InteleViewer on Windows Server 2012 R2

InteleViewer on Windows Server 2012 R2
 
At the radiology practice in which I work, we recently received the following question from the office of a referring physician: Can Intelerad’s InteleViewer PACS imaging client be run on Windows Server 2012 R2?  A member of our IT team reached out to Intelerad Support.  They provided the following advice known to work with Windows Server 2008, and suggested that we try the same on Windows Server 2012 R2.  So we did.

Infrastructure
As is the case in many organizations these days, we would deploy this test installation as a virtual machine running on top of VMware.  Now that we’ve upgraded to VMware ESXi 5.5.0, we’re able to run Windows 2012 successfully, reliably, and best of all, virtually.  I allocated two virtual CPUs and 4 GB of RAM in a fresh virtual machine configuration.

Windows Installation
Because this is a test, and we don’t want to burn a legitimate Windows Server license, I reached for Windows Server 2012 R2 Datacenter Preview Build 9431, a trial installation that I’d downloaded some months ago.  As anyone who has installed Windows Server 2012 R2 can attest, it’s very quick to install it with the GUI console and otherwise default settings.  After that, I installed VMware Tools and all available Windows Updates.  Finally, I enabled Remote Desktop.

Installing InteleViewer
Installing InteleViewer is as simply as going to the InteleBrowser URL of your IntelePACS installation, logging in, scrolling down to Installers, and then choosing InteleViewer Tracks.  Those who support an Intelerad installation on a daily basis are very familiar with this process.  We chose an available ‘64-bit Windows Installer,’ and installed it using all the default settings.  Upon launching InteleViewer for the first time, we added the secure hyperlink to our IntelePACS installation.  Before the day was over, we’d briefly try versions 4-6-1-P122, 4-7-1-P129 and 4-8-1-P65.

Enabling ‘MultiUserMode’
The point of installing InteleViewer on Windows Server 2012 R2 is probably obvious.  An organization wants to allow multiple users to run simultaneous sessions of InteleViewer from a single server via Remote Desktop Services or Citrix.  InteleViewer requires two application-specific registry changes in order to make this work successfully.  The settings are documented below, and also in a PDF file in case the formatting isn’t intuitive here.  You should be able to paste the content into a text file, rename the extension to REG, and then run it once on your Windows Server.  If you wish to create these registry entries manually, note that they are of type ‘String Value.’

Windows Registry Editor Version 5.00

[HKEY_LOCAL_MACHINE\SOFTWARE\Intelerad Medical Systems\InteleViewer]
“MultiUserMode”=”true”

[HKEY_LOCAL_MACHINE\SOFTWARE\Wow6432Node\Intelerad Medical Systems\InteleViewer]
“MultiUserMode”=”true”

The Test
After installing InteleViewer and making our registry changes, we rebooted the Windows Server for good measure.  A colleague and I were then able to run simultaneous InteleViewer sessions without issue.  It should be noted that both of us are IT Professionals and not medical professionals.  And this limits our evaluation to a binary observation of whether or not InteleViewer works, rather than a substantive evaluation of how well it works.  As mentioned before, we ran versions 4-6-1-P122, 4-7-1-P129 and 4-8-1-P65 successfully.  So far, so good.

A Glance Through Windows 8.1

Windows 8.1 Start Page ©Microsoft.

Windows 8.1 Start Page ©Microsoft.

 
It’s been a busy couple of months and then some since my last post.  Fortunately the July 4th holiday weekend here in the United States provided a respite from my day job in technology, allowing me time to… play with more technology.  Just over a week ago, Microsoft announced their Windows 8.1 Preview release.  Since I have no back yard to grill in here on the East Coast, I spent my holiday afternoon at my office, where I replaced Windows 7 on my primary business desktop with Windows 8.1.  If this move proved ill-advised, I’d have days in front of me to make my workstation useable again.  It’s probably worth mentioning that I work in a role where such experimentation and evaluation are part of the job.

