PACS During Holidays

Medical Imaging 24x7 service

Healthcare is one of many services which run around the clock specially at emergency rooms where patient is in high need of medical intervention on the spot. 

Medical imaging is not an exclusion! In fact, requests for imaging procedures for emergency patients is very frequent due to the fast and the non-invasive nature of some imaging procedures like CT scans, ultrasonography, and even general x-rays which existed in emergency rooms for decades.

High end procedures like PETCT, MR, and SPECT scans are done as well for some emergency patients. For that reason, imaging departments in any general hospital are on service for 24x7 including national holidays.

During holidays and non-working hours, imaging departments usually provide services by assigning technicians on shifts and physicians on call trying to help emergency patients to save their lives and to prevent further medical complications.

 

Absence of PACS admins

Now and after transforming most of imaging services to digital, those services are in hands of a new technology called PACS/RIS. If that system is down, or out then the whole department is usually on hot plate. Due to lack of clear policies and weak technology implementation, PACS/RIS operation is almost impossible without an administrator. In fact, running PACS/RIS without an administrator at any time means threatening lives of many patients.

There are many examples were administrator interference is needed. One example is merging or rejecting wrong images which require administrative access rights to the system. In fact, wrong patient information is; in many times, a serious threat to patient's safety. See FDA similar reported event . The role of PACS admin cannot be substituted by any one. 

One more example of tasks assigned to PACS admins, is the follow up of consistent backup handling. It's beyond changing the backup tape, it's about consistency. Backup logs should be verified for a successful backup job. Thus, role of PACS admin is continuum.

PACS Admins 24x7

Now and after knowing that PACS admin's job is continuous, that doesn't mean that a PACS admin should be available in the hospital all the time!  Yes, a PACS admin should be available in the hospital at least during working hours where regular appointments are scheduled. However, PACS admin should be available on call 24x7 just like any other IT service. In fact, many Internet technologues can help in providing remote support from outside hospital without imposing any threat to data security. 
Thus, PACS administration has to be treated according to the field of information technology standards in both payment scale and team organization to co-op with the demand for the PACS admins.

PACS admin team restructuring

Moreover, to be able to adopt a new PACS team organizational structure and payment scale, a job description for this post has to be defined. In fact, the best resource I have came across about forming PACS team and defining job description accordingly is a document written by Herman Oosterwijk and Janet Skinner from OTech Inc. and Skinner Associates (PACS Admin and IIP Resource Guide 2008, PDF Format). In last guide, authors discussed development, training, career tracks, job Descriptions, titles, salary of PACS professionals and more. 

 

Recommendations

To solve the issue of absense of PACS admins during PACS operation hours I will recomend the following actions.

1. PACS (imaging IT) Team should be formed with proper team members in terms of quality, quantity and good work environment to cover the operation hours (24x7).

2. PACS admins should be on call during after working hours and during holidays with proper job dispatching and compensation system.

3. PACS admins should have access to hospital network using secure VPN connections to help reaching the system everywhere at any time.

4. For smooth operation with minimum down time, service level agreement (SLA) should include an explicit agreement for support during "after working hours" and public holidays.

5. Service agreement should assure 24x7 monitoring of log traps (logs send to vendor's support team) which is the only way to assure optimal down time.

6. Call management system has to be implemented to help PACS administration team managing this heavy job. This system will provide PACS team with ability to schedule jobs and organize support efforts.

 

Conclusion

Above discussion is not inclusive. It's actually a second call for a dialogue within Kuwait imaging community. That dialogue was already started before in the early days of Q8PACS by Mr. Ahmed Al-Mutairi (former senior PACS admin at AlSabah hospital, Kuwait) and was presented earlier to the Radiology & Nuclear Medicine council at that time.

This dialogue will be neccessary to start reform in PACS operations and thus in leveraging medical imaging services in Kuwait.

 

I think this is the time to start the dialogue Again!!