Author Archives: Jacques Gagnon

Navigating the Obstacle Course

Navigating the Obstacle Course

When we talk about having access to care or to your medical file, some confusion can arise. What does “having access” mean? For most, we need to have access to care services when we are sick or afraid of being sick. When those situations occur, we desperately seek help. Does having a family doctor ensure that you will have access to care? Not necessarily because you have to tackle the challenge of getting an appointment and show perseverance. A disease usually strikes without warning, day or night, and often the only choice you have is to show up at a hospital’s emergency room. The system does not respond adequately to all those who experience anxiety or fear, whether it is justified or not. I have time and time again accompanied elderly people to the emergency room, and I found that they needed to be comforted. Should this be of lesser importance? Does their fragile state deserve less attention? Your baby may not be seriously ill, but observations are conducted directly at the emergency room. We cannot constantly blame people for going to the emergency room when they need care, and when they have nowhere else to go. Given that people do not know what services are provided to them, they do not know where to go.

“Having access” means easily getting help. If you have to cross barriers to get there, we cannot talk about accessibility, especially if you are underprivileged, distressed and sick. You are already hard-pressed and you are sent on a real obstacle course, where your patience is tested as you must wait on the phone for hours. Those who provide services must manage their processes and facilitate your access.

Let’s also take the example of your health records. Yes, you have access to your electronic Health Booklet, but you need to access clicSÉQUR first, which is not totally user-friendly, especially for those who would need it most. So, suppose that you finally end up having access to your Health Booklet. What you see are lists of incoherent numbers. All these figures, results and reports do not correspond to your file; they represent codes and the lingo used by specialists. Having access to your file also means having access to explanations that must come with the raw data. This means you need to be able to communicate with a qualified person.

There are too many barriers between you, the access to care and the people who care for you. We need to break down those barriers.

L’angoisse du résultat

Des histoires comme celle de Fatima, on les compte par dizaines de milliers paraît-il. Fatima est une jeune femme épanouie dans la force de l’âge. Elle a un métier qui la passionne, elle enseigne aux enfants. La société lui doit tout le bien qu’elle apporte aux petits, au-delà de sa paye. Mais voilà qu’elle a remarqué une bosse sous son aisselle. L’anxiété l’habite dorénavant, si bien qu’elle essaie de voir son médecin, mais la pandémie allonge l’attente du rendez-vous. Elle voit enfin Stéphane, un médecin dévoué et emphatique, il écoute et lui prescrit un examen radiologique, mais là aussi l’attente est longue. Son chemin pour en finir avec l’angoisse commence ici. Elle finit par accéder à l’examen après des mois d’attente, victime collatérale de la Covid. On l’accueille avec égards bien sûr, Jeanne sait pourquoi on se présente à elle, et en tant que femme elle a la sensibilité. Fatima prend place dans cette froide et impersonnelle salle d’attente. Lucie, la technologue, viendra la chercher et la soumettra à l’examen; ici encore Lucie prendra grand soin de Fatima car l’examen est plutôt désagréable. À la fin,  on la renvoie gentiment en lui disant que son médecin l’appellera lorsqu’il aura le rapport d’examen en main. Difficile de calmer cette angoisse quand on ne sait rien, de ce qui va arriver. Toutes les personnes qu’elle a vues savent l’importance et la valeur de Fatima, elles lui ont montré.

Mais que se passe-t-il quand elle attend l’appel de Stéphane ? Son ordonnance est entrée dans un processus qui la transformera en rapport d’examen livré à Stéphane. Elle passera tour à tour dans les mains de Lucie, de Magali radiologiste, de Christiane secrétaire, de Viki pour l’envoi. Enfin de retour à Stéphane, elle pourra savoir ce qu’est cette bosse. Déjà Fatima a beaucoup attendu, il faut que la production soit efficace et rigoureuse, on ne veut pas d’erreurs, et surtout pas de rapports perdus ou oubliés. Stéphane a beaucoup de patientes et il n’est pas sûr que l’on constatera un délai trop long si un rapport se perd.

