Modern Cloud-Based Radiology Platform

Andersen was selected to address these challenges, due to our proven track record with medical imaging solutions. Our objectives for this project were as follows:

• Developing a fast, modern SaaS platform for imaging operations to streamline radiology service delivery;
• Fully replacing the outdated legacy system with a robust solution;
• Migrating historical data from the previous platform to ensure service continuity;
• Increasing the daily order processing capacity from 3,000 to 10,000 transactions;
• Engineering a headless Transfer Agent module for efficient DICOM image transfer;
• Integrating seamlessly with external systems, including PACS and fax services;
• Introducing a rule engine to manage orders effectively within the RAD workflow.

During this RIS development project, we successfully navigated several technical challenges and tasks:

• Lack of API compatibility. Some third parties frequently changed their APIs without providing release notes, requiring extra validation and adaptive solutions;
• HL7 communication. Andersen's team set up this system following a normalized HL7 message template. During testing and production emulation, HL7 messages occasionally contained different data types in certain segments. This variability was addressed proactively by our team from the very beginning of the project;
• GUI-less Transfer Agent. One of the major challenges was to integrate with all clinics via a GUI-less Transfer Agent (a Windows service running in the background). This module was developed from scratch to securely transfer DICOM images;
• Integration orchestration. Ensuring that all integrations work together is crucial for completing end-to-end user scenarios. If third-party services are unavailable, orders cannot be completed, and patient reports cannot be delivered;
• Historical data migration and synchronization. All historical data was successfully migrated from the legacy platform, ensuring synchronization between both systems during the client transition phase. This allowed clients to seamlessly complete their RAD flow on the original platform while simultaneously beginning operations on the new platform, with their latest orders continuously updated via a heartbeat mechanism.

Technically, the creation of the platform was made possible via:

• Amazon API Gateway;
• AWS Config Delivery;
• AWS Lambda Delivery;
• AWS WAF Delivery;
• Amazon CloudFront Delivery;
• Amazon DynamoDB Delivery;
• AWS Systems Manager Delivery;
• Amazon ECS Delivery;
• Amazon EKS Delivery;
• Amazon MSK Delivery;
• Amazon RDS Delivery (Amazon RDS for PostgreSQL);
• Amazon Route 53;
• Amazon CloudTrail, among others.

The resulting compliant clinical SaaS for radiology encompassess the following functionalities:

• Data ingestion. Receives DICOM studies (MRI, CT, PET, X-ray, ultrasound, etc.) via a locally installed Transfer Agent, which compresses the DICOM objects and generates JPEG thumbnail images for each study;
• Workflow automation. Implements a complex status model managed by a configured Camunda BPMN engine, ensuring consistent progression of orders from creation to completion;
• Comprehensive handling of patient records. This includes merging duplicate records based on Master Data Management (MDM) rules and submitting to the Assigning Authority (AA);
• Reporting and document handling. Facilitates the creation of radiology reports and secure document management, meeting compliance requirements;
• Dashboards and analytics. Presents key information on configurable dashboards, enabling users to quickly visualize and analyze operational and clinical data.

While working on the medical imaging platform, Andersen has attained the following results:

• Complex platform delivery. Implemented a sophisticated system designed to handle 21,000 users and over 10,000 orders per day;
• Data migration. Successfully migrated all historical data (orders, users, files, etc.) from a non-relational document database to a relational database, ensuring data integrity and continuity;
• Extensive monitoring. Deployed over 40 microservices and over 400 transfer agents with robust monitoring in place (Amazon CloudWatch, AWS Systems Manager Incident Manager, Prometheus, Grafana, Loki) for health checks and performance insights;
• Meeting project requirements end-to-end. Ensured that functional, non-functional, and performance specifications were fully met;
• Regulatory compliance. Built the solution to meet ISO/IEC 27001 and HIPAA standards, guaranteeing secure handling of sensitive medical data;
• Turn-key approach. Used Andersen’s project delivery services model enabling full control of budget and scope.