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Experience >> Electronic medical records
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Electronic medical records |
Project 1: Electronic Medical Records, or EMR, as part of a medical practice management software, developed with Caché
Client:
AMSPlus is a provider of electronic medical billing and medical practice management software. For over 20 years AMS had been supplying hospitals and other large medical service providers with advanced solutions for continual improvement of the revenue cycle, as well as reducing business risks by integrating all aspects of the billing into a single, seamless service. The technology is used by the 10 largest hospitals in the US.
Take over maintenance and refactoring of a troubled project - building a multi-functional Practice Management System (PMS). It presents a complex of workflow optimization units such as Electronic Medical Records (EMR) and billing management.
Drawbacks included:
- started by another offshore developer in 2003;
- project was far behind agreed-upon deadlines;
- plagued by poor architecture;
- contained multiple bugs; and
- many incomplete features.
Special challenge:
Initial request was for on-site development assistance at AMS' US development center; however, due to visa difficulties AMS decided to utilize the resources available at our development centers, so the project team was established at our location.
Technical approach:
Facilitate the creation of a totally secure EMR and billing modules that would
- access patient records electronically from any PC,
- integrate seamlessly with the MAS, and
- integrate it into the next-generation PMS.
Technology: Intersystems' Caché, CSP, Java Script.
Solution (in process):
Maintenance and refactoring of PMS, of which EMR is a constituent part.
Benefits:
Practice Management System
- helps doctors and medical officers optimize workflow;
- tracks appointments with medical staff and equipment usage;
- stores and easily accesses electronic medical records; and
- manages most medical accounting problems and medical billing.
Project 2: Electronic Medical Records as part of a Complete electronic medical office, developed with Access and Microsoft SQL Server database
Client:
Project:
Corrections, enhancements and upgrades to The Digital Office program (TDO)
Overview:
DogBreath Software Inc. is a leading developer of software for endodontists to collect and analyze data that would address all aspects of endodontic practice, including treatment and financial management, scheduling and clinical trial participation.
Drawbacks included:
Version 1.01 of TDO was created in 1998 by various DogBreath consultants using MS Access, resulting in a system that was unstable and subject to multiple problems, including:
- the initial database structure was not normalized so some data was doubled;
- instead of keys, the values themselves were used for linking data;
- various data types weren't stored in their corresponding field types, etc.;
- many functions, such as image processing, file operations, and direct interaction with equipment (e.g., cameras and scanners) either were inefficient or didn't exist.
As a result of poor architecture and innumerable bugs, the TDO failed to capture its market; a 2001 effort to remedy the problems was unsuccessful.
Financial constraint, solution and process:
When TDO was first conceived, DogBreath started by hiring an architect from the original MS Access team. However, they soon realized that the project required a larger development team, the cost of which was prohibitive for a small company. After researching various alternatives, DogBreath decided to explore a relatively new idea: transformational outsourcing.
- They started the process by posting an RFP to which they received response from 40 offshore companies, including NTR.
- Their second step was to interview the applicants, eliminating half of them.
- Next they arranged programming tests for the remainder.
- We scored highest in the testing, but DogBreath was cautious and didn't want all their eggs in one basket.
- They decided to utilize us along with three other offshore companies for the TDO project.
- Initially, we assigned two of our top developers to work together with the system architect.
- Very quickly it became apparent that two of other companies were more introducing new problems into the code, rather then fixing the old ones, and they were terminated.
- 12 months and a new release made it obvious that our performance and the other company's differed significantly on issues of quality and reliability and the second company was demoted to testing.
- DogBreath decided to engage additional NTR staff to work on their ecommerce site (eie2.com) and other internal projects.
Special challenges:
- TDO had to be developed in compliance with the American Dental Association (ADA) requirements regarding insurance and medical history forms;
- data transfer had to match the format accepted by insurance companies; and
- it was necessary to provide interaction with a wide range of diagnostic equipment.
Technical approach:
- create a process to fix bugs and react to the users' needs;
- create an intuitive user interface; and
- port Access-based system to MS SQL backend.
Technology: Access VBA, MS SQL Server
Solution:
The new TDO is Windows-based software that runs on Access and Microsoft SQL Server database. Using SQL Server enhanced the reliability of data storage and facilitated additional functions, such as data replication for remote divisions. Some of the functions were relocated to ActiveX controls which allowed us to partially hide the code and improve overall performance. The following modules were rendered in ActiveX:
- modules associated with passwords and security
Benefits:
TDO is a sophisticated custom software program comprised of several modules that seamlessly integrate the following into an easy-to-install, user-friendly program:
- financial and clinical data,
- digital and scanned radiographs, and
- photographic and video images.
Additional features:
- All the clinical x-rays, still and video images, patients chart and diagnostic data, referral communications, e-mails and phone calls received/sent, are saved and accessed intuitively from TDO;
- possibility of communication with patients (through the case presentation and education modules), with referring doctors (through the custom reports and letter modules), with endodontic colleagues (through TDO chat, discussion groups), with insurance companies (through emails) and within the office (through the interoffice e-mail);
- a state-of-the-art library of digital images that cover all aspects of educational information necessary to educate the patient.
Results:
NTR has been referred to as DogBreath's "rescue team" because of its exceptional overall performance in fulfilling the requirements beyond expectations, and because the new version has captured over 20% of the specialized endodontic software market.
As of 2005 there were nearly 300 practicing endodontists in 17 different countries using TDO with integrated EMR.
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