Ce processus est animé par un fil conducteur qui assure l’efficacité et la sécurité, c’est la suite logicielle Postscriptum

The value of one’s life

A doctor giving an interview just outside the hospital where she works is worried. Will we be able to care for everyone?, she asks. We will have to make choices, some heart-wrenching choices, she adds. Who shall receive care? Which patients should be prioritized? That question has been answered since we have given priority of care to patients suffering from Covid-19 over so many other ill people. A forced choice as we faced the unknown, but would have it been better to prioritize the people who were ill instead of a sickness? The reality is that all types of care were affected and that the consequences of that choice remain unknown.

Jacques Gagnon, the CEO of Imagem, a firm that specializes in the development of healthcare technologies, says that from the moment we start categorizing human lives, we loose a bit of our own humanity. History has shown us many times that we have valued some people over others to varying degrees based on their skin colour, their race or their social status. Are we, today, such a long way off from that reality? When we accept to let our elderly die in residential and long-term care centres stripped of their dignity and establish mental disabilities as a criterion to not prioritize, we dehumanize. Do we know the value of having these people with disabling conditions with us?, asks Gagnon.

In other words, what is a life worth and how do we justify prioritizing some lives over others? Last summer, the French Canadian magazine “L’actualité” examined the issue and concluded that life, in effect, had a book value. In the article published June 1, 2020, the journalist, François Delorme, wrote that [following the 9/11 terrorist attacks] the families of single, poor or elderly victims received less money, proportionally speaking, than the families of victims who were young or rich or who had children.

During the pandemic, this given book value was prioritized. We chose to care for Covid cases in order to revive the economy as fast as possible. However, life has a value of another nature. Don’t we say that some human works have an inestimable worth? When the time to care for or to protect others arrives, what factors should we consider to guide our actions? In a setting of artificial intelligence, one would find an algorithm to use. Should a person’s age, material wealth, health status and profession be part of the equation? We know however that, as the American mathematician Cathy O’Neil puts it, “algorithms are opinions embedded in code”. In short, we can’t hide behind an equation; we must tackle the question.

Gagnon suggests that we be first and foremost empathetic. Our moral – and quite human – values lead us to regard with esteem all life despite what this life provides. No life is worth more than another. The only thing that should matter, says Gagnon, is that we should always save as many lives as we can.

As a businessman, Jacques Gagnon draws a parallel with the world of business. Within an organization, the value of an employee isn’t measured on the sole basis of his or her economic profitability. Their autonomy, sense of responsibility, creativity, teamwork skills and personal and professional experience, among other things, are all factors that need to be taken into consideration.

Consequently, thruth can perhaps be found in a life, in a life that has a beginning and and end, in a life that can only be assessed in its entirety, in its essentiality, in the greatness of its modesty. Who are we to choose between one or another?

We must be first and foremost empathetic. Our moral – and quite human – values lead us to regard with esteem all life despite what this life provides. No life is worth more than another. The only thing that should matter is that we should always save as many lives as we can.

Jacques Gagnon, Engineer

CEO of Imagem

How far will fear drive us?

We often say that fear marks the beginning of wisdom. Under other circumstances, fear can also be the result of ignorance, of disengagement and sometimes of closed mindedness. Like any kind of upheaval or event of major importance, the COVID-19 pandemic will have enfeebled our convictions. From this day forward, humans have a perception of risk and are aware of the limits of their own existence.

If, before COVID, our health system displayed some weaknesses, its functions remained operational. However, the last year will have shown us that this system is fragile and hanging by a thread, a thread that is held with difficulty by humans who even through the roaring of the storm, and although thoroughly exhausted, have demonstrated unbelievable strength and courage.

Jacques Gagnon, the president of Imagem, a firm that specializes in the development of technologies in the healthcare sector, doesn’t hide the fact that he is worried. How will the healthcare system manage to stand the ravages in a post-COVID era?