Now given enough time and patience, just about any operating system can be made to work for the majority of routine productivity tasks.  I’m equally comfortable using Windows XP through 7, Mac OS, Ubuntu Linux, etc.  I don’t consider one significantly more useable than another.  Of course there are a fair number of industry-specific applications that are written around a particular operating system, a particular web browser, and even a particular version of a particular web browser.  And that’s where we can run into the most trouble when making a major transition, such as from Windows 7 to Windows 8 or 8.1.

Getting Started
Normally we might begin by talking about making a good backup and testing it.  But I don’t store business or personal data on this PC, and I plan to reinstall any applications that I might need once my operating system installation is complete.  Moving on.

Had I not already downloaded the ISO file containing Windows 8.1 and burned a DVD copy, I’d need to do that before I go any further.  But I’d taken this step days earlier, taking care to note the product key listed on Microsoft’s download page.

Next, I like to kick off a new operating installation with a clean slate.  So I began by booting a CD containing DBAN (Darik’s Boot and Nuke), after which I ran a single-pass wipe of my entire hard drive.  Now the drive will appear empty for what comes next.

Installing Windows 8.1 is as simple and painless on a clean system as you’d expect.  I accepted all of the defaults, and the whole process took less than 20 minutes from start to finish.  Anyone who has ever installed any version of Windows won’t have an issue getting through the basic installation on a modern business desktop from HP, Dell or Lenovo.  Soon you’re done, and ready to sign in for the first time.

Authentication
I was initially prompted for a Microsoft account.  I gave my Outlook.com credentials, and carried on.  As a business user, I was frustrated by what appeared to be the lack of an option to begin using the computer without signing on to Microsoft’s cloud first.  Then again, I may have made this choice without knowing it when I selected, ‘Use express settings.’  Fortunately, I later joined the PC to our business domain, after which I can authenticate using my company Active Directory credentials, and get away from Microsoft’s cloud.

Full Disk Encryption
Despite my earlier statement that my PC had no data that I wanted to keep, I never run a locally-installed desktop or laptop OS that doesn’t have full disk encryption enabled.  Ever.  So I immediately started looking for the BitLocker Drive Encryption option.  Windows didn’t detect a Trusted Platform Module (TPM) in my system, but some quick Googling revealed a local Group Policy change that allowed me to run BitLocker without it.  The option to ‘Run BitLocker system check’ wouldn’t pass either, so I just skipped it and carried on.  Eventually I got my entire hard drive encrypted via BitLocker and protected by an adequately strong password.

AntiVirus
I was unable to install our corporate Sophos Antivirus on this Windows 8.1 Preview release.  This was one of only two apps that I haven’t yet been able to get installed at all.  But this gave me an opportunity to check out Microsoft’s free Windows Defender instead.  As it turns out, Windows Defender was already enabled and running.  This too may have been turned on for me when I clicked, ‘Use express settings.’  Windows Defender should suffice for the time being.

Installing Apps
As a Systems Administrator, I rely on things like the VMware View Client and the VMware vSphere Client to do my job.  My usual install of the former worked just fine while the latter did not.  I couldn’t get the latest VMware vSphere Client to install, even in Windows XP compatibility mode.  For the time being, I can run this from somewhere else.  I’ll discuss the rest of the apps in a little more detail later.

[Edit 07/19: As Humberto Maynoldi later shared in the Comments, you can get the VMware vSphere Client installed successfully using the following steps.]

  1. Navigate to Control Panel > Programs and Features > Turn Windows features on or off.
  2. Check the box next to .NET Framework 3.5. Click OK.
  3. Then install the VMware vSphere Client 5.0.

User Account Control
User Account Control (UAC) is one of those features that sounds great in theory, but in reality, it prevents a host of legitimate legacy applications from being installed successfully.  We just about always have to disable it.  As it turns out, the UAC slider that we’re all familiar with doesn’t actually disable UAC in Windows 8 and 8.1.  In addition to moving the slider down to ‘Never notify’, I edited the registry value listed below in order to completely disable it.  Unfortunately I didn’t learn this until I struggled with one of the apps described later.

[HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows\CurrentVersion\Policies\System]
“EnableLUA”=dword:00000000

Healthcare Apps
Now my day job consists of supporting IT in a healthcare environment, specifically radiology.  So I was particularly interested in how our healthcare apps would perform.  If they didn’t work, this would represent a deal-breaker to any company-wide rollout of Windows 8.1 in the foreseeable future.  Not that a rollout of Windows 8.1 is particularly likely anyway.  While the following applications won’t be of interest to general readers here, they are of specific interest to some of my colleagues and very necessary to my personal evaluation.

MedInformatix Version 7.5-L
The group that I work for relies on the MedInformatix 7.5-L Radiology Information System (RIS) to schedule patients, manage their charts and generally run the practice.  The MedInformatix client installed without issue.  The EIS Crystal Report Viewer v2.4.5 that we often install in conjunction with MedInformatix seemed to install properly as well.  I also installed Adobe Reader 11.0.3 without issue for viewing PDF files within MedInformatix.

Intelerad’s InteleViewer 4-4-1-P160 (64-bit)
This Picture Archiving and Communication System (PACS) client installed without issue.  Initially I thought that I couldn’t launch it from the Windows 8 ‘Start’ page, and even reported the problem to Intelerad as such.  I later observed that the main InteleViewer shortcut had been grouped with the Windows systems apps, and that I was trying to launch an ancillary utility from the Start page.  Once I figured out that Windows 8.1 doesn’t always group legacy Windows applications intuitively, I found that I can pin the correct InteleViewer shortcut to my Start page and launch it when desired.  I’ve yet to observe any problem using InteleViewer with Windows 8.1.  It should be noted that Intelerad doesn’t officially support any of their applications on Windows 8 yet.

Nuance PowerScribe 360 v1.1 SP1
The radiologists in our practice use Nuance PowerScribe 360 to dictate their findings on each set of images and convert their speech to a text report.  Incidentally, this technology has all but done away with the need for medical transcriptionists, a field once thought to provide a reliable American middle-class livelihood.  At any rate, PowerScribe 360 would not install reliably until I discovered how to truly disable UAC as mentioned earlier.  After that, I was able to fully install the application, at least as far as I could discern.  Upon first launch, I got through PowerScribe’s voice training exercise using a Nuance PowerMic™ II.  From that point, I assumed that I was all set.  I was wrong.

I quickly found that handing off cases from InteleViewer to PowerScribe 360 for dictation – a routine part of our company’s radiology workflow – consistently triggered a “Catastrophic failure” in PowerScribe.  Additionally, PowerScribe stopped recognizing my PowerMic on the second day.  In the short time that I’ve had to play with Windows 8.1 so far, I’ve not been able to run through a complete pass of our radiology workflow, from MedInformatix to Intelerad to Powerscribe and back again, with any success.  Were I a practicing radiologist, and not just an IT guy supporting them, I’d be scrambling to revert to Windows 7 at this point so as to carry on with my job.

ActiveFax
ActiveFax is a corporate fax solution that our company uses to send and receive faxes to and from referring physicians, insurance companies and anyone else that we do business with.  I attempted to install the ActiveFax 4.25 client that we use on Windows XP and Windows 7, but the installation failed.  I then downloaded the latest ActiveFax client, version 5.01, but quickly found that it was incompatible with our older version of the back-end server software.  We’ll have to upgrade our ActiveFax server to the latest version before being able to use a Windows 8 compatible client.  This scenario is again fairly typical of the kind of thing that corporations run into with every new operating system.

Mozilla Firefox
I do all of my web browsing with Mozilla Firefox, and consequently, it is one of the first things that I install on any new system.  Firefox seems to perform fine on Windows 8.1, including with my favorite extensions.  No surprise here really.  Consumer-facing apps like Firefox are typically far quicker to support new platforms as they arrive.

Conclusion
The Windows 8.1 Pro Preview release is reasonably useful, right up to the point where we start using heavier, industry-specific Windows applications on it.  As is typical around every new Windows release, the more expensive, enterprise-grade apps typically take far longer to support a new operating system than the apps that consumers might download at little or no cost.  Certainly these hiccups and shortcomings will be resolved in due time.  Some may be resolved in time for a late-2013 final release.  Meanwhile, those tech geeks among us will be looking through this Windows 8.1 Preview.  I hope to have more to offer in the weeks ahead.