Imagem: constantly refining its expertise

Imagem made its way into the healthcare system by accident. After all, what does running a simulation showing metal waves melting at Alcan and one showing the effect of treatment on tumours have in common other than using simulations for research purposes. No matter, different people came together, seized an opportunity and brought together their experience in engineering to create Imagem. 

Digitalization of the images from the radiation simulation

At the end of the 1990s, the process involved in preparing a patient for a radio therapy treatment is how Imagem acquired an understanding of the first issues in health information technology: information has to be easily accessible, and the process to have access to the information needs to be transparent and non-invasive.

Doctors need a simulator to prepare patients for radiotherapy treatment. Radiation is damaging and it should carefully target cancer cells. By using fluoroscopy, a doctor gets to see on a screen the organs of a patient in real time. Imagem undertook the project to digitalize the real-time images so that they could be displayed even when targeted radiation stops.

While researching our options, a doctor indicated preferring not to change his working methods, which required that he press a pedal to activate the radiation beam and to turn on the screen to see the image of the organs. By digitalizing the images, Imagem was able to improve the images by developing algorithms and have them displayed on the screen even when the pedal wasn’t pressed. Before then, a doctor would have seen a blank screen. 

Imagem met the doctor’s requirements without any need for him to change his work method. From then on, even without pressing on the pedal, he had access to the images without having to emit a radiation beam on the patient.

The project progressed and was completed, without ever stopping, over the course of more than 5 years.

Device used in radiation oncology to generate contours

In the simulation room, the medical physicist uses the precise measurements of a patient’s body to calculate the location of the tumour and the dose of radiation a patient will need.

Imagem built a device similar to that of a robot’s arm that could digitize the contours of a patient’s body in 3D at the level where the tumour was located. The collected data was then processed and sent to the software used by the physicist. Through this project, we became aware of the responsibility of these important healthcare players when it comes to treating patients. We also learned about all the advanced safety measures that are put in place to protect them. By desire and determination, we also became entrusted with a part of this responsibility. From there comes the second issue: security and responsibility.  

This project was implemented in two radiation oncology centres, and our device was used for over 5 years without any indication of a malfunction.   

Digital diagnostic imaging 

In the late 1990’s, there weren’t many digital devices in Québec and in the rest of Canada. Right from the start though, Imagem was interested in the use of digital diagnostic imaging (DDI) in healthcare, which was an emerging technology at the time. The engineers working at Imagem thought that DDI was a path to the future and that is why they took action.

This is when Imagem also made its mark; one of rigour and integrity from the very start as the firm emphasized the necessity to integrate the existing data on patients, focusing on interoperability before its time. Imagem also conducted the process of digitalizing X‑ray images so radiologists could have a complete patient file with results of previous examinations on film. The first beneficiaries of this system were the medical archivists who now had access to digitized information.

Imagem installed the first fully integrated teleradiology system in 2001; radiologists would use this system remotely just as if they had been physically at the hospital. Emergency physicians could rapidly, often before a patient was out of the examination room, listen to a radiologist’s vocal report. This provided great benefit regarding the quality of care.

Imagem also considers itself a forerunner in the development of the methods utilized to store images, by using hard disks and multiple copies for redundancy. This improved access to the images required for file preparation. Digital diagnostic imaging has become over the last 20 years the spearhead of the firm.

Interview: offer a vision

1. PACS V.1 Negative X (1995)

First PACS viewer: it processes the information from the images captured with various digitizers such as Howtek, Cobra Scan and Vidar. Imagem develops its expertise in digital diagnostic imaging and builds its knowledge on its clients’ areas of interest.

2. PACS V.2 Imapacs (2000)

Dicom PACS Server Imapacs v.2, Imadiag viewer, Imaview viewer, Imaris radiology information system (RIS), dictation included, with Playdiag transcription, implementation with digitalization of previous X-ray images stored on hard disks – an innovation at the time. The installation used SunRay thin clients and a Citrix application server. Creating interfaces between other applications and radiology devices became our speciality. Imagem starts its research and collaboration with different universities, in particular the Université du Québec à Chicoutimi (UQAC), and the School of Advanced Technology (ÉTS).

The suite Interview comes into existence with its 8 applications. The suite of software was used by 2 hospitals and ran for 10 years.

3. PACS V.3 Imapacs (2010)

Dicom PACS server Imapacs v.3, Gemini viewer, Imaview viewer, Imaris radiology information system (RIS) v.2, Psvox dictation and PSscript transcription, implementation with digitalization of previous X-ray images stored on hard disks – an innovation at the time.

The suite of software was used by 2 hospitals and ran for 7 years.

Postscriptum: medical report, dictation, transcription and voice recognition

A radiologist would produce his reports using a microphone and a tape cassette. Imagem proposed a more efficient tool, creating its first medical dictation and transcription system. Doctors could immediately listen to the radiologist’s voice recorded report regarding a patient. This was a fully integrated system reserved for radiology professionals. 

The Postscriptum Suite features 20 applications and is used in more than 40 healthcare institutions.