Gagnon believes that no one has really ever thought that one day, working in a hospital would be dangerous. Janitors, nurses, doctors, receptionists, lab technicians, respiratory therapists, all of them have been exposed to this COVID-19 virus, a virus that is difficult to contain. And they are still exposed to it. Inevitably, it changes our perception of the field.

The Need to Lay New Markers

For many months, hospital parking lots have been largely deserted. Are people less sick than before the pandemic or is the population afraid to go to the hospital? Does fear have something to do with this situation?

Gagnon, who knows the hospital environment well for having set foot there very often, says that if people are afraid to go to the hospital, to receive treatment or worse to go and work there … it’s just unthinkable.

According to him, fear is at the root of many of our ills. Before, we used to pray God; today, the new god is technology. We believe that technology can remedy all our shortcomings and correct our destructive behaviours. Instead of reducing our carbon footprint, we seek technological developments to sequester carbon. Instead of taking charge ourselves of our health, we wait for a pill or a miracle treatment.

Jacques Gagnon talks about last week’s commemoration ceremony of the tragedy of Saint-Jean-Vianney and how this tragic event had impacted on urban development policies and how precautions are now exercised. The Saguenay flood had the same effect. And now COVID.

What lessons will we learn from this worldwide pandemic? It’s still too early to know. All the same, we will need to rapidly determine up to what point we will allow ourselves to be guided by fear.

Fallen Angels

Since the beginning of the pandemic, we have collectively portrayed healthcare workers as angels. We have applauded their courage and their resilience and have expressed our admiration. However, have we sufficiently taken care of our angels?

They chose a career to be at the service of the sick, caring for the ill, and helping others without realizing that one day they would be putting their own life on the line at work.

Jacques Gagnon reminds us that at church, we were told that we all had a guardian angel. Truer words have never been spoken! When we are suffering, in a state of disarray and helplessness, we need to be comforted, we need the kindness of an angel. However, the angels we are talking about, we don’t want them in heaven, we want them at our bedside. And to have them there, we need to take care of them. From now on, our angels are very much aware of the risks of their profession, says Gagnon.

This fear, the same one that today torments police officers who are afraid of being filmed while they carry out their duties, the fear that keeps social workers awake at night as they ask themselves if they properly assessed the severity of a case, the one that thwarts desires and subdues passions, let’s hope that this fear will not deprive Québec of the service of these precious angels.

What Is the Greatest Threat We Face?

Regardless of global warming sceptics, planet Earth is talking to us and what she has to say is not at all reassuring. Slowly, and yet still too rapidly, the planet is suffocating under the pressure of human activity. Is the glass full? No. The pandemic has given us an eye-opening look on a new threat: viruses can mute faster than the vaccines produced to fight them. In a world where its end has been prophesied since the beginning of time, how are we to survive if not together by working hand in hand on problems that unite us.

On a small scale, business owners experience it on a daily basis. To move forward, to successfully complete their projects and to make their business grow, they must count on their employees, people of all races and religions, people with different orientations and interests. The responsibility of uniting these people in a common purpose lies with business leaders.

Jacques Gagnon, the CEO of Imagem, a firm that specializes in the development of technologies in the healthcare sector knows a thing or two on the subject. For more than 25 years, he has built on the know-how of his team and utilized their expertise to support the healthcare network and its professionals through two software suites, Postscriptum and Interview, fully developed by Imagem. 

According to him, this way of doing things, of uniting and pulling forces together, should also be put into practice in the world of politics.

Gagnon says that one cannot impose his or her way of thinking, but some form of leadership must be exercised to show that we are more efficient when we work together. It is possible for people to talk and to stand united; you just need to find the right words to do so. What we need right now is global leadership. We need to unite and build on our similarities, and Gagnon believes there are many. We need to stop talking about our sources of conflict. We need to find a meeting point.

Day after day, business people use diplomacy, assume leadership, show open-mindedness and manifest an intense desire to find lasting solutions. Maybe this should be taken into account to face head on the current and future global threats.

