For Chuck Podesta, senior vice president and CIO at Fletcher Allen Health Care in Burlington, Vt., the question is far from academic or theoretical. As he and his colleagues at the 562-bed hospital in central Vermont move towards enterprise-wide diagnostic imaging management, they are investigating how to transition “PACS administrators” into diagnostic imaging professionals. That new breed of professional will report to IS and serve the needs of clinicians across the organization. It's a question that quickly becomes entangled in issues of strategy, tactics, budgeting and office politics.
For two years now, the full-time employees who manage PACS and imaging at Fletcher Allen have been reporting up through IS to Podesta. But those five professionals are still physically sitting inside the radiology department; and there's the rub. As Podesta and his colleagues try to move the organization towards a true enterprise-wide imaging management philosophy, there is still the lingering perception, especially within the radiology department itself, that these imaging managers belong to radiology, even as they increasingly manage images in cardiology and other clinical areas.
So, at the moment, Podesta is preparing revised job descriptions and likely their titles, as part of a broader strategic plan that will physically move them into the IS department. All this change is going on against the backdrop of an enterprise-wide EMR implementation from Verona, Wis.-based Epic Systems Corporation. The organization is already live on a PACS solution from Alpharetta, Ga.-based McKesson Corporation.
Physically moving the personnel in question will help build a sound support center, Podesta says. “For our next step, we've got to make sure our customer service is solid (by) building a service center that provides service excellence, and a project management office that is optimally managing projects. Once those elements are in place, these customers will feel that their needs are being covered.”
Making a crucial transition
While those outside healthcare might be mystified at the complexities involved, CIOs nationwide understand that as they move towards enterprise-wide imaging management, transitioning “PACS administrators” into positions responsible to all clinical departments is becoming an increasingly urgent - yet multi-faceted - challenge.
And that challenge is definitely faced at large multi-hospital systems, such as Ochsner Health System in New Orleans, and Christus Health, a 44-hospital system based in Dallas.
Ochsner System Vice President and CMIO Lynn Witherspoon, M.D., who chose to be CMIO of the seven-hospital, 35-health center system last December after breaking his CIO job in two, says Ochsner is in transition. “In our organization today, PACS administration is a shared function among the members of our enterprise storage development team,” he says. Ochsner deployed a central image management facility using the Impax Data Center from the Mortsel, Belgium-based Agfa, and has consolidated several of its image capabilities. “We've transferred our cardiology images over there, and all the regional hospital images,” says Witherspoon. “There are two folks in IT, one from radiology and one from cardiology involved in it. So our PACS administration function right now is very collaborative but a bit distributed.”
What is emerging right now, he says, is “something like a PACS council” for the organization. But achieving buy-in from clinician leaders across the diverse organization on issues such as imaging management governance will continue to be a challenge, he adds.
At Christus, George Conklin, senior vice president and CIO, says he has benefited tremendously from the merger that brought two Catholic health systems together in 1999. Conklin says Christus moved forward with a PACS deployment that began in 2003. “We were able to enforce a model of PACS system management from the corporate level from the outset because this was driven as a corporate initiative.” And, “While the PACS administrators sometimes sit inside information management and sometimes sit inside radiology, they're all governed by a corporate-level senior PACS administrator who reports into my organization,” he notes.
All this is helping a great deal, and is partly offsetting the overall challenge of implementing PACS across such a large multi-hospital system, particularly one with a large number of small, rural hospitals. Indeed, the maximum number of hospitals that will ultimately end up with PACS will be about 22 of the 44, Conklin says (20 have gone live so far). “It just doesn't make financial sense to do PACS for our very small rural facilities,” he says. (Christus is partnering system-wide with McKesson for its PACS needs.)
Doing it with a “big bang”
Another hospital system that “got lucky” with respect to PACS implementation and the PACS administrator challenge has been the two-hospital, 500-bed Nebraska Methodist Health System, based in Omaha. (Nebraska Methodist has implemented the PACS system from Kansas City, Mo.-based Cerner Corporation, which is also its core clinical vendor.) There, System Vice President and CIO Roger Hertz and application development manager Sean Wiese also manage four system-wide imaging management professionals who service radiology, cardiology, and all other departments that use diagnostic images. As at Christus, the Nebraska Methodist folks did a “big bang” approach, hiring and placing the first imaging management professionals at the same time they went live with their PACS system.
As at Christus, there had not been a long history of PACS administrators sitting in the radiology department. Still, says Wiese, “Pain comes with it either way you go. The thing we continue to struggle with is that, while we're focusing on our strategic vision, we still struggle with the tactical vision of managing the business within the department.” Still, things are going quite well in general, he says. “The longer we work at it, the better we get at it.” Wiese says another advantage the organization has is that the radiology department has a liaison who works with the enterprise-wide systems analysts, as they are called, to manage imaging issues.
Experts say the imaging management transition will be a gradual one that will require patience and education for clinician leaders and clinical department managers. Hertz says it's like anything else: “You have to help them understand how this will help them, and help the organization as a whole,” he says. “You have to develop a vision of why this needs to be centralized. It goes back to the old strategic planning process.”
