7 Keys to Unlocking a Devops Culture: Introducing the vRad Radiology Platform

At vRad, we have a passion for connecting – with each other, with clients, and with patients. In technology, we strive to break down the language barrier between geek-speak and common users to share our tools and processes. 

Go ahead, chuckle a little. You have probably found yourself in a meeting with an engineer or a systems administrator listening intently with the best of intentions to what sounded like English but didn’t make any sense.

In an effort to connect more directly, we are embarking on a quest to share how we maintain and enhance the vRad Radiology platform. We’re going to start by sharing an overview and then cover topics ranging from how we manage projects to how we manage downtime; and if you are interested in the nerdy side of things, we’ll cover that too.

Why vRad Uses Agile: the vRad Platform

vRad is a technology-enabled practice, and the vRad platform is the foundation on which our teleradiology and radiology service capabilities are built.

Teleradiology is the function of radiology imaging interpretation – such as x-rays, MRIs, CTs, etc. – by transmitting images through the cloud to an off-site radiologist.

To give you an idea of the scope of vRad's platform, it:

• Connects over 2,100 facilities to over 500 radiologists – both located in all 50 states;
• Ingests over 1 billion images annually for over 6.5 million patients;
• Requires over 2,000 software builds, preparing for over 30 major annual releases.

We like to refer to platform maintenance as changing the oil on a moving car. Since we never stop serving patients the car can never stop moving either – and agile development helps support that reality.

vRad’s platform consists of three major areas:

• Radiology Information System (RIS)
• Picture Archiving and Communications System (PACS)
• and Suite of Practice Management tools (Biz)

A Radiology Information System (RIS) is a radiology-specific electronic health records system that is utilized to track, manipulate and distributed patient images.

A Picture Archiving and Communications System (PACS) is the software and hardware used for ingesting, storing and viewing medical images (such as x-rays, MRIs, CTs, etc.).

Utilizing our platform, vRad provides radiology services to hospitals across the country through our network of radiologists also spread across the country.

Let’s look at an example of the vRad platform at work.

Let’s say that you are skiing Saturday night and you take that double black diamond a little too fast, have a nasty fall – it wasn’t your fault, the hill was really icy. You might end up in the emergency room - you are cold, wet, and your leg really hurts. The ER physician asks to have an X-Ray performed on your leg.

As your wheelchair gets rolled into the X-Ray room, the radiology technologist does not have to concern himself with calling the on-call Radiologist and waking her up – that’s because their local radiologist practice uses vRad to provide nighttime and weekend coverage, so they have a radiologist on hand 24 hours a day, 7 days a week.

Let’s take a look at what happens next:

1. The RadTech helps take an X-Ray of your leg
2. He then sends the images to vRad and fills out some additional information on vRad’s web portal
3. At vRad’s datacenters, the images are ingested and an order is created
4. The radiologist opens the images at his home and dictates a report
5. The report is received at vRad’s datacenters and from there distributed back to the hospital
6. Back at the hospital; the physician attending you gets an alert that your report is done and comes back to let you know the good news – your leg isn’t broken!
7. At any point in this process, our Operations Center representatives can step in to assist

This all happens in about 20 minutes, alongside 20,000 other orders being read.

The technology platform that runs all this is developed primarily in-house at vRad headquarters. We have a team of about 35 that analyzes, develops, maintains, tests, and manages the platform and we deploy major updates monthly to bring new features to our clients. The RIS part of the platform manages the orders, workflow, and report distribution. The PACS is responsible for ingesting, storing, and viewing images. And our Biz applications make sure the business surrounding getting radiologists licensed, credentialed, and scheduled goes smoothly.

vRad Technology Quest Log

Over the next few months, we’ll share with you the following topics, lending insight into how our engineering team manages the largest teleradiology platform in the world.

How We Manage Our Projects

vRad Agile (#1): An in-depth look into our agile methodology at vRad

How We Build Our Code

vRad Development Pipeline (#2): Our development pipeline from check-in to production deployment

vRad Test Environments (#3): Managing 30+ environments for continuous testing, user testing, and platform demonstrations

vRad Automated Testing (#4): vRad enables our development efficiency by relying heavily on automated testing – learn a bit about our different types of automated tests.

vRad’s Build Tools (#5): A look at the nerdy internals of the system that helps vRad manage our codebase and environments

How We Do Maintenance and Security

vRad Software Security (#6): How We Ensure Security for vRad’s Clinical Platform

vRad Maintenance Window (#7): An example of our approach to limiting impact of technology maintenance

Until our next adventure,

Brian (Bobby) Baker

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