PACS support: the radiology approach

In 1999, Rex Healthcare, a 394-bed facility located in Raleigh, N.C., faced a growing problem. The radiology department was performing a total of 130,000 procedures a year, running out of space to store the film, and having trouble managing the file room. While the IT department was focused on the Y2K scare, radiology forged ahead with a plan to implement PACS on its own at Rex Hospital. Rex had installed a mini-PACS system for ultrasound in 1996, but there was no internal support for the system's hardware or software. Being the first in the area to implement PACS, Rex wasn't able to recruit anyone locally to support the system, so they decided to take two areas that PACS had a great impact on and use their own people. The director of radiology asked the RIS analyst and the Film Library manager, both of whom were registered technologists, to implement and support the PAC system. The key to PACS support is not computer knowledge, although it helps. The key is to understand the radiology department as a whole and the workflow from within, which makes it hard to fully support from an IT perspective. The current PACS team at Rex is composed of a PACS analyst, system support specialist and an electronic imaging center manager. When we went live with PACS, it was obvious that not all of the existing file room personnel would make the technology leap, which they realized themselves. We didn't push anybody out, but we did raise the bar of expectations. By redefining job descriptions and having the EITs (electronic imaging technologists) become more involved, increased respect was quite evident among the hospital staff. The clerks that once only hung and filed films are now troubleshooting CD burners, teaching physicians the PACS, and filming necessary exams. The final key to success is to take ownership of your system. By taking ownership, I mean that a PACS team should be established to do troubleshooting and first-line support, know the servers and application, and feel comfortable performing daily checks and tasks. Being an advanced radiology PACS site in our area, we have become an important facility for site visits. We take site visits very seriously, and have composed a package that includes information about the hospital, network/modality diagrams, EIT job descriptions, PACS information and various time studies that we have completed since going firmless. An administrator with a vision and strong support from within will get a PACS up and running, but ongoing upkeep requires a team that is dedicated to the success of the project. By taking ownership of the system and following the keys to success, a department has the ability to reengineer radiology workflow not just in the hospital, but in the community as well.