Up until a little while ago, we upgraded to new PACS releases rather late in the game. Of course, this may have meant we gave up a nifty new feature or two, but it also meant the upgrade we got was tried and tested, and worked as expected for us. This changed when our company was eager to start using Intelerad’s mammo viewer. We heard the risks about it being beta software, and the decision was made to press ahead with it. I have covered the outcome of that decision already, but let me reiterate that we have (hopefully) learned our lesson as a company, and will be extremely hesitant to be on the cutting edge in the future.

Intelerad stepped up to the plate (perhaps not as quickly as we would have liked) to deal with the challenges we faced as a result of that upgrade, and has been doing quite a few little and big upgrades to get us back to an efficient workflow. The backend changes are difficult for us to test, but thankfully, they have thus far been trouble free. It is the frontend changes with Inteleviewer I want to touch on. Prior to this whole issue, we generally rolled out an upgrade to all the Rads at once. And luckily, everything went smoothly. We have adjusted that process, and now designate particular reading rooms as test beds. As it turns out, we made this adjustment in the nick of time.

I feel I should step back for a moment and state that Intelerad is trying really hard to get us upgrades that solves various particular issues. For all I know, we are getting these upgrades as soon as they are done being coded (with some brief internal testing). Considering the situation, this is an acceptable short term situation. Anytime something is sped through the process, you gain time, but you may give up quality (although you may not, risks must be weighed).

We received one build of the software that promised many significant fixes, and we were very impressed with those fixes when we did our initial testing prior to upgrading any of the Rad stations. However, during that initial testing, we also found a pretty nasty bug that had made its way into the software. It was obvious enough that we were able to find it without involving a Rad for testing. Upon bringing this to Intelerad’s attention, it was verified, and a fix was provided in short order. We proceeded to retest the fixed version, and found no other noticeable issues, so we upgraded a Rad station. A couple Rads rotated through, and were happy with the improvements. And then a Rad noticed a change in behavior that was not desirable. I hesitate to call it a bug, it may have been, or maybe it was by design, but either way, it was a change that was met with frustration. It was only noticeable during particular workflow, that only some Rads follow, which is why the first couple of Rads had no problems. We have had to hold off on the rollout pending a resolution to this issue, which we hope comes quickly, as we are anxious to get the Rads using this much improved version.

Every company is different, but I strongly suggest there be some sort of testing phase prior to upgrading any critical system. A little time spent up front can save a whole slew of time spent cleaning up a potentially avoidable mess.

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It might just be that Intelerad went through some growing pains, which ultimately led to my post a few weeks back. Our customer service had declined a bit, and coupled with a new product install and associated “issues” it meant we were not the happiest of customers. Part of this is surely our fault… it is one thing to beta test something like MS Word… but if it doesn’t work quite right, you likely won’t be horribly inconvenienced. The same cannot be said for the world of radiology. It might just be that we have learned our lesson (they don’t call it the bleeding edge for nothing).

Thankfully, there has been much progress on the mammo viewer front. We received an Inteleviewer update that seems to have addressed a number of issues (even some that we just reported, either they are psychic or they have impossibly quick programmers). Other issues have been addressed in a manner that either gives us hope for a timely resolution, or at the very least offers us solace in the knowledge it is being worked on diligently, even if the results might not be forthcoming for a while yet.

I don’t think there is anything remotely resembling a trouble free PACS system. When certain problems arise, all you have to fall back on is vendor support; their ability to solve the issue, and their ability to communicate effectively. Intelerad hasn’t been perfect in this regard, but at the end of the day, as an IT professional, I’d still choose to have Intelerad in my corner over some of the alternatives.

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A while back Intelerad put a bug in our Radiologist’s ear about a mammo viewer they were working on. We had been using Threepalm’s offering, which was a fairly nascent offering as it was. The biggest gripe we had with 3palm was that it worked off a separate worklist, which is far from an ideal workflow. Feature wise it was adequate, and after getting some bugs ironed out, it was working. Not to our liking per say, but it was working.

The mammo viewer built into Inteleviewer also works. However to say it is not meeting our expectations would be an understatement. At least we are back to a single worklist workflow.

Let’s touch on some of the good points:

Single worklist. Yes I had already mentioned this, but this is definitely the best “feature”. At the same time that we went to the Inteleviewer mammo viewer, we also got their new worklist. Aside from some quirks, it has been well received. It really is a significant leap forward from Intelerads old Reporting Worklist tool.

The interface. It isn’t so much that the interface is good, rather, since it is essentially Inteleviewer, it is familiar. Threepalm’s layout was quite unique and somewhat non-traditional. It made it difficult for our Rads to learn their way around. MG in IV plays to IV’s strength, it is laid out logically, and features are fairly easy to find.

Administration. Managing the Intelerad world is actually quite easy. Granted, this may be more a case of being liking what you are familiar with, but to me and my team, it lessens the burden. Not to mention having two dicom applications fighting for disk space is never a good thing.

Unfortunately, at the moment that is all I can come up with for positive things to say about Intelerads mammo viewer. I feel it prudent to stop and clarify that the software is not classified as finished yet. Intelerad openly admits they have much to learn about the mammo world. Yes they do.

Now I will touch on some of the not so good aspects.

