Cloud-based medical imaging system

    A multi-component solution for securely syncing medical images between medical equipment and an EHR system

    Learn how we helped our client:

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    store medical images and other patient data in a centralized place

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    facilitate sharing of medical images among radiologists and clinicians

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    ensure secure and cost-effective medical image storage

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    relieve patients of needing to bring images to consultations

    Business context

    Our client is a midsized hospital network with facilities distributed across several US cities. The network has a hospital management system (HMS) with a custom electronic health record (EHR) module.

    Here are the challenges our client encountered:

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    Difficult access to medical images

    After diagnostic sessions, radiologists had to print images or burn them on DVDs and give them to patients. The biggest problem was that patients often lost medical images or forgot to bring them to consultations with their clinicians. Also, when patients visited doctors in another city, they usually didn’t have medical images with them.

    Cumbersome security management of medical images

    Medical images were stored at each radiologist’s individual workstation, with no centralized access. Thus, the client’s compliance department had to maintain the security of each radiologist’s workstation within the whole hospital network instead of simply ensuring the security of the EHR module.

    Ineffective complex diagnostic sessions

    Within one complex diagnostic session, a patient goes through examinations on different medical equipment for a proper diagnosis. Before each examination, the radiologist needs to view images from the previous examination (such as an ultrasound). To view them, the network’s radiologists had to physically visit other radiology departments, as they couldn’t access these images directly at their workstations.

    Our client needed to make medical images an integral part of patient information and establish secure access to them via the central EHR module. To provide this capability, Yalantis built a software solution for seamlessly transmitting medical images from medical equipment to the centralized EHR system.

    Software product overview

    We developed a multi-component software solution that ensures secure data exchange between all hospital network facilities and the cloud.

    Our solution also optimizes storage costs, as the cloud EHR system doesn’t store physical medical images. It contains only links to images stored on the local servers of each radiology department.

    Our solution consists of the following elements:


    A new EHR system software component Including:

    A medical images orchestration system

    that coordinates the handling of medical images across all facilities within a hospital network

    Additional modules for the general permission system

    to ensure that medical images are protected and managed according to the overall access and data handling policies

    A new interface

    that enables radiologists to review images during diagnostic sessions and add them to scan reports

    Additional viewers

    that allow radiologists and clinicians to view DICOM images at their workstations together with other patient data in the EHR


    Custom DICOM server software

    Synchronized with the EHR module aggregates and pre-processes all medical images received from medical equipment and serves as the only secure medical image storage within each radiology department. We also provided the client’s IT department with detailed documentation to set up medical equipment to transfer images directly to the server of the corresponding radiology department in the hospital network.

    Yalantis’ approach to development

    Before embarking on the actual development process, we performed the following activities:


    Overview of business challenges

    We outlined key challenges to focus on such as decentralized medical image storage and difficulty of access to it.


    Requirements elicitation

    We elicited, analyzed, and prioritized our client’s requirements to identify core functionality and select the right technology stack.


    Market research

    We researched similar software solutions on the market to define their functional, customization, and integration capabilities.


    Development of a deployment strategy

    We thoroughly assessed the client’s current business condition to decide on a deployment strategy that would preserve the radiology department’s workflow.

    Implementation options for the client

    We offered the client two implementation options to choose from:

    Integration with ready-made PACS and VNA solutions
    The first option was building a DICOM network out of existing PACS (picture archiving and communication system) and VNA (vendor neutral archive) products. A PACS solution enables the storage and transfer of medical images in DICOM format. A VNA solution enables the storage and transfer of medical images in various formats.
    Custom software solution
    The second option was to create a custom solution tailored to the specifics of the client’s hospital network. This solution promised the highest level of health data security and seamless integration with the client’s existing HMS and EHR systems.

    The client chose to build a custom software solution, as it could entirely cover their business requirements and easily integrate into the existing workflow.

    To optimize the custom development process and reduce expenses, we relied on specialized ready-made frameworks and libraries. With their help, we avoided building certain small solution components from scratch. For instance, we used ready-made libraries for the DICOM viewer and for processing secure HL7 protocols.

    Solution architecture

    We built a high-level solution architecture to outline the technical realization of our solution based on the client’s business requirements. The architecture consists of the hospital infrastructure, cloud infrastructure, and a secure private network.

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    Hospital infrastructure includes:

    Enhanced EHR account capabilities

    allowing clinicians to send patient data (patient ID, patient’s body orientation inside medical equipment, etc.) to medical equipment and the EHR system and view medical images

    Periphery equipment

    for printing medical images and burning them on DVDs for patients’ personal use

    Local DICOM server

    that stores medical images within a single radiology department

    Mobile and tablet devices

    that clinicians can use as an alternative to their workstations to securely access patient data, including medical images

    Hospital infrastructure

    Hospital infrastructure

    Cloud infrastructure consists of:


    A media conversion service for transforming DICOM medical images to JPG and MP4 formats so they can be displayed on mobile devices, tablets, and laptops


    An orchestrational DICOM service for identifying and retrieving medical images from the radiology department’s server


    An API gateway and decision-making service for handling all data requests that defines on which device a clinician is making the request and in which format and through which protocol the clinician should receive the requested data


    A conditional access service that enforces data access policies, ensuring that only authorized users get access to the patient’s health data


    The central EHR system that contains patients’ records


    An HL7 server to convert medical images to the secure HL7 format and securely transfer converted images to devices that can’t display DICOM images

    Cloud infrastructure

    Cloud infrastructure

    Ensuring software security

    To guarantee secure data exchange between hospitals and the cloud, we implemented a secure private network. It ensures that data is exchanged via secured TLS channels to prevent data compromise or interception.


    To provide secure medical image storage, we ensured that:

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    each radiology department’s local DICOM server is the only place where medical images generated in this department are stored

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    the EHR system and the orchestrational DICOM service contain only links to the original images on the DICOM server

    Our deployment strategy

    To avoid interrupting hospital services, we deployed our software solution in three stages:

    Partial deployment within a single facility

    Medical equipment in this facility sends medical images to both the radiologist’s workstation and the new DICOM server.

    Full switch of a single facility

    Medical equipment in one facility sends images only to the DICOM server in that facility, and clinicians can access images only via the new EHR component.

    Full migration across all facilities

    The new solution is implemented across all facilities within the client’s hospital network.

    Project results


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    A radiologist’s workstation stored all medical images generated during diagnostic sessions.

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    Patients could receive medical images only as hard copies or DVDs.

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    Clinicians expected patients to bring copies of medical images to every consultation.

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    The hospital’s compliance department had to regulate the storage of images and access to them with time-consuming security measures.

    Below is the worst case diagnostic flow the client’s staff experienced.


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    Centralized image storage

    Medical equipment transfers medical images in DICOM format directly to the server, not to the radiologist’s workstation. Now, the radiologist uses their workstation only to send, access, and view patients’ medical images.

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    Easy access to images

    Patients don’t have to bring medical images to consultations. Any authorized clinician across all hospital facilities can view a patient’s images along with other health data in the EHR module.

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    Hard copies upon request

    The radiologist can still print images or burn them on a DVD at the patient’s request. But now, the radiologist also always adds medical images to the scan report and sends them to the EHR system.

    Here is the current diagnostic flow in the client’s hospital facilities.

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