The Challenges of Globalization

As stated by Gagnon, the COVID-19 crisis has been a vivid demonstration of much stinginess, particularly with regard to vaccines. As it has been the case so many times since we’ve become “globalized”, the most powerful in the world take what they think they are entitled to leaving the less fortunate to their fate. Gagnon uses Haitian people and all poor countries as an analogy, as if we can leave all of them without vaccines. Have we become that much desensitized to misery? asks Gagnon.

Unfortunately, a small committee of people cannot resolve the COVID-19 pandemic or all the environmental issues we face. These issues are subjects of worldwide concern; they are global problems and must be addressed as such.

Gagnon maintains that the greatest threat we face is not natural disasters or viruses; our greatest threat is ourselves and our inability to face problems together. We seem to be unable to unite around a common priority. The contempt we have for others prevents us from sitting and working together.

Yet, Gagnon says that when he sees artistic and musical performances reach people all over the world, when he sees Innus moved by the OSM, when he sees Japanese moved to tears by the music of Beethoven, when he sees the unanimity of sentiment before these splendours, he believes that salvation of humanity is possible.

Human resources: Where is the problem?

Healthcare workers are exhausted. The pandemic, which continues to claim victims, is overwhelmingly pressuring the health system and the lack of personnel for primary care is complicating the situation considerably. As it is the case in several other sectors of activity, the field of healthcare has experienced labour shortages for many years now. But what do we really mean by labour shortage? Above all, how do we prevent other sectors of reaching the limits of their human capacity?

According to Jacques Gagnon, the CEO of Imagem, a firm located in Saguenay that specializes in the development of technologies in the healthcare sector, workforce issues would have more to do with management issues.

Gagnon says that managers must ask themselves serious questions. Too often, the reason an employee doesn’t do the job right is because they have not been well integrated or they have not found their strengths nor have they been able to utilize them. No matter the organization or the work to be done, no employee is able to train himself or herself alone. Someone must take the time to guide them and to help them grow within a firm.

Imagem embraces this type of ideology. The firm, which has developed and designed the software suites Interview and Postscriptum, which help organizations respond to the challenges linked to managing diagnostic imaging and to producing medical reports, has seen over the past 25 years a significant increase in its workforce. This pleasant challenge has led the administrators to look at best practices in the field of human resources.

Interpersonal skills and good judgement say a lot about a person. The diplomas a person has also are of value; they show a person’s ability to summarize, analyse and achieve results. Those are qualities that Jacques Gagnon looks for in employees.

Selected foremost for their human qualities, the candidates who have secured a position at Imagem over the years have been able to make a place for themselves thanks to the time and the energy that was invested in their integration and training.

Beyond qualifications per se, individuals and human intelligence must be valued. One can develop know-how; it can be worked on. Often, expectations managers have are unrealistic and the criteria they use to evaluate candidates are inadequate.

— Jacques Gagnon, Chief Executive Officer of Imagem

Break the mould

The message “In search of new talent” taken directly from a dozen job offers gets an eye roll from Imagem’s CEO. According to him, talent is something that is developed and cultivated with time. Employers who are seeking rare gems or “all-purpose” people can only experience disappointment. No one can expect that candidates can fit perfectly in a stiff mould.

Gagnon mentions that beyond qualifications per se, individuals and human intelligence must be valued. One can develop know-how; it can be worked on. Often, expectations managers have are unrealistic and the criteria they use to evaluate candidates are inadequate.

Managers would also benefit from recognizing that the true value of their organization lies on their employees. The healthcare sector is a modern-day example. Without nurses, doctors, personal support workers (PSW), healthcare professionals, the system simply collapses.

