Kestral End of Year Review 2013

For Kestral, 2013 has been an exciting year, with new products, customers and faces.

New customers have been welcomed into the Kestral fold, from small and brand new facilities to large, established multi-site practices. Our support team have been busy providing order entry solutions, upgrading clients to Karisma v3 and applying numerous Medicare updates to name just a few activities.

With the acquisition of LRS Health, Kestral’s presence in pathology was significantly increased. We look forward to providing a wider range of options to our customers. As a result of this acquisition, Kestral Support Manager Stephen Bettoli was promoted to Operations Manager for both Kestral Computing and LRS Health, while Team Leader Jan Sebire took over as Support Manager. Support team members Hendra Wijaya, Lyn Gannon and Dominic Noone were also recently promoted to Team Leaders.

The focus for the Development team throughout 2013 was on the Forge platform. There are now three products running on this platform; our internal administration program HQ, a point of sale program and Karisma v4. This development has provided great opportunity for us to learn about and evolve our touch screen interface capability.

Karisma Version 4 was showcased this year at the annual RANZCR meeting held in Auckland in October. With our pathology products in focus, we also attended Melbourne’s National Histology Conference. The International HL7 Interoperability Conference in Sydney was a showcase for Fast Healthcare Interoperability Resources (FHIR); a new form of HL7 messaging based on common web technologies such as RESTful API, XML and JSON.


Kestral at RANZCR 2013

In other news, Jan Sebire, Lyn Gannon, and Jeff McKee attended the annual Jonas University (JSU) in Canada this year. The four-day conference comprised of cross company introductions of the markets and products within the Jonas group, best practices/knowledge sharing sessions and presentations from various academic and industry experts.

On behalf of everyone at Kestral, we’d like to wish our customers and friends all the very best for a safe and happy holiday period and a prosperous year in 2014.


The Karisma v4 Data Analysis and Workflow ‘Ecosystem’

It’s not often a software company employs a large and experienced Development team equally capable of creating a data analysis program as a touch-capable RIS. It’s no wonder that solutions which truly integrate analysis and workflow are few and far between. Most radiology business owners would know the frustration of bolted-on solutions all too well.

With the evolution of Karisma to a next generation RIS, we have augmented the program’s reporting power with a whole new engine. With Business Reports Studio, Kestral brought sophisticated data analysis to the RIS. With Karisma v4, we have taken it to a whole new level.

Because version 4 incorporates vastly expanded auditing capability and a simplified user interface, there’s in-depth access to deeper data analysis, more graphically-rich reports to display and a simpler way to bring it all together. This tightly cohesive system delivers the power to move seamlessly between your data analysis and your everyday operations.

You can think of this unprecedented scale of integration as an ‘ecosystem’; with every part of your normal day-to-day RIS workflow in perfect harmony with your reports – as illustrated in the diagram which follows:


Karisma v4 includes a number of built-in reports, providing a thorough examination of the relevant data with category drilldowns and even more detailed information by individual record. From revenue raised to service turnaround times, the information you need to know is at your fingertips. From each report, a range of workflow actions can be performed with the simple touch of a button – it’s all part of the harmonious integration of your entire solution.

More than just the numbers, more than just a good looking graph; Karisma v4 provides truly in-depth analysis of every aspect of your system. Every report generates quickly from within a seamless workflow and financial ‘ecosystem’ where your operations are never further away than a couple of clicks.

Karisma v4 will be officially released in the coming months. Join us on our Website, Facebook, Twitter and here at WordPress for more information as it becomes available.

Karisma v4 : What Does It Audit?

In any organisation, it’s important to keep an eye on the big picture. Everything that happens throughout your facility is a piece of a whole. If you don’t have access to all the pieces, you can’t get a true idea of what’s happening across the business.

In Radiology, we use audit trails to see every change ever made to our reports to help track down errors and diagnose exactly what happened in what order by which users. Audit trails are essential tools for looking back over time to see every action in the finest detail with complete and clear hindsight. Audit trails give us the big picture to help us understand mistakes, formulate improvements and implement change to the systems and processes in place at our organisation. Having this picture helps make sure mistakes are never repeated.

So how do we know what parts of our Radiology Information System (RIS) to audit? Which pieces of the puzzle do we keep?

  • Report Modifications?
  • Request Modifications?
  • Patient Demographic Modifications?
  • User Access?
  • Report Printing?

What about the other information within the system?

  • An exam’s description?
  • An exam’s billable price?
  • A doctor’s phone number?
  • A critical system setting?

The problem with looking back is we can only appreciate what should have been tracked when the mistake has been made.

