ICT for Health | Diagnostic Imaging | Teleradiology | PACS Training

A Picture Archive and Communication System (PACS) is more than just hardware and software: it requires a set of policies that govern and describe what its users should do, not only for routine operations (such as Quality Assurance (QA)/Quality Control (QC), merging images, burning CDs, and so on), but even more importantly for exception cases (such as backup procedures, shutdown, and downtime procedures). A proper set of PACS procedures should be derived from a policy that includes a mission statement, governance with well defined responsibilities, and clearly defined boundaries for the procedure.

If a PACS lacks proper policies and procedures, it will often result in the system operating sub-optimally, and it could ultimately impact patient care. A PACS is rather flexible and is not necessarily "self-maintaining". If there is a not a policy and procedure for tasks such as regularly checking certain error logs, exception files, or audit trails and if someone does not clean the CR cassettes, computer fans, calibrate the monitors, back-up the database and images, one can only expect disaster to strike.

Policy and Procedure Baselines

Policies, procedures, and site-specific documentation may be organized in several categories. One possible way to break these down is as follows:

• Administration
• Maintenance
• Support
• Architecture and Integration
• Disaster Recovery/Business Continuity

Through the use of broad categories one can easily begin to break down specific areas that require attention and prioritize them as necessary. It is fairly easy to determine that the Administration section would include the guiding principles for the project, its governance and leadership, roles and responsibilities, and perhaps an organizational chart. This information will serve not only as a reference, but also as a template for defining future policies and procedures.

One area that requires a great deal of focus and discipline is a policy for change management. Whether a facility is large or small, has two diagnostic workstations or two hundred, supports one small radiology practice or a large conglomeration of facilities, it is absolutely critical to have a policy in place for making changes to the system.

This would include not only changes to the system such as software upgrades, but changes to workflows such as how images are being distributed, compression settings, network settings, monitor settings, locations of workstations, and so on. Think of all the different areas of the IT infrastructure, including the impact on end users, which can be affected by even the most benign system change.

A best practice regarding change management is to designate a representative from each area for which the change could have a potential impact and meet to collectively discuss the issues. Having expertise present regarding the network, operating system, PACS architecture, and workflows can save hours of downtime and negative impact to not only PACS, but other systems which may suffer the after affects of implementing a change which is thought to be benign.

A good policy will include a definition of the purpose and scope, descriptions of what constitutes a planned change versus an emergency change, and general guidelines for the procedure on how to request a change. A policy for managing change should be at the top of the list of things to do when implementing PACS.

The Disaster Recovery/Business Continuity policies and procedures are another critical set of rules. As a matter of fact, one should not implement a new system, subsystem, or even add any part to the PACS without documenting what to do when the system fails, for whatever reason. Although we are highly dependent on technology, this is OK, as long as we have a proper backup procedure in place.

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