Butterfly Cloud can connect to your organization’s DICOM endpoints via secure DICOM-TLS connection or Butterfly Link, available with Blueprint memberships.
How to Use These Instructions
The purpose of this Guide is to assist an Administrator of a Butterfly Cloud to enable DICOM and HL7 communications between Butterfly Cloud and the Customers’ DICOM archive, Worklist, or EMR using Butterfly Link. Butterfly Link is available with Blueprint memberships.
Butterfly Link
Introduction
This guide is an overview of how to install the Butterfly Link software and is intended as a reference for administrators. The Butterfly Cloud application is a Windows software application installed on a server or workstation machine that securely connects a medical facility’s DICOM and/or HL7 end-points to Butterfly Cloud. Butterfly Link communicates with DICOM devices (PACS, Ultrasound modalities, and Modality Worklists) to send and receive medical image data across the network. The software can also send and receive HL7 data between Butterfly Cloud and the facility’s EMR or interface engine(s). Butterfly Link communicates via an outbound, encrypted WebSocket connection to Butterfly Cloud and uses this connection for bi-directional data flow.
The Butterfly Link can be packaged both with and without a DICOM Router for managing store and forward capabilities. The Butterfly Link with a DICOM Router will have certain storage and compute capabilities based on the number of devices and studies you intend on processing data through daily. Please work with your Butterfly Implementation Team to size the VM for the Butterfly Link as necessary.
Frequently Asked Questions (FAQs)
How does Butterfly Link work?
Butterfly Link is a 64-bit Windows executable that runs in the background as a Windows Service.
Butterfly Link makes an encrypted outbound WebSocket connection to Butterfly Cloud and this connection is used for bi-directional data flow. The connection is secured with two layers of protection:
- A hospital specific security code is validated against Butterfly records at the beginning of every session.
- TLS 1.2 Encryption.
Do we need a dedicated server for Butterfly Link?
No, a dedicated server is not required. The software will run in the background on a current application server as long as it meets the minimum specifications.
Can the software run in a VM environment?
Yes, Butterfly Link can run on a VM as long as the server stays on, meets specifications, and has a static IP address.
Do we need to do any special backups of the software?
If you are using the packaged DICOM Router with the Butterfly Link, you should ensure that there is a process to backup data on disk per your organization’s data retention and backup policies. Butterfly does not store the data until it is successfully sent and acknowledged by the Butterfly Link DICOM service.
Is there a requirement for a server to be in the DMZ?
No.
What encryption do you use to transfer data to/from Butterfly Cloud?
TLS 1.2 is used for all data transfers between Butterfly Link and Butterfly Cloud.
What are the network requirements?
The server hosting Butterfly Link needs to be able to communicate with your internal DICOM and HL7 endpoints via TCP. Outbound HTTPS access must also be permitted to Butterfly Cloud as per the System Requirements.
System Requirements
Installers should confirm that they have access to Butterfly Cloud with Administrator permissions before initiating a Butterfly Link installation.
- The installer requires local administrator rights to install software on the device due to Windows UAC, and the need for the installer to register the service.
- The hosting server has a static or reserved IP address on the local area network.
- The hosting server can access the Internet.
- The system should operate on Windows Server 2016 or later (64-bit).
Butterfly Link without DICOM Router Hosting Server Requirements
- Computer or virtual machine running Windows Server 2016 or later (64-bit)
- 2 vCPU
- 4 GB of RAM
- 10 GB of free disk space
- Network access to LAN on which hospital services are accessible (i.e. EMR, PACS, MWL, 3rd party Ultrasound machines)
Recommended Configuration
Service Account
- Use a Domain Managed or Local Service Account.
- Account should be a member of the Users group with the following permissions:
- Log on as a service
- RWX on the Link installation path - C:\Program Files\Butterfly Link\AntiVirus Considerations
- There should be no need to make exclusions for antivirus software.
- Firewall or Proxy
- The Butterfly Link service makes an outbound connection to Butterfly Cloud, there should be no need to adjust firewall rules, however, this may differ based on your specific network configuration.