So, how do we audit the right information? We audit everything

Karisma 4 is built on our newly designed Forge platform. With Forge, auditing is automated across the entire platform. Put simply, auditing happens seamlessly across every bit of your data. Regardless of the action performed, it is stored, audited and retrievable.

No change is ever lost.

Every single bit of the system is audited, right down to the smallest settings for report delivery. Whatever is entered, deleted, modified, changed, moved, corrected, re-entered, verified, amended, authorised or altered, Karisma v4 automatically tracks and stores the changes, providing a permanent and retrievable audit trail.

So you can access and view everything again, any time; forever.

It’s all part of

Giving You The Complete Picture

Karisma and Touch Screens

The ever increasing demands on radiology providers are driving us to look at time-saving technology. Kestral is developing version 4 of Karisma RIS to take full advantage of touch screen application as this technology becomes common in places such as airport check-in and shopping malls. 

Touch screens are being utilised in every context from tablet devices to retail kiosks and beyond. The next generation Windows® 8 technology makes instinctive use of touch gestures as a natural companion to the keyboard and mouse. Karisma RIS v4 harnesses this inspiring technology to provide users with the most intuitive GUI we’ve ever developed. Touch screens simplify the way Karisma RIS is used through clear and simple menus.

Kestral developers have built a rock solid foundation on which to assemble the most powerful capabilities Karisma RIS has ever known – all customised to make the very most of touch screen technology.

More information on Karisma v4 with touch capability will be available closer to release.

The Fundamentals of Mobile Radiology

Ultrasound, MRI, CT and general x-rays exams carried out in an imaging centre today are captured and stored in digital format, which has made it possible for radiologists to send images and radiology reports over networks to general practitioners and specialists.

Due to the rapid uptake of mobile devices such as the mobile phone and the tablet computer, it has become possible to incorporate functionality so that radiologists can review diagnostic reports, alter content and authorise at any time or place in order to meet the needs of referring doctors and patients.

This post aims to look at what is necessary to make mobile radiology possible; and at the benefits of a more mobile radiology solution.

Essential Features

In order to best utilise mobile technology, there are a few essential features that must be available to radiologists and other users.

These essentials are mostly no different to the features you’d expect from a traditional desktop solution – except that access to them is possible from virtually anywhere. Let’s consider the most important examples of this.


The traditional work list must be on hand to the mobile user for maximum efficiency.

To augment this, notifications need to be ‘pushed out’, meaning the user will be alerted whenever a new case is available for authorisation.

Push notifications and numbers must be sent to active mobile devices informing radiologists of the current number of reports requiring authorisation.

Reporting radiologists who use mobile devices to access unauthorised reports require the ability to edit and format reports prior to sending to referring doctors.


A method for reporting on the cases available on each mobile device is also essential. Time is saved when there is no need to return to a desktop in order to make changes to, or authorise reports.

The method utilised must make it simple for the ensuing voice file to be transferred to the main system.

Large voice files saved to the device can quickly add up in terms of valuable storage space, so the best solution is to transfer the file and not save it locally.


Another efficiency-maximising essential feature is the ability to edit and format reports. There’s little point accessing cases if no changes can be made by authorising practitioners.

It can sometimes be necessary to make changes to transcribed text and format elements such as bold, italic, font size and type. These changes must be made from the device in order to make the most of mobile radiology.


Perhaps the most essential feature in a mobile RIS application is connectivity for the mobile device to send authorised reports to the appropriate referring doctor.

The mobile application device must also display separate worklists according to studies to be dictated, reports to be authorised, urgent studies and reports that require immediate attention.

The RIS must provide real-time updates to the user of the mobile application device.

Optional Features

Along with all the essential features, there are some which would be ideal to have in the right circumstances.

Not everybody wants a detailed look at revenues by service and time of day, but those who do would make good use of a reporting dashboard.

A graphical snapshot of the number of services being performed throughout the business, as well as the money they are bringing in are the sorts of things a report can provide business owners.

An example is shown below.

Mobile Reporting Graph

A graphical snapshot of revenue by service.

Workflow Options

Even with the very best technology, your mobile radiology process only performs as well as the workflow you put in place. Every business will have its own specific needs in terms of workflow and every good system must be customisable in order to adapt to changing requirements.

Below is just one possible workflow which makes best use of the technology currently available for mobile radiology solutions.

Mobile Radiology Workflow

An example of mobile radiology workflow using available technology.

How It Works

Exams which are reported onsite in the RIS are sent to the typist who can generate the report. These reports, which require authorisation, can be viewed on an iOS device offsite. If the radiologist is happy with the report, they can authorise it immediately from the application.

However, if amendments to a report are required, modifications can be made using the application, or if necessary dictation can be added directly using the Dictation feature. The voice file created is uploaded to the RIS, where it will appear in the Typist work list, so it can be transcribed and generated again.