Contact us if you would like more information on our products and services.

The responsibilities of a PACS and RIS supplier

For non-specialists, programming is often seen as a mysterious universe where preconceived ideas take root. Have you ever said about software or an application that a certain task was « not so complicated » to accomplish, that you only needed to « do this » to produce the desired result? In truth, the path leading to an efficient application often takes turns and presents many unforeseen obstacles… Who knows what kind of bug you might encounter?    

We have all gone through frustrating moments after having lost some data because of a bug or a human error. Luckily, it’s rarely a matter of life or death. However, in a healthcare setting, such extreme cases do exist.

A PACS and RIS supplier must therefore assume important responsibilities: thousands of professionals are relying on these applications in order to carry out their healthcare work, day in, day out; dozens of thousands of examinations are performed non-stop on a daily basis, hardly slowing down at night, to which are attached medical reports that need to be written up. Since doctors and other health professionals rely on these systems to make a diagnosis, the slightest error, should such clinical systems suffer a malfunction, could pose serious risks for patients.  

Diagnostic imaging is at the very heart of modern medicine. When linked to a patient’s personal information, it ensures that the treatment that a patient is receiving is the one for his or her condition. It is therefore essential to ensure the efficient functioning of the RIS/PACS systems and the integrity and delivery of the accurate information. The responsibility of this task lies with the supplier who will make sure that all devices are working correctly.

When Barriers Call for Creative Solutions

In spite of the variety of needs, Imagem doesn’t produce different versions of its Interview suite, its RIS/PACS product. Adaptations measures are integrated into the Suite and provide flexibility, but in time, they might meet an obstacle:

• Respect the specificities and the working methods of each healthcare facility;
• Dispute resolutions over design and improvement requests and the actual system;
• Evolving needs along the way;
• Compatibility between different versions;
• Maintaining software levels and keeping track of versions used by clients and of updates that need to be done.

Imagem is fully aware of the seriousness of the responsibilities that lie with its mission to help those who are helping. Everything has therefore been set up to ensure that its RIS/PACS systems work correctly. Therefore, Imagem will:

• Install the latest tested versions of all its products when completing a new installation;
• Maintain software levels and keep track of database and operating system updates that need to be done between clients by taking into account the particularities of the environments (updates may require that versions be sequenced to ensure a secure transition);
• Proceed with data migration when necessary;
• Establish an action plan in cooperation with healthcare administrators and professionals to avoid misunderstandings and needless worries.

And to meet his responsibilities, a RIS/PACS supplier must first establish a relationship of trust in order to facilitate communication between all parties involved.

Imagem: Great teamwork that ultimately benefits all Quebeckers.

Labour shortages: a problem for employers

Jacques Gagnon, CEO of Imagem, a high-tech firm specialized in managing data collected and processed by health systems, doesn’t believe that a labour shortage exists; he thinks it’s more of a mismatch between demand and offer. While many firms are actively seeking to hire employees, Gagnon, an engineer by trade, thinks that the situation could improve if administrators changed their mindset. According to him, administrators don’t invest enough in human resources, which can result in workforce retention problems and this is a matter of growing concern in all spheres of activity.

For 25 years, Imagem has been working at creating software to help healthcare professionals carry out their daily activities. Among its flagship products are two software suites, Interview and Postscriptum, which have been developed to respond to the challenges linked to the management of diagnostic imaging and the creation of medical reports. Needless to say, this firm that is based in the Saguenay, has grown significantly over the years, in such a way that it has had to recruit new talents more times than none. It is a happy problem to have, and it has led administrators to reflect upon the best practices in human resources management.       

Studies have revealed that the responsibility for adaptation and integration problems rests with employers in 85% of the cases. Either employees didn’t have access to the right tools or didn’t work in a favourable environment or employers didn’t give employees the right tasks. No matter the case, an employee would be critically evaluated, says the founder of Imagem, who attaches particular importance to his employees’ well-being.

Gagnon adds that an employer should never underestimate the importance of integrating newcomer employees into a team and of offering them opportunities for development. Furthermore, Gagnon says that, among other details, he gives attentive consideration to degrees because diplomas are, according to him, a guarantee of success. The degree an employee holds shows that he or she has the ability to synthesize and analyse information, to work and think, and to do much more. These are qualities Gagnon looks for in an employee.

But beyond the diploma, an employee also needs personal qualities. A candidate must be motivated, useful, accountable and rational. My responsibility as an employer is to encourage employees to unleash their talents and help them find in what areas they excel. Gagnon knows that his employees won’t do everything right the first time around, and that is perfectly normal.

Jacques Gagnon believes that many employers ask too much of their new employees; employers expect to see fresh out of school recruits to be perfectly trained for the workforce. It’s absurd, Gagnon says. Students never have the opportunity to work on software while 100 other people are working on it at the same time or to use highly complex computer systems, such as those used at Imagem. Employees need time to get a grip on these systems and to understand the culture of clients in the healthcare industry.

