SIIM: Top 10 PACS problems, and their solutions

MINNEAPOLIS—“Technology is seldom the solution to problems, instead technology provides an opportunity for a solution,” shared Richard Kennedy, technical director of imaging informatics at Kaiser Permanent Medical Center in Los Angeles. During a presentation at the 2010 Society of Imaging Informatics in Medicine (SIIM) conference, Kennedy said that solutions to PACS problems fall under the purview of imaging informatics staff.

During a practical imaging informatics educational session, Kennedy listed the top 10 PACS problems and offered potential solutions to each:

1. Availability and uptime: The business continuity paradigm is changing; they become too expensive for most facilities. Instead, departments need to plan alternative workflows for scheduled and unscheduled downtime.
2. User communication: PACS reach more users than most people realize. Over-communication is impossible. Kennedy recommended leveraging multiple means including posters and email blasts to directly reach out to all PACS users. PACS administrators should anticipate misinformation and manage it.
3. Network connectivity: Kennedy’s team uses a handheld meter to pinpoint problems.
4. DICOM problems: Most problems are configuration problems. Administrators should start the problem-solving process by investigating the most likely cause of the problem.
5. System speed: Kennedy carries a stopwatch to show users true versus imagined PACS speed. Actual speed often exceeds the user’s perceptions.
6. Quality assurance (QA) problems: Data integrity begins at the modality; provide technologists with tools for point of care QA.
7. Imaging outside of radiology: Imaging, and PACS management, is no longer confined to radiology. Re-think the PACS administrator position description and consider the role of imaging informaticist vs. PACS administrator.
8. Constant upgrades: Separate the platform from the application.
9. Dashboards and reporting issues: Departments need to know what’s happening in real time. Consider PACS analytics as a separate discipline from PACS administration.

        10.  User expectations: Engineer users’ expectations. Listen to vendors’ descriptions of system capabilities and share them with users.

After Kennedy’s summary, David A. Clunie, MD, chief technology officer at RadPharm, delved into a methodology for managing user expectations. The first step occurs during the courting phase of a PACS project. Users and administrators must document and share system needs with the vendor. Most PACS problems, however, crop up after installation. A disciplined and adept problem solver addresses issues by describing observed the expected behavior. Next, the administrator reviews documents and instruments the system, reviewing saved DICOM objects and logs. After gathering additional information, the PACS administrator seeks helps from colleagues, user groups and field engineers. The final step is to initiate a solution by changing workflow, developing a workaround or purchasing and deploying a product to solve the problem.

The upshot? Problems are inevitable. Solutions are possible and probable with a disciplined problem-solving approach.