The amended report will be viewable by the authorising practitioner from the mobile application on the list of unreported requests.

Reports can be authorised from the mobile application. Before authorisation, the report options allow the report to be released, authorised or delayed. When authorised, the report is sent to the referring practitioner and a copy is available from within the RIS.

The Complete Picture

The obvious benefit of mobile radiology is the ability to view, edit and authorise reports from virtually anywhere from the convenience of a mobile device.

As demand for services increases, along with the ensuing pressure to report more cases, the take up of mobile radiology is sure to increase at a rapid pace.

Free from the limitations of physical locality, clinicians can improve patient care by reporting more cases, in less time.

5 Reasons To Do It On The Web

Not too long ago, the term Healthcare IT was just another buzz word without a lot of substance. Now however, a host of medical purpose software applications are available and Healthcare IT is just standard operating procedure.

In this world of fast moving medicine and related solutions, physicians are under
pressure from patients to provide vital results. This isn’t always easy if you don’t
have the right technology to meet your day-to-day clinical needs.

Ideally, you want access to vital patient and results information at a moment’s notice from wherever you are. The way to achieve this is via a web based application; and there are several advantages to this method.

1.    Web Browser

Web based applications are used over the internet with whatever web browser you prefer. There’s no need to install any software on your machine and no need for updates. Every user is always on the latest and greatest version.

2.    No Setup / Configuration

When you use web based applications, the only thing you need to do is your work. All the setup and configuration is done for you via the application, so access to your reports is virtually instantaneous.

Plus, with Karisma Web, the only thing your practitioners need to request bookings with Karisma online is their password and a web browser. No special configuration at their end is needed.

3.    Cost Efficiency

Web based applications can considerably lower costs because of reduced support and maintenance, lower requirements on the end user system and simplified plans. Not only is information always available, but low end PCs and even smart phones can be used – resulting in quantifiable savings.

4.    Workflow Efficiency

Incorporated into Karisma Web are finely-tuned filtering capabilities. Practitioners will only be shown the information for patients with reports to which they have access and an association. This saves time and makes for more efficient workflow overall.

5.    True Mobility

Authorised users can access work from home or on the road. Web based applications mean the office goes wherever you go. At work, at home, a hotel, at a client’s office, even on a mobile phone – your data is accessible anywhere with internet access.

Giving your clinicians the power of Karisma from virtually anywhere in the world, means less down time waiting to get to your facility and more workflow options in general.

The evolving nature of Healthcare IT dictates that information is increasingly digital – leaving no need to expect anything less than immediate access.

Kestral End of Year Review 2012

For Kestral, 2012 has been a year of solid growth. A major version of our RIS was released, we developed new product solutions and we increased the Karisma base in Australia, New Zealand and Singapore.

Perhaps the biggest news this year was joining Constellation under the Jonas group. As part of Jonas, Kestral has been able to utilise the power of a corporate organisation to further the growth of our company and its services.

In May this year, Kestral officially launched Karisma V 3 which included new features like Karisma Mobile and Web, Inventory tracking, Order Entry, Data forms and Attachments.

Kestral recently launched its new customer management system called HQ. Each Karisma site will be managed by HQ, assisting account managers with real-time feedback on the performance of client systems.

The Kestral team in Perth celebrated the close of 2012 with a barbecue at the Yacht Club in Peppermint Grove, while the Melbourne team had their shindig high up in the clouds at a Melbourne hotel. You’ll find some photos on our Facebook page.

More details about 2012 for Kestral are included in the latest issue of eNews. If you’d like to receive the update, click the link to subscribe.

On behalf of everyone at Kestral, we’d like to wish clients, friends and families a safe and joyous Christmas and a prosperous, happy New Year.

The Kestral Development Philosophy

Kestral has always made it our mission to train and retain the best IT professionals to develop our systems. Our software development team is powered by a talented and cohesive group of professionals with a wealth of experience. Our current team have been developing our major product offerings together for as long as a decade.

Over this time, our developers have had in place a philosophy on how best to create useful and enduring software. This philosophy is simple; any stable structure needs a rock solid foundation. In software terms, what this means is a good application can only be built on top of a thorough library of code.

Think of the front end graphical interface of a software program as a house and the underlying code – the bits that make the program work – as the foundations. What happens when there is too much house and not enough foundation? The house, of course, falls over. When you build a strong foundation first, building the house becomes a much easier task and things are unlikely to fall over at a later stage.

What this means to our development team, when beginning a new product, is they initially spend most of their time on the library – the foundation. As the library takes shape, they can take some of the focus off the library and give it to the program. As development continues and the library approaches completion, more time can be dedicated to perfecting the user experience.Because the Karisma code library is so comprehensive (consisting in fact of 3.5 million lines of code), the strength underlying the application helps improve overall usability.