Imagem’s approach to human resources management instils, in all employees, a sense of belonging to the firm. When employees have confidence in themselves and in the firm they work for, they are more likely to work their way up the company ranks and discover their hidden talents.

Gagnon, CEO of Imagem, knows that his employees won’t do everything right the first time around, and that is perfectly normal. “My responsibility as an employer is to encourage employees to unleash their talents and help them find in what areas they excel.”

Is artificial intelligence trustworthy?

These days, we hear more and more about AI or artificial intelligence. In all or almost all areas of activity, AI seems to be the magic bullet to meet today’s challenges and to face those that lie ahead. How do we solve labour shortages? AI. How do we better target an audience? AI. How do we reduce the administrative burden? AI. However, according to Jacques Gagnon, the CEO of Imagem, a high-tech firm specialized in the development of health technologies, there is still a fly in the ointment: we overestimate the power of AI.       

To start off, Gagnon, who is an engineer by training, says that any AI system needs to rely on valid and useful data worth exploiting. The exercise itself requires a great deal of rigour to ensure that the collected information is relevant and verifiable and that all parameters that are likely to influence the data to be generated are taken into account.   

Beyond AI, there are people who still today have the responsibility of asking the right questions and of collecting clear, quantifiable and verifiable answers to those questions before processing the information using various algorithms that have been developed for the purpose: this is what we call “deep learning” or DL. In the field of science, just as in the health sector, rigour is law.       

Gagnon adds that a simple device that is improperly calibrated can skew data completely just as an erroneous interpretation given by personnel can invalidate the information that was collected. When we talk about artificial intelligence on social media, it is of no real consequence if Facebook erred when it showed you a pair of pants you should have liked. However, when it comes to health information, to err is not an option. That is why, in order to conduct a rigorous analysis, we must first go out on the field and ensure that the data that is collected is reliable and that the source of the data can be determined.      

According to Gagnon, AI must have roots in reality if we are to give it some kind of merit. In that respect, some aspects of work will always require human intelligence and methods will always need improvements, but, needless to say, AI represents a major leap when it comes to using processes that were completed, up until now, in a subjective way.

At Imagem, we are constantly focusing on eliminating errors from the processes completed in our firm – to the extent of what is possible, and from those put in place in our clients’ establishments. To do so, we follow strict control measures, among other actions. Imagem is subject to the particularly strict MDSAP (Medical Device Single Audit Program) and ISO 13485 standards. All of our applications seamlessly generate comprehensive log files, and the millions of actions that have been recorded allow us to know what there is to know about the operation of our software and to recover what needs to be recovered when needed. This scientific rigour is what carries our guarantee of quality. Gagnon reminds us that we should keep in mind that AI roughly corresponds to data processing and that human intervention is required to validate the accuracy and the veracity of the data.

Is our health information kept safe?

More than ever, Quebeckers realize the importance of protecting their personal information. Recent events that have shaken the world of finance certainly served as an eye-opener. Consequently, more and more people are asking themselves what measures are taken to ensure the confidentiality and security of the information that is collected about them, which includes their electronic health records.

According to Jacques Gagnon, CEO of Imagem, a high-tech firm specialized in the development of health technologies, solutions certainly exist when it comes to ensuring the protection of Quebeckers’ personal information regardless of the sector of activity.

Businesses usually have strong firewalls, which prevent people or malicious software to infiltrate their systems. Often, the real problem lies with internal security. That’s where breaches occur, says Gagnon. According to him, one of the ways a business can secure its environment is by seeking certification by a regulatory body.

Gagnon, who is an engineer by trade, mentions that in the field of medical devices, which is one of the most regulated sectors in the world, two standards provide a regulatory framework for his type of business: MDSAP (Medical Device Single Audit Program) and ISO 13485. Health Canada requires businesses in this field to obtain both certifications.

The ISO 13485 standard focuses primarily on safety and security, on risk management and on traceability. Consequently, it ensures that businesses offer products and services that meet customer expectations and comply with regulatory requirements for medical devices and related services.

As for the MDSAP, it’s an international assessment program for quality management systems used by medical device manufacturers who market their products in Australia, Brazil, Canada, Japan or the United States. 

So every year, Imagem is subjected to an external audit, which verifies that the firm has efficient and rigorous processes in place to ensure the quality of its products and services at every stage of their life cycle.

Jacques Gagnon says that the exercise is particularly onerous, but that it is absolutely indispensable for both the internal processes and the message that it sends. To some extent, the MDSAP and ISO 13485 certifications are indicators of quality that guarantee the reliability and the seriousness of his business. The certifications don’t make his processes infallible, but it shows that the risks within Imagem are minimal.      

In addition to the annual external audit, Imagem undertakes regular reviews of its operations and protocols. What is more, there exists throughout the firm a certain data culture that encourages staff members to treat any confidential information with all the professionalism that is required.

Furthermore, a task log for employees and users ensures a rigorous monitoring of the work being done.

Jacques Gagnon maintains that no matter the activity sector, all should be governed by quality management standards. In addition, business owners, including him, should take care of their staff and offer a secure and safe work environment.