PACS administration: A look into the crystal ball

Oct 12, 2008

There are some people who believe that radiology PACS networks are becoming commodities -- if they have not already become so. Will PACS administrators suffer the same fate?

Being defined as a commodity product means "a good or service whose wide availability typically leads to smaller profit margins and diminishes the importance of factors (such as brand name) other than price," according to Merriam-Webster's dictionary. In my view, PACS administrators (PAs) are not becoming commodities for a variety of reasons.

For example, user names and passwords will continue to be a problem. We need user names and passwords for nearly everything in life today and it keeps getting worse. My favorite is when they change the requirements of minimum length and what characters are required for each, especially when you've been using the same one for years. Instead of one password for 20 accounts, I now have several different passwords.

Biometric solutions also have not demonstrated reliability and durability. Newer technologies such as radiofrequency identification (RFID) or ID cards to swipe for sign-on may be solutions in the long-term, but for the immediate future, I am from Missouri -- show me! The emergence of a true electronic medical record will allow physicians to use only one sign-on for all information; at that point password problems will typically go directly to the IT help desk.

In good news, modality integration issues have been trending downward. As more and more modalities are replaced today and in future years, problems with DICOM compliance and the goofy nuances with different vendors will diminish. This should become a less important part of the PA workload going forward.

With the maturation of the PACS market, the next natural process will be a decline in the number of vendors. Increased competition will ultimately drive many current vendors from the market. Whether you are satisfied with your current vendor or not, there will be winners and losers, and the trend for vendor replacement will grow stronger.

For PAs, this adds the need for data migration to a completely new installation and implementation process. Two systems will need to be kept running in parallel for some period of time. Data migration is still more art than science, and the data are always "dirtier" than everyone thinks. This problem is driving the vendor-neutral archive market, but that's a whole separate article.

The biggest change will be the migration from technical work and technical support to more and more clinical-based support. This is where I believe you will see the good PAs become great PAs.

Today's standalone modality workstations are being integrated into the PACS workstation software. The migration of these software programs will make use of these additional modality-specific toolsets available for concurrent users, and there will be clinicians and referring physicians who will want to take advantage of them. It will be the PA's responsibility to train everyone on the use of these packages.

In the future, the PA will be focused on training, training, training. These software packages are more complex than just utilizing a Web browser for panning, zooming, and magnifying images. PAs will have to leverage their clinical training to be able to understand what the tools are used for and how to use them.

And, as we all know, the clinicians will take whatever you give them and still want more. As we move to fewer vendors and lower profitability in the marketplace, more vendors will move (some already have) to the train-the-trainer structure with initial training either via DVD or a Web-based format. That's how you will become the expert.

The best PAs are focused today on workflow to maximize their facilities' efficiencies. In the future, communication and facilitation will move to the forefront of their daily activities. As a result, the best PAs will get better.

By Michael Mack
AuntMinnie.com contributing writer
October 13, 2008

Mr. Mack is president of the Thomas Group, a PACS consulting services provider in Orange, CA. He can be reached at [email protected].