- Butterfly Link software should be set up with an exemption for proxy; the reason for this is that we use certificate pinning to ensure encrypted end-to-end connectivity without possibility of intermediate decryption by a proxy.
- Ensure that Butterfly Link can communicate via HTTPS with hosts in the following DNS subdomain:
- *.cloud.butterflynetwork.com
- Your organization is responsible for ensuring that the anti-virus or application firewalls do not impact the ability of the Butterfly Link to function correctly. either by disrupting in-place networking or the Butterfly Link processes. Butterfly Implementation Teams will make best efforts to attempt to determine which processes may be impacting the server but cannot ultimately know the entirety of the underlying infrastructure which is deployed into your network.
Butterfly Link with DICOM Router Hosting Server Requirements
Since Butterfly Link with DICOM Router provides on-router storage of studies between ultrasound machines and the Butterfly Cloud, you should provide on-server-storage of studies to meet your data throughput requirements. Butterfly has provided some guidelines for compute, memory and storage based on some throughput profiles. The consequence for insufficient compute, memory or storage on the Butterfly Link server will be studies remaining on connected ultrasound machine queues as the Butterfly Link processes existing studies. As such, you should test the capacity of the Butterfly Links and plan accordingly.
Minimum Requirements
- vCPU - 6 cores
- Memory - 16 GB RAM
- Disk - 32 GB, assuming ~15 exams per hour
- .NET Framework 4.7.1 must be installed on the system
Medium Requirements
- vCPU - 12 cores
- Memory - 32 GB RAM
- Disk - 125 GB, assuming less than 40 exams per hour
- .NET Framework 4.7.1 must be installed on the system
High-end Requirements
- vCPU - 16 cores
- Memory - 64 GB RAM
- Disk - 250 GB, assuming more than 40 exams per hour
- .NET Framework 4.7.1 must be installed on the system
Recommended Configuration
Service Account:
- Use a Domain Managed or Local Service Account.
- Account should be a member of the Users group with the following permissions:
- Log on as a service
- RWX on the Link installation path - C:\Program Files\Butterfly Link\
- Administrator (local or domain) level permissions are not recommended to run the Butterfly Link service.
AntiVirus, Firewall and Proxy Considerations::
- There should be no need to make exclusions for antivirus software - as per current testing.
- You are responsible for ensuring that the antivirus software does not stop the Butterfly-provided Windows Services or quarantine/delete/manage permissions of any files stored on the disk.The Butterfly Link service makes an outbound connection to the Butterfly Cloud, there should be no need to adjust firewall rules, however, this may differ based on your specific network configuration.
- Butterfly Link software should be setup with an exemption for proxy; the reason for this is that we use certificate pinning to ensure encrypted end-to-end connectivity without possibility of intermediate decryption by a proxy.
- Ensure that Butterfly Link can communicate via HTTPS with the following subdomain and IP address range. The DICOM Router and the Butterfly Link utilize separate whitelisting mechanisms for their communication to the internet:
- *.cloud.butterflynetwork.com
- 198.102.255.0/24 and 209.163.96.0/23
- Your organization is responsible for ensuring that the anti-virus or application firewalls do not impact the ability of the Butterfly Link to function correctly. either by disrupting in-place networking or the Butterfly Link processes. Butterfly Implementation Teams will make best efforts to attempt to determine which processes may be impacting the server but cannot ultimately know the entirety of the underlying infrastructure which is deployed into your network.
Installation Instructions
Get the software
- Log-in to Butterfly Cloud (cloud.butterflynetwork.com or yourdomain.butterflynetwork.com) using your Browser. Ensure that your user role in Butterfly Cloud is that of Enterprise Administrator. This is only available if your licensing tier qualifies for Butterfly Link usage. Please contact Butterfly Support if you are unsure if your software tier includes the Butterfly Link.
- Navigate to the Connections menu by clicking your username in the upper right of the window and selecting Enterprise Settings.
- Navigate to the Connectivity section and click the ‘+ Add’ option in the Connections section; then select ‘Butterfly Link’ to create a new Butterfly Link connection.