This process is illustrated in Figure 1 below:

Development Stages

Figure 1

This core development philosophy has proven invaluable to the ongoing advancement of Karisma, our flagship Radiology Information System. For example, having  the library in place means powerful new features such as Inventory tracking can be assigned mostly Application development – making for the best user interface with no risk of instability.

As we continue to enhance and evolve Karisma, our fundamental belief in keeping the foundations strong will always remain. Our users can be assured that the best new features will be underpinned by a stable and proven foundation.

The Rule Of Three

In speech and other kinds of writing, it is said that anything (situations, characters, objects) is more easily retained and digested by the reader in threes than in any other quantity. This is known as the “rule of three” and it can be seen in everything from classic tales such as The Three Bears to modern day political speeches.

In software development, we’re a different kind of creative, but we still have our own rule of three. At Kestral, we believe that the software we produce is most efficient when run on three tier architecture.

Not to get too technical, but the architecture of a software program refers to the levels on which it is built. Single tier architecture, for example consists of just one level; a program and its associated database/s all installed on your workstation (referred to as the Client). Two-tier architecture on the other hand consists of your Client accessing a Database over a network.

By adding an Application Server between the Client and the Database, two-tiers become three. When a Client queries the Database, information is processed over a high speed network on the Application Server to which the Client has access.

There are a number of advantages in adding an Application Server. Using a two-tier system means the Client makes direct queries on the database via the outside world. Due to the nature of the outside world, networks are often high latency. In other words, the outside world experiences longer delay times than a connected, low latency network.

With a three-tier system, the high latency network is between the Client and the Application Server. All information is processed on the Application Server which has a high speed, considerably low latency environment connection to the database.

The thing to remember about database queries is that one request from the Client might take scores of transactions on the Database to properly serve the query. For this reason, using the Application Server on the low latency network to process all of the information required from the Database means a significant increase in speed.

Our rule of three means our users always utilise the best method of extracting information from their data. In conjunction with a Database attuned to requests from the Karisma Client and its associated Agents on the Application Server, three-tier infrastructure makes for a faster, more efficient system.

The Unforgettable Benefits of Exam Codes

Schedules released by authorities such as Medicare Australia contain a series of item numbers relating to an examination and a charge. Radiology Information Systems (RIS) can use these schedules to charge for examinations entered on the system.

The main disadvantage of this is users must remember the item numbers for each exam for whichever schedule they’re using; for example, AMA.

Exam Codes

In response to this problem, some RIS make use of another sort of code, known variously as Exam Codes, Service Types and other terms. Exam Codes are a custom-defined identifier that can be mapped to the numerous item numbers in a schedule.

Here we take a look at the major advantages of a RIS that will allow you to never have to remember another item number.

One Code, Multiple Items

The immediate benefit of this is an Exam Code can be mapped to any item number from any schedule; and more importantly, one code can be mapped to different item numbers over multiple schedules. This will also allow staff to save images against one study in the PACS where integration with the RIS exists.

Simple Protocols

In defining an Exam Code, a business can select its own naming protocol so that identifiers make natural sense. For example, the Exam Code XANKR may refer to an x-ray exam on a right ankle as follows:

X(Department), ANK(Body Region) R(Side indicator)

Clerical Staff

This sort of naming convention makes it easy for users to search for an exam code, without knowing the item number from whichever schedule is required.

The upshot of this is clerical employees do not need to have a background in Medicine, they can just learn a simple Exam Code protocol – increasing the pool of potential clerical employees for your business.

Low Human Error

Even more important than the immediate Human Resources benefit, using Exam Codes greatly reduces the potential for human error, as an incorrect item number cannot be entered. Once the right Exam Code is added, the program will ensure the right item number is billed.

Updated Schedules

With a RIS that takes care of always fetching the latest schedule, there’s no need to update your Exam Codes.

For software that operates on item numbers, any changes to the schedule will mean having to update (and learn) the new numbers every time the schedule changes. With Exam Codes, you keep your identifier and the RIS takes care of the latest item numbers.

Correct Billing

Where a service contains multiple steps, and so multiple item numbers, the use of Exam Codes will ensure that all applicable charges will be applied at billing.

Through the use of the Rebate Library, the RIS caters for multiple and sometimes highly complex billing rules – including the ability to charge at different levels under varying, defined, circumstances.

The Complete Picture

With all of these benefits in mind, it makes sense to use Exam Codes rather than item numbers for the unique identifiers in your RIS.

Mapping one code to multiple item numbers, employing simple naming protocols and automatic updates to the item schedule will lower the likelihood of human error, make training staff easier and ensure the most accurate billing.