Scalable Web and Mobile Solution for Healthcare Software Provider

Scalable Web and Mobile Solution for Healthcare Software Provider

The Client Overview Our client is a leading healthcare software vendor, providing solutions catering to a niche area of radiology diagnostics, comprising analysis of non-invasive imaging studies like X-ray, MRI, Ultrasound, etc. Our client provides end-to-end web based solutions to improve returns on imaging for mobile diagnostic services, hospitals and imaging centers. Additionally our client also provides high performance software products for digital medical imaging, providing users with a rich visual experience. Our client s healthcare solutions cater to more than one third of major diagnostic centers, hospitals, nursing homes across USA and Europe. Business situation Our client s earlier solution, a web based application, catered to only one component of the process of tele-radiology i.e. image diagnosis. However the entire tele-radiology process is quite complex, wherein various medical images (X-Ray, Ultrasound, CT scan, MRI and echocardiogram) are diagnosed by the doctors and the results are created in the form of printed reports. This existing web application was used by doctors and clients to create these radiology reports. Since there are multiple entities involved in the entire process starting from nursing homes, diagnostics centers, radiology technicians and patients, the earlier manual process used to get very unwieldy. Our client s aim was to build a solution that would incorporate the entire tele-radiology cycle right from processing the request for taking the image to report generation, which is used by the hospitals and diagnostic centers. Our client wanted a request generation system which can be used by hospitals/nursing homes to generate the requisition for diagnostic center for taking images. This requisition would be finally executed by the radiology technicians. Another requirement was to build an image display and diagnosis recording tool which will be used by the physician. An important aspect of the tele-radiology cycle is to schedule and track the visits of the radiology technicians. These technicians visit hospitals for performing tasks related to review of medical images and diagnostic studies of patients. Since these visits are time critical, a mechanism was required for scheduling visits of these radiology technicians including estimating workforce requirements, checking the availability, assigning and tracking the visits.

Report generation being a key feature of the application, our client wanted to provide the teleradiology reports in different file formats such as html, xls, doc and pdf. Also since each diagnostic center has different reporting formats it necessitated a report generation functionality wherein every diagnostic center could customize the reports according to their requirements. Also in keeping with the upcoming technology trends and to facilitate all stakeholders to stay connected on the go, our client wanted to port the application on the ipad. The ipad application was required to provide a similar user experience as the web application without compromising on the quality of the medical images. Application Flow Nursing Home Nursing Home Requests Dispatch Centre for taking images Dispatch Centre Request scheduled for Radio Tech Confirmed Report Images sent to Dispatch Centre for Verification Radiology Tech Radiologist Report saved & converted as transcribed case Radiologist views the images in xviewnet(client application install on local machine of radiologist) and records his dictation about the case using voice recording tool Transcriptionist Transcriptionists hear the dictation recorded by radiologist and type the report Report converted to a Transcribed case

Business requirements and Challenges Some of the key business challenges faced were: Re-architecting old thin client application, as it was utilizing huge amount of server resources. Ensuring the solution is scalable and can incorporate additional and new features with minimal code changes. Providing a collaborative platform within the solution to enable real time communication among the users of the application. Enabling application users like radiologists and diagnostic centers to obtain a quick summary and status of all open diagnosis requests. Providing a mechanism to enable scheduling and tracking of the visiting technicians. Enabling every diagnostic center to define their reporting formats and providing them with options to generate and print reports in multiple file formats like doc, pdf and xls. Compliance with FDA rules and regulations since the end users of the solution were hospitals and diagnostic centers Developing on-the-go mobile application on new platform ipad while maintaining the look and feel and the user experience similar to the web. Xoriant Solution Xoriant team was involved in complete SDLC process of the web application which included requirement gathering from the client, designing the database and the application UI, developing and testing the functionality and deploying it to production. The team also provided technical support, which involved providing changes/updates on live production system. During project initiation an engagement roadmap plan was charted to define the timelines and deliverables, which was shared and duly approved by the client. Since the application was developed for the users in the diagnostics centers, medical clinics, imaging centers and hospitals, Xoriant team studied and ensured that the application was developed in conformance to the regulations laid by the FDA. A compliance checklist was created which was strictly adhered to while developing the application. Xoriant team designed and defined a request processing system used by both nursing homes and diagnostic centers. Nursing homes use this system to send requests for performing X-ray

