JS PACS

* This is a re-print of my article that ran in rt-image, vol. 21, no. 35 in Sept. 2008*

• Study is ordered and the patient is processed into the department.

• After arrival is completed electronically, the technologist, viewing a RIS-based work list, sees that order appear on the screen.

• The technologist can then optionally print out a small card for use in transporting of this particular study to be performed on an inpatient.  If the patient is an emergency department patient or an outpatient, the technologist can simply call the patient back into the imaging room.

• The technologist finds a study to be performed on the imaging device modality worklist, selects the correct patient from the list, and begins the imaging exam. If this is a completely integrated system, the initiation of a study on the imaging device would change the order’s status in the RIS to a “begin procedure” or “start procedure”.

• Imaging performed in the study is sent to PACS.  Once the images arrive in PACS, they would be in a “performed” status.

• The technologist then moves to a PACS workstation, finds that particular study on the worklist (set to display only studies that have not been marked as reviewed), and opens it up for viewing. While the study is opened, the technologist will review each image in the study, ensuring it is in the proper sequence, as an appropriate window/level, and is of overall diagnostic quality.

• While the study is opened, the technologist can scan any paper documents developed during the study (contrast questionnaires, etc.) and provide the radiologist with pertinent patient history through the use of a “study notes” type of tool.

• After assuring the study is diagnostic, scanning in paper documents, and providing study notes, the technologist then changes the study from a “performed” status to a “reviewed” status. This equates to the technologist handing the radiologist a piece of paper saying that the study is ready for interpretation. The study is no longer visible on the technologist’s PACS worklist (which was set to show only performed studies) and appears on a radiologist’s worklist (which is set to show only reviewed studies).

• The radiologist opens the study for interpretation, and, through properly deployed hanging protocols, views not only the images of the study but is automatically presented with the patient history and any scanned documents.

• Through the use of voice recognition technology, the radiologist begins a dictation session from within the open study. After the interpretation, the radiologist either reviews and signs the report immediately (placing the study into a “reported” status), or sends the report to a transcription for verification (placing a study into a “dictated” status). Within a short period of time, the review process is completed, and the report is sent back to the radiologist for signing, at which time the radiologist will verify the reports and sign it, thus placing the study into a “reported” status.

---

Add this page to your favorite Social Bookmarking websites

ABII® is a registered trademark of ABII® and SIIM®

Many healthcare career paths are built on successive education, and different ways of indicating ascension into higher levels of your profession are available. An obvious method is by the degrees that you obtain. Another common method is by obtaining certification along a logical progression of tasks or skill sets.

As the PACS administrator profession grows, so have the opportunities to obtain certification. Two organizations currently provide certification for PACS administrators. These two organizations are the American Board of Imaging Informatics (ABII) and the PACS Administrators Registry and Certification Association (PARCA). ABII offers the Certified Imaging Informatics Professional (CIIP) exam and PARCA offers a tract of exams that cumulate in the Certified PACS System Manager. I have had the opportunity to obtain both the CIIP exam from ABII and the CPSA level of certification through PARCA. A comparison of these two methods of certification is an ongoing hot topic among PACS administrators in the field. Regardless of which side you take or which certification method you prefer, there are unique aspects of each certification method that warrant consideration.

ABII
The American Board of Imaging Informatics and the CIIP exam were introduced during the 2007 SIIM conference. This exam has many myths associated with it. One myth is that it is associated with the American Registry of Radiologic Technologists (ARRT). This is not true. Yes, the CIIP exam has undergone psychometric development similar to that of the ARRT exams but it is in no way associated with the ARRT. The fact that the ARRT has served as a model for building the exam should be a comfort to those who take the exam in that it follows the many years of tradition that the ARRT exam has developed. No one can deny the fact that the ARRT is the obvious benchmark for testing in the medical imaging profession.

Another myth I hear debated among many PACS administrator's is that there is no way to prepare for the CIIP exam. This also is not true. The ABII website provides the test content outline which is a clear definition of the subject matter that can be found on the exam. Understanding each of these topics will help a CIIP candidate prepare for the exam. There are multiple ways to prepare for the CIIP exam. The best way to study for the exam is to simply be a PACS administrator for a year or two especially during an implementation, upgrade or replacement of a major system, such as PACS, voice recognition, or your HIS/RIS. Understanding and gaining experience in both clinical workflows and information system components is critical for being ready for this exam. Networking and attending seminars are also beneficial to gain critical knowledge for your profession and the exam.

PARCA
PARCA and the series of exams that encompass various levels of PARCA certification started a few years prior to the CIIP exam. This certification consists of a three tiered exam system. The entry-level exam Certified PACS Associate (CPAS) is made up of two tests. The first test evaluates a PACS administrator on their technical knowledge. The second test evaluates the PACS administrator on their clinical knowledge. These two tests can be taken in any order but are both required to progress to level 2.

Upon reaching level 2, an individual can take the Certified PACS Interface Analyst (CPIA) exam. The CPIA exam tests an individual on their understanding of DICOM and HL7. It also tests on troubleshooting in both areas. The second level 2 test an individual can take is the Certified PACS Systems Analyst (CPSA) which tests an individual on their ability and understanding of the various components of a PACS and system administration. Again, both of these tests are required for an individual to pass to the level 3 exam.

The Certified PACS System Manager (CPSM) is the final and encompassing exam. Holding this certification demonstrates that an individual has an advanced understanding of all imaging informatics topics which include image quality, advanced DICOM and HL7, security and systems integration.

As with the CIIP exam there are myths associated with the PARCA certification. The primary myth that I hear discussed is that you must study with materials from a specific organization in order to pass this exam. I can assure you that this is not true; I have never purchased any study materials from this organization, all preparation for PARCA exams were done based on my own experiences and learning.

Conclusion
Before giving my personal opinions of both certifying organizations, I feel compelled to offer a disclosure. I am a member of the CIIP item review committee as well as a CIIP item writer. I'll also reiterate that I hold both the CIIP and the CPSA certifications.

Both of these organizations offer positive things for PACS administrators. Primarily, both offer recognition that the individual has obtained a certain level of knowledge and understanding of the components and complexities of imaging informatics in today's healthcare environment. Additionally, both offer an increased level of professionalism in the rapidly evolving PACS administrator career. I will say that I feel there are distinct aspects of each exam. 

I feel the CIIP demonstrates concrete knowledge of PACS and the various components that interface with PACS. Additionally, I think the individual who holds a CIIP certification assures an employer or an organization a higher level of survivability during the crisis moments that imaging informatics can sometimes bring. It does this by assuring an understanding of all aspects of PACS encountered during day-to-day operations.

I feel the PARCA exams series also demonstrates concrete knowledge of PACS and all of the components involved. PARCA certification likewise assures an employer that an individual is qualified to operate autonomously in the imaging informatics field. Additionally, I would offer that the PARCA exam evaluates an individual on their ability to understand all of the aspects of imaging informatics that a PACS administrator may encounter throughout their career.

Ultimately, both certifying organizations hold critical places in the PACS administrator profession. Perhaps as PACS administrator's we should stop comparing and contrasting the two exams and work to obtain all levels of certification that we can.

* This article, written by John, was previously published in Health and Imaging IT 

---

Add this page to your favorite Social Bookmarking websites