- Download the Butterfly Link installer to your hosting Windows computer.
- Ensure that you copy the secret installation key - it will be needed for the software installation.
- Give the Butterfly Link connection a friendly name. Click ‘Save Butterfly Link’.
- You should see confirmation of your Butterfly Link connection.
- If you need to change the name or remove the Butterfly Link connection, select the Edit option.
Install the Software
- Run the ‘butterfly-link-installer.exe’ file that you downloaded from Butterfly Cloud.
- Input the Secret Key that was provided during the Butterfly Link Connection creation step. Click ‘Install’.
- Note: Currently integrations cannot be edited, so if the Secret Key is misplaced, the integration would need to be totally rebuilt. Save the Secret Key in an appropriate location for future use/troubleshooting.
- The installation path is - C:\Program Files\Butterfly Link\
- Close the Installation window upon completion.
Verify Butterfly Link Service
- Run the Windows Services Management application.
- Locate the Butterfly Link service and verify that its status is ‘Running’.
- You may edit the Log on As account as needed - see Recommended Configuration in this Guide.
Integration Configuration
You are now able to create the appropriate DICOM or HL7 integrations to your internal systems by associating them with the newly established Butterfly Link connection. Multiple DICOM or HL7 integrations can be associated with the same Butterfly Link connection and use the connection simultaneously.
DICOM: PACS/VNA or Modality Worklist Integrations
- The Integrations menu is located on the Connections tab, immediately below the Connections section.
- Click the ‘+ Add’ option next to Integrations and select PACS/VNA or MWL to create a new DICOM Storage or Modality Worklist connection.
- Enter a friendly name for the DICOM end-point that you are adding. For the Connection Type - select the previously created Butterfly Link Connection.
- A DICOM configuration screen will display after you have selected the Connection Type.
- Proceed to enter all of the necessary DICOM connection parameters.
- Note that the IP address must correspond to the DICOM end-point that is accessible from the computer hosting the Butterfly Link software.
- If Hostname is used then it must be resolvable by the computer hosting Butterfly Link. Click Save when complete.
Sample DICOM PACS/VNA/Worklist configuration screens.
Note
- If your PACS/VNA is not operating in promiscuous mode, then you will need to add the Butterfly Cloud AE title as an approved DICOM source.
- Please be aware that the PACS will see the IP of the server hosting Butterfly Link as the source of DICOM data from Butterfly Cloud.
HL7: EHR Integrations
- The Integrations menu is located on the Connections tab, immediately below the Connections section.
- Click the ‘+ Add’ option next to Integrations and select EHR to create a new HL7 connection.
- Enter a friendly name for the HL7 end-point that you are adding. For the Connection Type - select the previously created Butterfly Link Connection.
- An HL7 destination configuration screen will display after you have selected the Connection Type.
- Proceed to enter all of the necessary HL7 connection parameters.
- Note that the IP address must correspond to the HL7 end-point that is accessible from the computer hosting the Butterfly Link software.
- If Hostname is used then it must be resolvable by the computer hosting Butterfly Link. Click Save when complete.
Sample HL7 Destination configuration screen.
DICOM Connection Verification and Automatic Forwarding
Verify the Connection from Butterfly Cloud
- Then navigate to the Integrations section located under the Connectivity tab, immediately below the Connection section.
- Click the ‘...’ next to a DICOM connection. Select the Echo option to perform a DICOM C-ECHO from Butterfly Cloud.
- Verify that the output is similar to below.
- You have set up a secure connection to your DICOM destination. You may now send image data or query Modality Worklist.
(Optional) - Automatic Forwarding to DICOM Storage
- To automatically send any studies saved to a Butterfly Cloud folder to your DICOM end-point, you can associate it with an Archive.
- Select the Archive folder that you would like to associate with the DICOM connection. Select Archive Settings.
- Choose the DICOM Storage location to associate with the Archive folder.
- Now any study saved to this folder (using the Butterfly iQ App) will automatically forward to the chosen DICOM destination.
