IT Manager: The Invisible Conductor

Radiology IT managers and their teams can position groups for success under Imaging 3.0® and MACRA.

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When the radiologists at Lahey Hospital & Medical Center in Burlington, Mass., log into their workstations, they unlock an integrated suite of clinical management systems that includes their workflow manager, PACS, voice recognition system, a summary of the relevant electronic medical record (EMR) database, and a host of contextual communication, peer review, and quality reporting tools.

 With one login, the radiologists gain immediate access to all of the information they need to provide high-quality patient care. It's a significant improvement from the past, when the radiologists had to log in and hunt for relevant patient data in each system separately — a tedious process that bogged down their workflow and often resulted in an incomplete discovery of clinical information.

The radiology department accelerated this IT systems integration in 2013, when it hired John Gagnon, MBA, PMP, as its radiology IT manager and recruited members of the hospital's enterprise IT department to form a new dedicated radiology IT team. Since then, Gagnon and his team have worked closely with Christoph Wald, MD, PhD, FACR, chair of the department of radiology and president of the medical staff at Lahey, and other radiology department leaders to identify and implement informatics solutions designed to increase the department's efficiency and position it to meet the value objectives of Imaging 3.0®. (Learn more about Imaging 3.0 at acr.org/Imaging3.)

"Our vision was to drive value through scalable informatics solutions that help our radiologists optimally select, interpret, and protocol exams and communicate findings to referring physicians," says Wald, who is also a radiology professor at Tufts University Medical School. "To achieve this vision, we need a partner in radiology IT who understood it and who could translate it into purchasing the right equipment, contracting with the right vendors, overseeing the detailed work necessary to support our value delivery, and coordinating the talent management and development in the IT group to achieve a team approach with redundant skillsets amongst the individual analysts. That's what our radiology IT manager does."

Understanding a Radiology IT Manager's Role

As illustrated at Lahey, radiology IT managers work with radiologists to bridge the clinical and technical sides of imaging. Forging this connection is increasingly important as radiologists use advanced informatics solutions to maximize their efficiency and strengthen their value proposition, which will serve them well in the new payment models such as those under the Medicare Access and Chip Reauthorization Act (MACRA). "Radiology IT managers and their PACS administrator teams understand radiology's unique workflow and guide radiologists toward informatics solutions to optimize it," says Jay W. Patti, MD, chief informatics officer at Mecklenburg Radiology Associates in Charlotte, N.C., which contracts with NOVANT Health Presbyterian Hospital.

Unlike informatics professionals who work in a hospital's enterprise IT department, radiology IT managers and their teams work exclusively within the radiology department. Leveraging their deep understanding of radiology objectives and workflows, a radiology IT manager and team can address radiologists' informatics needs more promptly and with more tailored expertise than enterprise IT staff. "Hospital IT teams service every department in the hospital, making them generalists," explains Gagnon, who worked in Lahey's enterprise IT department before joining the radiology department. "In contrast, a radiology IT manager and team focuses solely on the success of the radiology department and becomes specialized over time to the department's needs."

While radiology IT managers concentrate on radiology, they also interface with the enterprise IT department. In this critical role, radiology IT managers work with enterprise IT on change management, project management, and IT security projects, as well as network and interface solutions. They also ensure the radiology department's informatics systems are compatible with the enterprise framework, and they represent radiology's interests in meetings with the hospital IT department and other hospital administrators.

"In the past, radiology was one of the only specialties that relied on IT solutions for nearly every step in the departmental workflow, but the recent adoption of EMRs has increased other departments' IT reliance. That means the dollars that used to go to IT-heavy specialties, like radiology, are now being shared among all specialties," Patti explains. "So having someone within the radiology department who understands IT and who can advocate for solutions to radiologists' unique challenges is extremely valuable."IT manager in text

Hiring a Radiology IT Manager

Since radiology IT managers must collaborate closely with a hospital's enterprise IT staff, Wald recommends hiring a manager who already has a relationship with that team, if possible. He says that's one of the reasons his department hired Gagnon, who had worked in the hospital's enterprise IT department for more than 15 years and had good relationships with his colleagues there. "If you bring in a candidate from the outside, it will take years for them to develop those relationships," Wald says. "I'm not saying not to hire that person, but, in my opinion, someone who has those relationships has an edge because our informatics systems are so interconnected with enterprise IT."