Employee Retention: A Challenge to Overcome

For Jacques Gagnon, there is no doubt that retaining employees once an employer has recognized their value also presents a challenge. The key? Valorizing their work, recognizing their abilities as well as their personal and professional qualities. According to a poll based on a sampling of 17,000 Quebeckers that was conducted by Léger, a Canadian market research firm, self-actualization, work relations and recognition bring more happiness at work than individual responsibility, salary and a sense of belonging.1

Gagnon notes that everybody needs to know they are important. Recognition is essential. We can offer higher salaries, but sooner or later it won’t make a difference if employees don’t feel that they are reaching their full potential and are appreciated. Using the healthcare personnel example, Gagnon refers to the situation of personal support workers. According to him, it is obvious that the value of their work is underestimated.

Many people would be completely unable to do to what PSWs do on a daily basis. They perform ungracious, but essential tasks. We should look at ways of integrating them with different teams and raise the profile of their role.

With respect to the fast-track training to become a PSW and the grants provided for training by the Québec Government, Gagnon finds that the approach was overly simplistic and hurried. According to him, lasting solutions must be sought in the long run. Without continuous training in the field, without support, without integration in the work environment, it is likely that few new PSWs will hold on to their job beyond the 12-month period imposed by the government as they are, after this period, discharged of the obligation to repay the $9,000 grant received during their training.

In an article published in the newspaper Le Devoir, on December 3, 2020, the FSSS-CSN (the health and social services federation in Québec) mentions that the lack of staff in the field is a concern for both old and new personal support workers. Also, there is another problem says Jeff Begley, the president of the FSSS-CSN: the salary of $26 an hour is still being negotiated.2

1 Léger, Workplace Happiness Index, November 2018 and March 2019. 


COVID-19 – We must act now

Doctors from the CIUSSS[1] serving the SaguenayLac-Saint-Jean region are sounding the alarm. In an opinion letter published November 21st in the newspaper Le Quotidien, the doctors who sit on the CIUSSS’s coordinating committee asked for the public’s collaboration with regard to following the Public Health’s safety guidelines that advise people to social distance and to wear a face mask.

[1] CIUSS– Acronym for Centre intégré universitaire de santé et de services sociaux | University Integrated Health and Social Services Centre.

Jacques Gagnon, who is the president of Imagem, a firm that specializes in the development of technologies used in the field of health information and administration, strongly supports the doctors of the Saguenay – Lac-Saint-Jean region. Gagnon, who is an engineer by training, works in close collaboration with health professionals, and he is of the opinion that following distancing guidelines is foremost a matter of respect.

Gagnon observes that every day, in addition to doctors, nurses and respiratory therapists, there are teachers, personal support workers and many workers in other fields who put their lives at risk. They are on the frontline providing essential services. They make huge personal sacrifices on a daily basis to help the population. Not following the public health’s guidelines is a show of disrespect to these workers and a lack of appreciation of the work they do.       

At this time, it’s clear that the Saguenay – Lac-Saint-Jean region is not doing very well case wise. Every day, the report of hundreds of new COVID-19 cases casts a spotlight on the region for all the wrong reasons.

Jacques Gagnon believes that it’s time for people to take this matter seriously. People have to stop behaving childishly. Truth is that we hardly know anything about this virus. Scientists can hypothesize and anticipate some consequences, but we don’t have any experience in dealing with what is happening. We ignore what kind of long-term side effects the virus might have on our health and on our lives. There are no guarantees even if we do develop a vaccine. Now more than ever, we must be vigilant, we must be concerned with what is happening and we must do what it takes to come out on top.

United We Stand Against the Virus

According to Gagnon, the Quebec provincial government must send a clear message to the population. There is no room for half measures like relaxing the rules for the upcoming holiday season. He also imagines that if things don’t get better, even Santa might need to be put on a ventilator. It doesn’t take a million ailing patients to overwhelm our health system. Our system is already hard pressed. We must protect our frontline workers and the members of their families. Gagnon maintains that social distancing is the key.   

As for those who think they are immune to the risks, and worst, who allege a conspiracy, the founder of Imagem offers words of caution. Reliable and credible sources of information help the quest for truth. Scientists do not possess absolute knowledge. The very essence of a scientist lies justly in having no certainty and this is why they keep on studying, observing and comparing while pursuing the objective of truth. The strategy they propose to limit the spread of the virus represents the best hope of a real solution.  

