infrastructure
PACS Coordinator
Director of Information Technology
PACS Manager
Enterprise System Administrator
PACS Technical Support Manager
Imaging Coordinator
PACS/Clinical Coordinator
Imaging Director and RIS/PACS
PACS/RIS/PowerScribe Admin.
Imaging Informatics Administrator
Radiology Systems Coordinator
Imaging Informatics Manager
Regional PACS Analyst
Imaging Supervisor
Imaging Systems Administrator
RIS/PACS Coordinator
Information Systems Support Services
Sr. System Anal. for Im. Informatics
Manager of Radiology Information Systems
Telemedicine Administrator

Let’s first explore a little of the evolution of this career. I suggest breaking down the evolution in periods of 5 years:

  1. Early childhood (pre-2000)
The period from 1995-2000 marks the emergence of the PACS SA as a career as many departments began assigning dedicated resources to support the PACS. Many systems had a very experienced dedicated PACS service and support person, often fulltime or, if not, a part-time or contract person present at a site. The tools for fixing studies, reports, and performing any troubleshooting were crude and it took a lot of time and effort to support a PACS system. You had to know about DICOM as it often required looking at dump or log files and there was a high dependence on vendors for support.

  1. Teenage years (2000-2005)
This era was characterized by the commoditization of PACS. It required more tools to support them, many more vendors had to be trained and, unfortunately, their knowledge levels decreased. This was another reason for providers to upgrade the education of their SA’s. More educated and trained the support, however, greatly depended on in-house resources. Another advance during this period, in terms of defining the PACS SA career, was the creation of certification organizations, i.e. ABII and PARCA, in conjunction with efforts to create more or less formal job descriptions (see post for a sample). At the same time, HIPAA became a requirement during this period, which brought additional requirements and corresponding job duties and functions.

  1. Reaching maturity (2005-2010)
As PACS systems got more sophisticated and configurable, the need for easy-to-use tools for fixing studies, setting up hanging protocols, creating reports and looking at audit trails became a necessity and available. The careers of “PACS assistants” or “associates” were created. These are super-users who work as technologists but can fix studies, merge them, set up and change simple configurations. Also, tech savvy file room personal were being trained to import and export CD’s in a manner that would not jeopardize system integrity. PACS SA’s were able to work on project management, define and implement institution-wide PACS policies and procedures, including critical down time procedures and reliable back-ups.

  1. Middle age (2010-2015)
The PACS SA career is reaching a period past maturity. As of 2012, there are an estimated 2,000 certified PACS SA’s, about equally divided between the ABII CIIP and PARCA organization. As a matter of fact, it is time to re-evaluate the certification requirements and create growth beyond the basic certification in the form of an enterprise certification for those professionals that elect that particular growth path. Tools are now rather sophisticated for the support of PACS systems. Remote access allows SA’s to manage systems in multiple locations, and PACS issues are being expanded along with open source tools such as DICOM sniffers and validators that are readily available to troubleshoot even the most tricky problems (see for example on how to use a DICOM sniffer). PACS SA’s are getting very involved with migrating issues for new upgrades, PACS replacements, or VNA and/or cloud solutions for archiving the images, and they are educating themselves about Meaningful Use criteria to get on the EMR incentives bandwagon.

  1. Ready to retire? (post 2015)
I don’t believe that the PACS SA career will become obsolete, but rather it will grow into a role that includes more components of training, project management, planning and coordination. Images are going to be not only available within the enterprise but cross-enterprises through new protocols defined by IHE, which allows images to be exchanged between radiologists referring physicians, specialists, and in some cases, they might be managed by patients through their own Personal Health Records. Imagine the issues that came along with the exchange of images using CD’s, these issues will be multiplied exponentially when the number of images being exchanged increases more than tenfold, all electronically.  Bringing up the appropriate prior studies for a comparison is already a challenge within a single enterprise; imagine this enterprise becoming a regional health information exchange. I think you get the picture (no pun intended). I do believe that the trend of bringing the SA job under IT will continue, even if not from a functional standpoint, then at least from a hierarchical perspective.

In conclusion, I don’t think that the PACS SA career will become obsolete in the foreseeable future, but will continue to evolve. However, independent of the PACS SA career, you might want to explore other opportunities as will be outlined in future segments of  this series where we will explore the career paths on the provider side, consultant and vendor sides as well.