| Certified does not mean competency, however it shows commitment and a certain basic level of knowledge |
Over the past several years, PACS support professionals have
evolved from being “one does all” generalists into several different career
paths with corresponding professional certifications[1]. Depending on the strengths and preferences,
as well as ambitions, of these health care imaging and IT professionals it is
now possible to select one or more career paths to meet individual and
organizational goals. Note that the careers described below are equally applicable
to PACS administrators as well as PACS support professionals, such as
biomedical engineers, service and support technicians as well as interface and
workflow analysts, working either on the provider side or the vendor side.
The different career paths have a foundation based on the
basic skill set of clinical and IT knowledge, with additional specializations
after that, which not coincidentally, have corresponding certifications.
The following career paths can be distinguished:
1.
The basic foundation for these health care
imaging and IT professionals is provided by the PACS Associate skills with the
corresponding PARCA CPAS certification (Certified PACS Associate). The core
competencies include:
a.
Clinical expertise which includes familiarity
with the various body parts and body systems such as the circulatory, musculoskeletal,
gastro-intestinal, nervous, endocrine, pulmonary and reproductive systems. The
candidate should be familiar with the most common medical terms and imaging
positioning, and know the workflow and appearance of the images created by
imaging modalities such as CT, MR, DR, CR, digital mammography and breast
tomosynthesis, US, RF, XA and IVUS and IV-OCT, NM, PET/CT and MR/CT.
b.
IT expertise including the basic hardware
components such as storage devices (RAID, SAN, NAS) and software knowledge of
MSDOS, Windows, UNIX, relational databases, image and data representations and networking
technology.
Here are some illustrative examples
of what these PACS associate professionals are expected to do:
·
Fix “broken” or “unverified” studies at the PACS
·
Configure hanging protocols at a workstation
based on body parts and view codes (e.g. PA of the chest, or MLO and CC of a
breast image)
·
Configure prefetching algorithms at a PACS
router based on modality type and/or series descriptions
·
Configure a new PACS workstation with its IP
address and port number and be able to perform basic network troubleshooting
(ping, tracert, etc.)
·
Query a PACS database using basic SQL queries to
find a missing study and/or provide basic statistics such as “all CT exams
added to the database during the past month”
·
Find the configuration file on a PACS server
using basic UNIX commands
·
Evaluate low level log and configuration files
that can be encoded in hex or binary representations
2.
The first level of specialization is to expand
the competencies into other specialties, enterprise imaging, workflow and in-depth
knowledge of PACS architecture corresponding with the CPSA certification. In
addition, these professionals are equipped to address image quality and other
QA issues and have a little knowledge of DICOM and HL7, enough to do basic
troubleshooting and configuration. They also deal with security and privacy
issues for the imaging and informatics systems. They might manage radiology,
cardiology, dentistry and other imaging systems that are situated in various
departments.
These are typical activities for these professionals:
·
Review audit trails on a regular basis for any
potential violations
·
Perform QC audits such as CR reject analysis
·
Run regular test plates on CR systems and test
patterns at the workstations to monitor the image consistency and persistency
·
Do an extensive workflow analysis and update
this to constantly improve workflow
·
Coordinate any changes and upgrades with other
departments
·
Manage storage, and track performance and
capacity
·
Manage the enterprise image management system
(VNA) in addition to the individual PACS systems
·
Coordinate storage and image management
requirements between different imaging departments and specialties
·
Manage several PACS associates who in turn are
responsible for the day-to-day operations while the CPSA is more focused on the
long term planning
3.
Some professionals expand into project
management, coordination, and/or take on an extensive teaching role, which
seems to be the area that CIIP candidates specialize in. In my opinion, CIIP by
itself is not necessarily enough to do that job as it does not emphasize
technical skills (for example, there is no requirement to know anything about
HL7), however, it has a nice spread of generic requirements ranging from
learning methods to health care delivery hazards, and creating and interpreting
requests for proposals.