Within his field of expertise, Jacques Gagnon favours this same scientific approach when undertaking a new project or whenever he needs to intervene in a situation. “Facts” – that’s the only thing that provides certainty.

In support of the message sent by the doctors of the region, Gagnon, in turn, invites the population to do its part in the fight against the spread of the coronavirus. The Saguenay – Lac-Saint-Jean must reverse the cycle. For the common good of all people and for the protection of essential workers and their family members, let’s follow the guidelines put in place by Public Health, let’s practice social distancing and let’s stand in solidarity.

Jacques Gagnon wishes to remind people that showing respect for frontline workers is a show of respect for life.

Data in times of crisis

Is your personal health data at risk during the pandemic?

If we are talking about risks related to physical facilities and possible intrusions, the level of risk is low. When we act in urgency, available resources are allocated to the crisis; in this case, people are mostly providing care. Ordinarily, focus is on running the hospital, treating patients according to established protocols and codes of conduct. However, these are not ordinary times. Hospital administrators must maintain patient capacity and add to that a critical management component to be able to deal with a hereto-unknown pandemic, a unique and historic event. Employees find themselves in a demanding situation where the atmosphere is tense and where they feel stress and fear.

The system must embody the essence of its mission of care, which lies in the hands of those who provide it. For them, we must meet the needs of their work environment and practice.

What does the pandemic tell us about health data?

We have a new and compelling need for data to show the spread of the virus and case distribution as well as the number of tests that have been administered and of people that have tested positive. We also need data to follow up on cases, to base equipment purchases and ensure good supply management and training. Jacques Gagnon, CEO of Imagem, a high-tech firm specialized in managing data collected and processed by health systems, compares the role of his firm to that of an orchestral conductor, as it must automate complex processes that are under development.

Crisis managers have different needs, but they require mental agility and must be in a reactive mode in order to give and obtain crucial information. They also need information that is accessible and accurate, readily available and adaptable. Imagem can demonstrate its capabilities to fully meet those needs.        

Just like a conductor, Imagem must automate complex processes that are under development.

Crises do occur and more will happen. We must take that into consideration and introduce flexibility as a precondition.

Not the least of the lessons to be remembered is that we should learn to look after our own affairs and stop counting on others, who are anyways busy looking after their own business. For us, buying locally doesn’t mean that we are closing ourselves off to the world; it’s rather a way of preserving a degree of autonomy and providing solutions to our situation.

Imagem’s vision is the most rewarding one can have: to take control of our technological destiny, here, where we live.

Apply rigour to all that we do

At Imagem, rigorousness comes in first place. Jacques Chagnon maintains that, in the current context, doctors carrying out treatment need to receive precise and errorless information. This rigorousness is of particular importance in these challenging times. The firm works diligently to ensure that the medical records that are produced remain flawless and that the records are sent to the people who need to have access to them. In addition to having its own set of domestic practices, Imagem has invested time and money to gain international accreditation and has completed all requirements in the recognition process for MDSAP (Medical Device Single Audit Program) and ISO 13485. Every year, Imagem undergoes an internal and an external audit. These certifications propel Imagem into the big league next to international players in the field.

“In the current context, doctors carrying out treatment need to receive precise and errorless information.”


Image Transfer to an Agfa PACS Server

This document is an effort to demystify the interactions between a PACS Server, radiology equipment and other PACS.

The DICOM protocol was established to resolve interfacing and communication issues with radiology equipment called modalities, which produce images for diagnostic purposes. This mainly relates to installing a server in such a way that it communicates with various modalities by using transfer protocols. The server makes images accessible to reading stations. However, the protocol does not establish how the server must operate internally; the transfer alone determines the success of the communication. The production of DICOM images is represented in the left part of the following figure.

