Monday, June 30, 2014

PACS professional career and certification options.

Certified does not mean competency,
however it shows commitment and a
certain basic level of knowledge
Over the past several years, PACS support professionals have evolved from being “one does all” generalists into several different career paths with corresponding professional certifications[1].  Depending on the strengths and preferences, as well as ambitions, of these health care imaging and IT professionals it is now possible to select one or more career paths to meet individual and organizational goals. Note that the careers described below are equally applicable to PACS administrators as well as PACS support professionals, such as biomedical engineers, service and support technicians as well as interface and workflow analysts, working either on the provider side or the vendor side.

The different career paths have a foundation based on the basic skill set of clinical and IT knowledge, with additional specializations after that, which not coincidentally, have corresponding certifications.

The following career paths can be distinguished:
1.       The basic foundation for these health care imaging and IT professionals is provided by the PACS Associate skills with the corresponding PARCA CPAS certification (Certified PACS Associate). The core competencies include:
a.       Clinical expertise which includes familiarity with the various body parts and body systems such as the circulatory, musculoskeletal, gastro-intestinal, nervous, endocrine, pulmonary and reproductive systems. The candidate should be familiar with the most common medical terms and imaging positioning, and know the workflow and appearance of the images created by imaging modalities such as CT, MR, DR, CR, digital mammography and breast tomosynthesis, US, RF, XA and IVUS and IV-OCT, NM, PET/CT and MR/CT.
b.      IT expertise including the basic hardware components such as storage devices (RAID, SAN, NAS) and software knowledge of MSDOS, Windows, UNIX, relational databases, image and data representations and networking technology.

Here are some illustrative examples of what these PACS associate professionals are expected to do:
·         Fix “broken” or “unverified” studies at the PACS
·         Configure hanging protocols at a workstation based on body parts and view codes (e.g. PA of the chest, or MLO and CC of a breast image)
·         Configure prefetching algorithms at a PACS router based on modality type and/or series descriptions
·         Configure a new PACS workstation with its IP address and port number and be able to perform basic network troubleshooting (ping, tracert, etc.)
·         Query a PACS database using basic SQL queries to find a missing study and/or provide basic statistics such as “all CT exams added to the database during the past month”
·         Find the configuration file on a PACS server using basic UNIX commands
·         Evaluate low level log and configuration files that can be encoded in hex or binary representations

2.       The first level of specialization is to expand the competencies into other specialties, enterprise imaging, workflow and in-depth knowledge of PACS architecture corresponding with the CPSA certification. In addition, these professionals are equipped to address image quality and other QA issues and have a little knowledge of DICOM and HL7, enough to do basic troubleshooting and configuration. They also deal with security and privacy issues for the imaging and informatics systems. They might manage radiology, cardiology, dentistry and other imaging systems that are situated in various departments.

These are typical activities for these professionals:
·         Review audit trails on a regular basis for any potential violations
·         Perform QC audits such as CR reject analysis
·         Run regular test plates on CR systems and test patterns at the workstations to monitor the image consistency and persistency
·         Do an extensive workflow analysis and update this to constantly improve workflow
·         Coordinate any changes and upgrades with other departments
·         Manage storage, and track performance and capacity
·         Manage the enterprise image management system (VNA) in addition to the individual PACS systems
·         Coordinate storage and image management requirements between different imaging departments and specialties
·         Manage several PACS associates who in turn are responsible for the day-to-day operations while the CPSA is more focused on the long term planning

3.       Some professionals expand into project management, coordination, and/or take on an extensive teaching role, which seems to be the area that CIIP candidates specialize in. In my opinion, CIIP by itself is not necessarily enough to do that job as it does not emphasize technical skills (for example, there is no requirement to know anything about HL7), however, it has a nice spread of generic requirements ranging from learning methods to health care delivery hazards, and creating and interpreting requests for proposals.

