Web Clinical Information System
Our customer is a major medical organization that serves a vast territory. Nearly a half million people use its services each year.
A widely used Clinical Information System (CIS) was developed in the early 1990's based on the fourth generation programming language known as EASEL. This language rapidly became untenable because of its failure to move beyond the 16–bit architecture for which it was originally developed. The Web Clinical Information System (WebCIS) was designed to:
- Rebuild and enhance the CIS system with up–to–date development tools to lower the maintenance cost, and provide an updated look and feel to the user interface (UI).
- Improve system reliability(24/7/365)
- Move to S/390
- Use a commercial application server
- Improve system migration paths
- Recast application in viable languages
- Decouple the application code from the CDR structure via SPs
- Decouple security services via LDAP/RACF/PKI
- Use Component–oriented technology
- Adopt Industry standards internally and in vendor selection (HL–7,XML,HTTP,TCP/IP)
- Reduce IT resource requirements
- Eliminate client software deployment
- Reuse developed components or integrate COTS components
- Automate monitoring of application services
- Maintain performance (2–sec response)
- Eliminate dynamic SQL through stored procedures
- Selective persistence of data at the Application Server Tier
- Patient demographics
- Primary care provider
- Advanced directives
- Last/next encounter
- Cardiac graphics
- GI procedures
- Referring physician lookup
- Discharge summaries
- H&P and OP notes
- Inpatient progress notes
- Outpatient clinic notes
- Problem lists
- Schedules/Census/Rounds reports
- Personal/Group patient lists
- Electronic signature
IBA implemented the project in close cooperation with the customer. IBA responsibilities included requirement analysis; application design; application construction; unit, functional and system testing; quality assurance; and warranty support. The IBA team was comprised of a Project Manager / Architect, Java Developers and a Tester.
The system is built using a framework that was developed specifically for this project. This framework includes the following key features:
- Security (authentication and authorization). WebCIS uses a single security system based on the LDAP server.
- Permanent session. This mechanism allows the user to exit the WebCIS application and then (after the next WebCIS login) resume the work returning to the same application state.
- Application history. Application history is a special behavior that allows accomplishing the following tasks: emulate a multi–window interface in one browser instance (allowing to save the current state of application workflows and navigate between different workflows); allow a program return to the previous states of a current workflow (using a stack of previous states); and solve the “back button problem” (using a stack of previous session states).
- Presentation. Presentation layer provides support of different browsers and screen resolutions, session expiration notification, unifies the view and behavior of HTML tables and table–related links and forms for the entire application.
The development was done in the IBA offshore development center with short on–site workshops in the United States.
The customer received a high quality application that incorporated the latest technologies. The new solution provides enhanced functionality and supports:
- 100K Clinical Transactions/Day
- 1.2+ Million Patient Records Online
- 600K+ Patient Visits/Year
- 5500 WebCIS Users
- 4500 Clinical Workstations
The customer was able to reduce development costs while maintaining high quality. All deliverables were completed on schedule and exceeded quality requirements specified by the customer.
The client complimented the IBA team for their “outstanding support, teamwork and world class service”, adding that their “dedication and commitment were instrumental in ensuring the completion of a successful production”. In conclusion, the client said: “Thank you for your efforts and for representing our company so well”.