Over time, we wanted to send some images to third party DICOM servers. The publication is represented in the right-hand side of the figure. It is important to note that a server is used to only stock and exchange images; a server doesn’t modify images.

DICOM Steps to Image Production

All images come from various modalities and manufacturers and they are all stored on the PACS server and added to its database. Over the course of 20 years of operation, Imagem has incorporated into its server technology an extensive range of imaging devices manufactured by GE, Siemens, Agfa, Hologic, Philips, Swissray, Toshiba, Kodak and others.

DICOM Steps for Displaying Images

Images can be sent to another destination, to another PACS

Load Balancing

We ignore what occurs exactly on the network between the Autorouter and the Destination, because we don’t have any control on the path that is taken. Also, we cannot know what the Destination does before and after it responds. Let’s suppose that the Destination utilizes load balancing

Factors behind the slowdown

The slowdown may be caused by different factors.

HL7 Messages and Base64 Encoding

HL7 Messages and Base64 Encoding

HL7 standards are widely used across the world to exchange clinical data. Rules for transmitting data are based on the use of readable ASCII characters. Messages can therefore be easily read. Each message comprises a sequence of segments. The first segment of a message always begins with 3 ASCII characters, the letters ‘MSH’ for Message Header. Other segment types found in a message can begin for example with ‘PID’ for Patient Identification. Elements within a segment are contained within symbols such as the pipe ‘|’ used to separate the fields, the caret ‘^’ used to separate the components, the ampersand ‘&’ to separate subcomponents and the tilde ‘~’ to indicate a field repetition.

An HL7 message allows you to insert binary files, such as images, or readable text, such as RTF encoded text, for example.

The important thing to remember here is that the HL7 protocol has been developed using readable text.


When we have a standard, such as HL7, that uses a text or ASCII based protocol, we run into the problem that when the information is encoded, the system inserts a character, which the parser recognizes as a control character. For example, if we want to use the ampersand character (&), in a message, such as “chest XR PA&LAT” or “Gilbert & Son”, the ‘&’ character must be converted, because within the HL7 standard it is a control character.

The problem is exacerbated when we have a whole document converted as an RTF file. The RTF format consists of ASCII readable characters and ASCII control words, such as <CR> for carriage return or <LF> for line feed.  

The <CR> that you find in the RTF file is also used in HL7 to mark the end of a segment. In reports, the tilde (~) is used to express an approximation and it is also a control character in HL7.

We can see that serious errors can occur without careful attention. And although the parser has the capability of recognizing characters it does not possess the ability to think.


There are two solutions to this problem. The first is to replace the characters that we want to use in a message – and that are used by HL7 as control characters – by escape sequences. For example, if we want to insert “chest XR PA&LAT”, the sequence will be “chest XR PA\T\LAT”.

The second would be, when we have an RTF file to insert, to convert or encode the text to BASE64, which will consequently remove all special characters from the ASCII sequence of the RTF file. Conversion to BASE64 also enables you to insert binary files, such as images or WAV or MP3 sound files, among others, into the data file and ensures the preservation of the integrity of the data to be transferred.

Here is an example of a BASE64 encoded string, which represents an RTF report:

Here is an example of a BASE64 encoded string, which represents an RTF report:

Note of Caution

If, while analysing the content of a message, the parser encounters a character that it recognizes as a control character, it will reject the message. This might be difficult to detect.

The HL7 is an exchange standard for the transfer of important health information and results between two applications or systems that must share a patient’s health data. It goes without saying that the exchange processes cannot alter, in any way, pieces of data included in a report. Parties who play a role in the data exchange must therefore recognize their obligations and ensure that the reports they send are properly encoded. At this time, and in related cases, Imagem must parse RTF reports to extract conflicting characters with HL7. Since this involves a structural alteration that may lead to erroneous reports, Imagem shall not be liable in such cases. Imagem encourages managers and decision makers to ask their suppliers to correct this deficiency that Imagem considers critical. Imagem wouldn’t tolerate this bad practice, which it considers an error that needs to be corrected.