I am convinced that a significant percentage of facilities have toyed with PACS, whether they installed a full-blown system that archives all radiographic images or a simple distribution-and-archive solution for a single modality. However, it is apparent that many of them are not achieving the “total” success that is possible?whether they have made the leap to a full radiology PACS or are taking baby steps with partial PACS solutions.

In both our personal and professional lives, we are encouraged to take time to reflect on where we are, how we arrived at that point, where we should be going, and just how we are planning to reach our destinations. I call this reflective time “pulling over to the side of the road.” Once there, we take out the map, determine where we are, and then plan the route to our destination. We need to escape the daily grind of each day and spend time?real time?pondering if we could have done something differently to achieve an improved result.

I honestly believe that those who fail to take this time in a meaningful way?and not simply check a box?are doomed to make the same mistakes time and again. In fact, when I interview job candidates, I always say, “Please tell me about an experience that, after the fact, you reflected on what was done and how goals were achieved, and asked yourself, ‘What could I have done differently and why?’ ” I am always surprised by how many people have never reflected; in fact, they were very sure that they had always done everything perfectly and, therefore, had no experience to share with me.

Your Questions Answered

Q: I came upon your articles on the Web. They are very well-done and informative. We are about to hire a PACS administrator. What are your views on whom they should answer to: the radiology administrator or the information-systems administrator?

?David Malamed, MD (Philadelphia)

A: It really depends. For a single facility, typically the PACS administrator (PA) reports to radiology, with a dotted line to IT. For a multihospital system, there often is a systemwide IT structure but a site-by-site radiology structure. If the PA is to be a systemwide role, the PA should report to IT.

If you already have a PACS or are replacing a PACS, the day-to-day interaction is very different than implementing PACS for the first time. As I have mentioned in my columns, after the go-live date, 95%?98% of a PA’s activities will be radiology/clinical focused.

So, by now, you’re probably saying, “Mike, I get it. But what about informatics?” In the past 12 months, I have seen exactly what I was just writing about. I usually do not have the opportunity to visit live PACS environments that were not designed and implemented by my colleagues and me at The Thomas Group Ltd (Anaheim, Calif). However, last summer, I accompanied some clients on a few site visits. I found these calls to be very interesting, as they afforded me the opportunity to see and learn about what others had done and to have frank discussions with my clients as to why I would recommend or discourage them from doing the same.

I also have spoken with individuals at a variety of sites that either have or will deploy some portion of PACS but will not be able to:

A) read 100% of images in soft-copy format (except mammography); or

B) achieve any significant cost savings in total film costs pre-PACS versus post-PACS (as film is still being printed for most studies).

Based on these findings, it is clear to me that many sites have not completely leveraged their purchased technology to truly optimize what the PACS can and should do. In fact, my colleagues and I have been hired by facilities that already have PACS to help staff members improve their efficiencies and fully capitalize on the PACS technology.

In many cases, if you were the person who drove and championed the project, you will, of course, be excited about what you accomplished and how you did so. But how do you know your grade? Have you given yourself an “A” already and begun bragging to others? You might want to “pull over,” just to check your perspective.

In fact, I want all of you to ask yourselves these questions: Have you truly examined where your project is? Can you improve your results? Could you better distribute images and reports across your enterprise? If not, you really need to take the time to understand and truly benchmark yourself versus the “A” players. Have you examined how much film you are still printing and why? Who is still demanding film? Is your department also paperless? Why or why not? A paperless, filmless environment not only supports a truly virtual reading environment for your radiologists, but it also allows your referring community to truly be able to obtain all of the patient information that they need in one place. If your department is filmless, but paper still is driving or limiting your workflow activities, you are not achieving what you could with this technology. If you have implemented an EMR and your PACS is not integrated, you are not being as successful as you could be. Have you surveyed your referring community and benchmarked their satisfaction with your radiology services?

Do you have a question for Michael Mack?

Do you have a question for Michael Mack that you’d like to see answered here in “Informatics Report”? Email your questions to .

As I have followed up with my clients and both seen and heard about the progress that they have achieved, I am excited that PACS is possibly making a positive operational and financial impact at many facilities. However, I also am concerned about the countless facilities that have spent the money but are not achieving everything possible with their investment.

My message is unwavering: You should constantly reflect on what you have done and what you could have done better. So, stop right now, “pull over,” and invest some time reflecting on what opportunities are still waiting for you to achieve!

Michael Mack is VP of business development at the Thomas Group Ltd (Anaheim, Calif). Having more than 20 years of experience in the medical imaging industry, Mack now specializes in PACS planning and implementation.