These are typical activities that a CIIP professional might be involved with:
·         Creating an implementation plan for a new release
·         Developing a migration strategy from one vendor to another
·         Providing a comprehensive learning plan and tools for a new release implementation
·         Being part of a multi-functional team to evaluate RFP responses
·         Managing the implementation of a new speech recognition application
·         Coordinate communication about new upgrades, changes, with an organizational control board

4.       A PACS system has many interfaces, not only to many modalities (there could be dozens of those in a typical installation), but also to a scheduling system, reporting system as well as an EMR. There could also be an enterprise solution for archiving involved, such as a VNA. An Interface analyst will manage and support these interfaces having competencies as defined by the CPIA certification. These professionals are intimately familiar with HL7 and DICOM data formats and protocols. They can use simulation tools and have access to a wide variety of test transactions and test images, and can use validation and test tools such as network sniffers to troubleshoot even the most tricky interface problems.

These are typical activities that a CPIA professional would perform:
·         Develop an acceptance test plan and perform the acceptance testing for any new releases
·         Troubleshoot random connectivity issues between modalities and a PACS system using a network sniffer
·         Map and configure HL7 messages into the DICOM worklist
·         Assist interface engine specialists with mapping HL7 messages to meet the PACS requirements
·         Assist the purchasing team by specifying interface requirements, especially with regard to required IHE profiles
·         Validate any new software and new modality interface against the hospital specific requirements for information content
·         Work with biomed and IT to make sure any new installation and device is properly evaluated by reviewing interface specifications, conformance statements and IHE profile definitions.

5.       In addition to the interface specialist as defined by the CPIA requirements, there is also a place for HL7 experts, specializing in the HL7 standards. These professionals are certified as a HL7 interface specialists and there are several types of specialists, covering version 2, version 3 and CDA. In the context of medical imaging, the version 2 certification is the most applicable. These professionals have a very detailed knowledge about the HL7 data formats.

Typical activities for these specialists would be:
·         Program interface engines to map different HL7 messages accommodating different versions and unique hospital requirements
·         Manage the hospital specific extensions of the HL7 transactions
·         Test any new interfaces and validate them against the hospital requirements
·         Manage and control the interface specifications
·         Develop hospital specific conformance profiles that can be used to test and validate changes and upgrades

6.       There is an emerging group of professionals that are called “medical informaticians.” Speaking with recruiters, these are the hottest jobs right now. Unfortunately, there is no certification (yet) that addresses this need, although the PARCA CHEA comes close. As a matter of fact there are no master’s degree programs in the US that I know of covering these specific requirements (Canada is ahead of the US in this regard). These are health care imaging and IT architects that assist an institution developing an enterprise (and beyond) imaging solution.

Typical activities for these specialists would be:
·         Negotiating with the regional Health Information Exchange (HIE) the interface, information exchange, and security and privacy policies
·         Assisting in developing the architecture for the private HIE and its interface with the VNA
·         Managing and coordinating the many imaging exchange scenarios
·         Managing the imaging components of Personal Health Records and patient portals
·         Develop and manage a comprehensive image import and export policy
·         Specify requirements for performance and throughput of any external connections to clinics, partners, third parties, for clinical trials, etc.
·         Be the interface between the EMR specialist and the imaging departments to facilitate image enabling an EMR
·         Specify and test enterprise wide IHE profiles such as PIX/PDQ and the XDS family (XDR, XCA, etc.)

In conclusion, as is obvious from the information above, there are plenty of growth opportunities for health care imaging and IT professionals. In my opinion, there is too much emphasis on how to change from existing PACS careers into other areas (witnessed by the SIIM tracks on “how to become the next CIO or COO”), while there are in my opinion plenty of opportunities to stay within this field of expertise and grow accordingly. There is definitely a need for professionals that understand the workflow and intricacies of the interface and data formats, especially now that there is so much emphasis on image exchange and image enabling of EMR’s. In short, the future is bright, especially for those who recognize the opportunities and possibilities for advanced certifications.

[1] The certification organizations that provide the applicable certifications are ABII, PARCA and HL7