The first item is not actually a flaw of the mammo viewer at all, but it is directly tied to our mammo workflow. The new worklist function that I previously stated was a significant improvement, has one troubling flaw. It is SLOW. Specifically, whereas the previous version made a case available immediately to the Rad once completed by a Tech, this version has a background process that needs to run, and until it does, the Rad will not be presented with the case, regardless of how frantically (s)he press the refresh button. Initially this was set to several minutes. Intelerad fairly quickly responded to our complaints and lowered the cycle to 60 seconds. However, given our workflow, this is still much too long. Our Techs will mark the case complete, ready for dictation, and then step directly into the reading room to have the Rads confirm everything is in order before sending the patient on their way. Each time they do his, there is the potential for up to a minute of lost productivity while everyone waits for the worklist to present the case on the screen for selection. If you work in radiology you likely understand that over the course of a working day, this results in a very significant loss of productivity, and as such is the bane of the Rads. The part of this that is so odd is that Intelerad seems to find it hard to believe this “little” delay is such a big problem. Perhaps we have an entirely unique workflow… but I don’t expect such to be the case.

Once Rads get the case open, Things don’t improve much. Ok, maybe that is a little harsh. While the mammo viewer does not yet have many modality specific tools (we are assured those are coming in later releases), the fact that it leverages existing Inteleviewer tools means it is certainly adequate. The hanging protocols, while not yet user editable, cover the basics well enough.

The other major gripe we have is around the ability (or inability as the case may be) to handle priors. There are two distinct issues. First of all, frequently the system doesn’t realize there are priors, so they are not displayed automatically for the Rad. We are still going back and forth with support trying to convince them there is a problem. When the software does decide to play nice and show priors, or when the Rad manually pulls them up, it has trouble aligning the priors. Most of the time, the issue has to do with extra issue captured in the scan, which the viewer faithfully tries to display, at the cost of pushing the image all over the view port. Our previous Threepalm software did suffer from this as well, but to a much less significant degree. There are times however when the software just throws reason out the window and essentially hides the breast image outside of the viewable region of the screen. When his happens, you are lucky if part of the marker is still viewable to give some indication that the breast is there somewhere. The image can be panned around so that it comes back into view, but a whole lot of panning is required, and it really does not leave a positive impression with the Radiologist.

Here is hoping that Intelerad can come through and address our major complaints. If so I will gladly post an update.

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Intelerad Medical Systems recently announced a new partnership agreement with peerVue, a software solutions provider with U.S. offices in New Hampshire.

PeerVue has integrated its qiVue solution with IntelePACS, allowing users to address such issues as critical results management, peer review, technologist QC, emergency department discrepancy management and teleradiology discrepancies.

With the integration, radiologists can access peerVue features directly from InteleViewer, which enables true point-and-click reporting of critical results, study discrepancies, and other quality and communication-related activities.

Intelerad, peerVue Sign Partnership Agreement | News | Imaging Economics.

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Intelerad had two people onsite for our first rollout, this one at our main clinic. The PACS side of things went pretty smoothly. Our only real issue was an incompatibility between IntelePACS and GE Xeleris nuc med. All of our other headaches and challenges were RIS related (as expected). But all in all, our staff thought the transition to the “future” was very well done, and they are happily enjoying the benefits of a faster, less paper filled, workflow.

Building our own RIS, while a huge hurdle and project, has been a blessing in some ways. Tailoring workflow to best optimize various aspects as related to our practice has been super. I do not think a RIS vendor would have come close to the efficiency gains we are experiencing. As we have learned with PACS, once you are up and running, and they have your money, they are not as interested in your “feature requests” as you are. To be fair, Intelerad has done a reasonable job with us. And they certainly bend over backwards in issues related to support. It is just those pesky “feature requests” that are an issue.

I will endevour to update this on a weekly basis, to cover some of the issues and lessons learned from the past couple of months, as well as those we foresee in the future.

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– Pre sales communication: Intelerad has been a delight to deal with. Questions have been answered quickly, and the general attitude we have been given has been positive. Fuji has been adequate with responses to questions, but not quick, and the feeling we have gotten from the sales people has not been as comfortable. Edge: Intelerad

– Viewer features: Fuji has a fuller feature set than Intelerad. They correctly display mammo images, and have better support for echo clips. The ability to move images between colour/greyscale monitors is nice. With the additional functionality, we have noticed increased complexity as a result for the end user. IntelePACS seems easier to use, and hopefully they maintain that as they fill out the feature set. Edge: Fuji

– Support: This is quite hard to judge solely from the pre-sales process, however, we do have some opinions on the matter. Intelerad has no on site support, everything is done remotely. Fuji does have a couple of service personal close by. Fuji seems more controlling, wanting to handle routine support items such as modality machine changes themselves, not letting the client have certain admin abilities. Intelerad continuously monitors the system for the client, allowing some proactive measures to be taken. For our needs, Intelerad has the better support offering. Edge: Intelerad

– Architecture: Given that we have multiple locations to deal with, Intelerad allows us to forward studies directly to the rad’s PC. Fuji lacks this ability. Both allow web viewing for our referring doctors. Having IntelePACS run on linux is nice from a disaster recovery/security perspective. Fuji could share a tape library with other servers, Intelerad monopolizes that hardware. Edge: Intelerad

– Demonstrations of product: The apps person from Intelerad had a good grasp of the product, and worked through the demo’s in a consistent and straightforward manner. Fuji’s demo was more ad hoc. Questions that the apps person could not answer were answered in a followup with Intelerad. Fuji never did address such questions. Fuji setup a full fledged environment with 2 greyscale/1 colour monitor. Intelerad used a couple of colour monitors. Edge: Intelerad

There are certainly more criteria to evaluate PACS on. However, this summary is a partial view of our process thus far.

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