Radiologists at Mecklenburg Radiology were similarly pleased when Peyton R. Watson, RT(R), was promoted to manager of radiology systems in 2005. An employee of NOVANT Health, Watson started out as a radiology technologist and has a long history with the health system. In 1999, he began managing the hospital's first radiology information system (RIS). Four years later, he became the hospital's first PACS administrator. Patti says Watson's experience with radiology IT systems and his relationships with both the radiology and IT departments made him a perfect choice for radiology IT manager. "Radiology departments don't have to look far to find a suitable radiology IT manager," Patti says. "They can easily groom a savvy and confident PACS administrator for the position."

While Watson's clinical background was an added bonus for Mecklenburg, Wald says a radiology IT manager doesn't necessarily need to come with clinical experience, as long as they are willing to learn. In fact, Gagnon had little clinical knowledge when he joined the department at Lahey. He eventually gained that knowledge from Wald and the other radiologists. "When you hire a radiology IT manager, you might not find someone who understands radiology," Wald explains. "You'll probably have an easier time finding someone who has deep IT knowledge, and you'll have to invest real time and effort in bringing them up to speed. This investment pays many dividends, given the integrated systems and other value-driven solutions a radiology IT manager can bring to your group."

Working with a Radiology IT Manager

Regardless of a radiology IT manager's level of clinical understanding, the radiologists must communicate with that person regularly to achieve their informatics goals. Patti recommends appointing a tech-savvy radiologist as the point person to work directly with the IT manager. Sometimes these radiologists are often called chief information officers or chief radiology informatics officers. "Identifying a go-to radiologist is just as important as finding the right radiology IT manager," says Patti, who fills this role in his group. "You can't just hire a radiology IT manager and not interact with that person."

Watson says his relationship with Patti has been critical to Mecklenburg's informatics success, with projects that have included PACS upgrades and new software integrations. Watson contends that having a radiology informatics liaison in the department is just as important as, say, having a chief of neuroradiology. Without that perspective, he says, a radiology IT manager is forced to make assumptions about the department's needs. "When we purchase a new informatics solution from a vendor, for instance, it's like a bowl of vanilla ice cream," Watson explains. "Radiology IT managers and their teams are the ones who add the chocolate syrup, sprinkles, and other toppings that make it better. But choosing the appropriate toppings is difficult without knowing what the radiologists want to achieve with the solution."

Making the Investment

Radiology groups that don't have radiology IT teams and need more individualized attention that perhaps enterprise IT can offer sometimes contract with consultants for their informatics projects. Wald says his group has hired radiology IT consultants to work on its EMRs and RIS in the past, but the approach was not as fruitful as having a radiology IT manager and team on staff. "Consultants aren't cheap, and you spend a lot of time bringing them up to speed only for them to leave once the project is completed," Wald says. "It's not the most efficient way to do business."

Instead, Wald recommends that radiology groups approach their hospital administrators about dedicating radiology informatics teams. He says groups can easily make a financial case for such a request by, for instance, documenting the amount of time radiologists spend searching for patient- and exam-related information in disparate systems — the way Lahey's radiologists used to do. "If you calculate the amount of time spend based on each radiologist's full-time salary across the year, you'll get a substantial number," Wald explains. "If groups can show how much that number would decrease as a result of system integrations and other informatics projects, they can illustrate why it's worth spending the money to hire the people who can make those things happen."

For that reason alone, groups of all sizes and hospital affiliations should invest in a radiology IT manager and team, Wald says. "Even if a group has only 10 radiologists, they would be well advised to set aside some professional income to hire someone to manage their informatics systems," he says. "It will make their lives easier, and it will help ensure they have the appropriate systems in place to meet the reporting requirements under MACRA. Radiology is already dependent on IT, and our dependency is only going to increase as metrics drive how much we're paid going forward."


By Jenny Jones, Imaging 3.0 project specialist

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