These are typical activities that
a CIIP professional might be involved with:
·
Creating an implementation plan for a new
release
·
Developing a migration strategy from one vendor to
another
·
Providing a comprehensive learning plan and
tools for a new release implementation
·
Being part of a multi-functional team to
evaluate RFP responses
·
Managing the implementation of a new speech
recognition application
·
Coordinate communication about new upgrades,
changes, with an organizational control board
4.
A PACS system has many interfaces, not only to
many modalities (there could be dozens of those in a typical installation), but
also to a scheduling system, reporting system as well as an EMR. There could
also be an enterprise solution for archiving involved, such as a VNA. An
Interface analyst will manage and support these interfaces having competencies
as defined by the CPIA certification. These professionals are intimately
familiar with HL7 and DICOM data formats and protocols. They can use simulation
tools and have access to a wide variety of test transactions and test images,
and can use validation and test tools such as network sniffers to troubleshoot
even the most tricky interface problems.
These are typical activities that
a CPIA professional would perform:
·
Develop an acceptance test plan and perform the
acceptance testing for any new releases
·
Troubleshoot random connectivity issues between
modalities and a PACS system using a network sniffer
·
Map and configure HL7 messages into the DICOM
worklist
·
Assist interface engine specialists with mapping
HL7 messages to meet the PACS requirements
·
Assist the purchasing team by specifying
interface requirements, especially with regard to required IHE profiles
·
Validate any new software and new modality
interface against the hospital specific requirements for information content
·
Work with biomed and IT to make sure any new
installation and device is properly evaluated by reviewing interface
specifications, conformance statements and IHE profile definitions.
5.
In addition to the interface specialist as
defined by the CPIA requirements, there is also a place for HL7 experts,
specializing in the HL7 standards. These professionals are certified as a HL7
interface specialists and there are several types of specialists, covering version
2, version 3 and CDA. In the context of medical imaging, the version 2 certification
is the most applicable. These professionals have a very detailed knowledge
about the HL7 data formats.
Typical activities for these
specialists would be:
·
Program interface engines to map different HL7
messages accommodating different versions and unique hospital requirements
·
Manage the hospital specific extensions of the
HL7 transactions
·
Test any new interfaces and validate them
against the hospital requirements
·
Manage and control the interface specifications
·
Develop hospital specific conformance profiles
that can be used to test and validate changes and upgrades
6.
There is an emerging group of professionals that
are called “medical informaticians.” Speaking with recruiters, these are the
hottest jobs right now. Unfortunately, there is no certification (yet) that
addresses this need, although the PARCA CHEA comes close. As a matter of fact
there are no master’s degree programs in the US that I know of covering these
specific requirements (Canada is ahead of the US in this regard). These are
health care imaging and IT architects that assist an institution developing an
enterprise (and beyond) imaging solution.
Typical activities for these
specialists would be:
·
Negotiating with the regional Health Information
Exchange (HIE) the interface, information exchange, and security and privacy
policies
·
Assisting in developing the architecture for the
private HIE and its interface with the VNA
·
Managing and coordinating the many imaging
exchange scenarios
·
Managing the imaging components of Personal
Health Records and patient portals
·
Develop and manage a comprehensive image import
and export policy
·
Specify requirements for performance and
throughput of any external connections to clinics, partners, third parties, for
clinical trials, etc.
·
Be the interface between the EMR specialist and
the imaging departments to facilitate image enabling an EMR
·
Specify and test enterprise wide IHE profiles
such as PIX/PDQ and the XDS family (XDR, XCA, etc.)
In conclusion, as is obvious from the information above,
there are plenty of growth opportunities for health care imaging and IT
professionals. In my opinion, there is too much emphasis on how to change from
existing PACS careers into other areas (witnessed by the SIIM tracks on “how to
become the next CIO or COO”), while there are in my opinion plenty of
opportunities to stay within this field of expertise and grow accordingly.
There is definitely a need for professionals that understand the workflow and
intricacies of the interface and data formats, especially now that there is so
much emphasis on image exchange and image enabling of EMR’s. In short, the
future is bright, especially for those who recognize the opportunities and
possibilities for advanced certifications.
[1]
The certification organizations that provide the applicable certifications are
ABII, PARCA and HL7
