The Business Need
A Health Care Provider establishes and manages employer sponsored on-site clinics providing primary care health services to employees and their dependents. The Provider’s Management realized they needed a better Electronic Health Record (eHR) system because:
- The current vendor-provided eHR system’s cost increased as the number of managed records increased. This cost model was increasingly un-attractive as the Provider’s business grew. A less expensive approach was needed.
- The existing system was not HIPAA compliant (for example transmitted data was not always encrypted).
- The Provider’s Executives also new there was a major opportunity to differentiate their care clinics by tracking the overall health trends of the employees served. Demonstrating deceasing cost trends around health care offered was critically needed to empower employers to negotiate better overall rates with insurers. But the existing system did not capture the data needed to make such an analysis possible.
- The existing system was not well liked by users because of un-intuitive workflows and the need to enter too much text data.
Centric’s High-Impact Approach
Centric was engaged to define the new application’s software architecture, evaluate buy versus build alternatives, select packages, and design and build the new system.
The team realized early in the project that the envisioned application called for a modern Portal paradigm. Personalization based on worker roles was critical given that doctors, nurses, and administrators would make heavy use of the new system. The user interface for the system needed to be 100% browser based to deliver the application in a Software as a Service (SaaS) manner to newly-opened clinics. Finally, the rate of change in the medical industry is heavy with the need to support evolving data transfer standards (HL7), privacy regulations (HIPAA), and changing care protocols. Continual development of the new system would be a constant an open, modern, development environment and software architecture was a must.
Centric’s Software Architects selected three open-source applications to deliver the needed functionality. Liferay would provide the core portal infrastructure. Tolven’s application would provide the Electronic Health Record (eHR) functionality. Select processing of entered and imported patient data would be accomplished via the Drools rules engine. Portlet applications built on Liferay include single sign-on and security, patient profile creation, appointment scheduling and alerts, the exposure of various clinic services and healthcare resources, and system user alerts. Tolven’s eHR was also exposed / integrated within the Liferay portal. Developing interfaces to the providers of lab results data extended Tolven’s functionality.
As patient information is collected, the Drools rules engine is used to extract data into a health care trend data warehouse allowing for the analytics needed to demonstrate increasing employee health over time.
One of the great benefits of the new eHR system is the wizard driven patient information entry panels. These easy to complete screens allow medical staff to enter patient care data. The system also allows for easy update of these wizards when, for example, additional questions must be asked of a patient during a diagnostic procedure. XML documents describe the data that needs to be captured, as well as select data validation attributes. To update a wizard system administrators need only update the underlying XML document.
The cost of ownership of the new system is low, and is not depended on patient data entered or number of users.
The system is well liked by the users due to its consistent user interface and ease of data entry.
Finally, the eHR system’s underlying software architecture has provided the needed development environment to allow for efficient extension of the application as business needs mandate. Development efforts planned for future releases included deeper integration with lab results providers, additional rules creation allowing for better and more efficient care, and additional reports and analytics.