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Getting PACS administrators, IT and radiologists to work together

If there's a disconnect between PACS administrators and radiologists, mend the relationship -- and don't even think about outsourcing, speakers at the RSNA annual meeting said.

CHICAGO -- Picture archiving and communication systems (PACS) administrators and their radiology information system (RIS) peers are feeling the heat right now, and it's coming from a number of directions: Radiologists are demanding more usability and better features in their systems. IT higher-ups are demanding stronger security to comply with new privacy laws. And the federal government -- through meaningful use -- is demanding that their systems be plugged into electronic health record and personal health record systems.

On top of that, U.S. economic conditions are forcing some health care organizations to consider outsourcing IT -- including RIS and PACS administration -- to both foreign and domestic companies. These systems' previous complexity and lack of stability might have made outsourcing unthinkable a few years ago, but today's systems are more stable. Fewer uptime concerns might make administrators feel that there's less of a need for on-site RIS and PACS teams.

Outsourcing is "pretty common," Chris Meenan, director of clinical information systems at the University of Maryland School of Medicine, told "It's a challenge for me to even find people with the technical skills and the health IT background. … The funny thing is, when you talk about RIS, those people are like gold," he said. "You don't even tell people who your RIS person is. They're guarded so closely because there's so much time invested in these folks and they're so key to your success."

The way to begin solving all those problems and stave off outsourcing, said Meehan and other speakers at the Radiological Society of North America (RSNA) 96th Scientific Assembly and Annual Meeting, is for IT managers to recognize first that RIS and PACS teams need to change from the isolated, reactive workers they tend to be into proactive, customer-service types. The change doesn't happen on its own; their managers need to enable it by fostering communication between the two teams and radiologists, while measuring progress and offering incentives for gains.

How divisions occur between radiologists, PACS administrators

How do disconnects occur between radiologists and some RIS or PACS staff? It starts with their separate environments. Typically, IT staff are used to working by themselves in brightly lit, cool, climate-controlled rooms. Radiologists are used to staring into monitors, packed all together in warmer, darker reading rooms.

Often they are in separate locations on different floors, in different buildings or even towns. When that's the case, it's hard for them relate to each other and work together to solve problems their technologies pose. For example, IT staff typically wants to lock down data as much as possible and log out users who even briefly leave their workstations. Radiologists, on the other hand, want to be less inconvenienced by security measures so they can increase throughput.

If these rifts persist, and if end users complain that support is hard to reach or the PACS inexplicably goes down on a regular basis, IT leadership needs to address the situation, Meehan said. Ultimately, RIS and PACS administrators must work for the greater good -- keeping radiologists as productive as possible, patient care at the highest quality possible, and throughput as fast as possible.

Get PACS administrators into reading rooms

To understand the problems of radiologists, RIS and PACS staff need to get into reading rooms and not only listen to radiologists describe problems, but also watch them in action to see how their workflow can be improved or streamlined, Meenan said.

Rounding -- having RIS and PACS administrators regularly visit radiology reading rooms to interact with their users -- is a key way to detect problems before they're reported, added Dr. Marc Kohli, co-presenter and assistant professor of radiology and imaging sciences at Indiana University.

While that might sound strange, the things that do come up in rounds are the technical inconveniences that radiologists don't know could be solved -- or that in their minds don't equal the importance of filing a report -- but are adversely affecting productivity andm by extension, revenues.

"Culture is as important as competency," Meenan said. "Having that culture that your PACS team is involved in your mission -- that they are there to watch these systems -- is important. I can't overstate it enough. It's critical to the success of the PACS team."

Meenan's watershed moment came when he was pulled out of his office in a data center to help a radiologist work through a problem that involved a patient in surgery. The incident changed his opinion of his job. Previously it had been about keeping a system running; now it had become about helping live patients -- "enabling radiologists to deliver world-class service [with] world-class systems," he said. Reminding IT staff of this part of their mission, he added, can help influence them to work better with clinicians.

This more proactive attitude can be fostered in existing staff, but it's even better to set expectations during the hiring process. Make them understand they are there to watch for problems and solve them, instead of waiting for a report to come in. Also, hire people who are good communicators, can work under pressure and have a thick skin.

Survey and report on PACS support, create incentives for good performance

I guarantee you, if somebody outsources your PACS administrators, you're going to be in a world of hurt as radiologists.

Dr. Marc Kohli, assistant professor of radiology and imaging sciences, Indiana University

Once you've established a mission for RIS and PACS teams, and have started seeing a change in attitude, establishing incentives is next, Meenan recommended. Setting goals, such as solving a certain number of tickets or problems in a month, can help make IT staff accountable for their work. Plus, enthusiasm grows if there are rewards for improved performance.

Measuring IT staff performance can go beyond simple task-counting, Meenan said. Surveying radiologists' satisfaction regularly -- and giving them a chance to describe issues they think need solving -- is another effective way to determine if your initiatives are working. Free online survey tools to accomplish this can be found online at a number of sites, including Google Docs and

For example, radiology departments that don't want in-house PACS support teams outsourced can survey PACS support on how radiology can better communicate problems and report issues before they turn into crises, Kohli said during his presentation.

"Why do I really care about building a survey?" Kohli asked. "You're showing that [IT staff] do provide a higher level of service than could be provided from an external consultant. I guarantee you, if somebody outsources your PACS [administrators], you're going to be in a world of hurt as radiologists."

Problems from outsourcing can include a lack of institutional memory -- that is. it's hard to solve a system's problems when no one's sure of the rationale behind its implementation in the first place -- as well as a negative impact on clinical workflow, which outsiders are too far away to grasp.

"Health care systems are not plug and play," Kohli told "They don't work like USB flash drives. There is a ton of custom work that goes into these integrations, and that's something you can't duplicate overnight."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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