and Ultrasound exams on their patients. Each request can also be assigned a priority level depending on the urgency. These requests from multiple nursing homes are added to the request queue of the diagnostic center. The Diagnostic Center analyzes and schedules these requests as per their priority and sends a confirmatory message back to the nursing homes. These scheduled requests are then assigned to different technicians depending on the criticality, location of the visit, technician availability, etc. Scheduling feature was also built in the application to allow diagnostic center to schedule the visits of their technicians/physicians efficiently. The application uses the physician database to provide a list of technicians and their suggested visits as per their location. The application also takes the hospital addresses as an input and then uses Google Maps and Google Earth API to define the best possible route for these visits. After every visit the status is updated in real time and the time is auto logged. This enables diagnostic center to schedule the visits of the technicians optimally and track their status in real-time. Any delays are flagged and the application re-schedules / re-assigns the visits accordingly depending on the proximity of the visiting locations. Xoriant team developed and incorporated a display and analysis tool for the interpretation of medical images within the application. This tool supports the DICOM standards for images, and transfers them over internet using JPEG2000 compression. Xoriant team also created web-services to communicate and retrieve patient data, upload the technicians/radiologists diagnosis and annotation to the application. This tool also provides a voice recording mechanism to enable the radiologists to record the diagnosis of medical images which is then made available for transcription. For the reporting functionality, we developed a template designing tool by which the users can design their own templates for generating reports in html format. While generating the reports in pdf formats; ColorPilot and DynamicPDF APIs were used for designing new pdf reports; whereas DynamicPDF APIs were used to edit and update existing pdf documents. These reports were also made available to the user in different file formats of html, doc and xls. Mobile experts from Xoriant s Mobile Center of Excellence re-architected the web solution for porting it on ipad. For developing the ipad application, we used the proprietary framework Xoriant Enterprise Mobile Platform (XEMP) which provides framework components to significantly accelerate mobilizing existing enterprise applications. Employing this framework resulted in rapid application development and ensured short release cycles. The UI team made relevant changes in the application screens to provide a rich user experience while maintaining the quality of the medical images which is an important aspect of the application.

INPUT PROCESSES INPUT X-Ray Request Nursing Home Web Application Scheduler Scheduler Upload X-Ray Request Fax Fax File Imaging Radiologist Image Files Search in Folder Create Case View Case Save in db & PDF VoiceRecord Case Case Transcript Conceptual Diagram Tools and Technology Microsoft IIS 5.0 and ASP 3.0 HTML, DHTM and JavaScript JQuery AJAX, JSON Database: MS SQL 2000 Google Map APIs, Google Earth APIs Visual Studio for development Parasoft Insure++: C/C++ Runtime Analysis, Error Detection Tool for testing. Xoriant s key contributions Some of the key contributions in this assignment were: Xoriant team initially analyzed the existing application to re-architect it to a thick client application. Client side technologies like AJAX, JQuery, JSON & Javascript were used to ensure optimal usage of server resources. Newer functionality was designed and developed in terms of modular and standalone entities that can be easily integrated within the solution. Developed a collaborative platform that included, a live chat application using AJAX and

web services for user communication. SMS functionality was also built in this application wherein a user can send SMS to another user using this application. SMS / Chat messages were logged in SQL database to enable users to retrieve history for future reference. Designed a dashboard with multiple IFrames with each IFrame indicating a different activity, thereby providing a consolidated view of different user activities. IFrame data is refreshed at an interval of every two minutes to provide the end user real time information in rich user interface. Used 3rd party APIs, DynamicPDF and ColorPilot to design new PDF reports and predefine report templates specific for every end customer. DynamicPDF was used to extract sections of content from other pdf reports, edit the existing pdf documents without modifying the overall format of the report. Used Google map and Google earth APIs to obtain attributes of travel time, distance between locations, etc from the addresses fed into the application. Delays in reaching target destination by the technician were flagged in the system which enabled tracking and scheduling technician visits in real time. Developed special test cases to validate compliance with the numerous FDA guidelines as applicable to the application. Xoriant s proprietary framework Xoriant Enterprise Mobile Platform was used to enable rapid development of the application for the ipad device. AJAX calls, Javascript objects and CSS were modified to make it compatible with IE and Safari browsers in ipad and to provide a rich user experience. Client Benefits Project execution comprising a blend of onsite and offshore resources enabled our client team to meet aggressive weekly release targets with more the 10 releases done in each quarter. Aggressive releases resulted in shorter time to market thereby giving our client a first mover advantage over competition. Our client registered 30% growth in its customer base in the first year of launching the solution. Xoriant Mobile Center of Excellence enabled client to develop solution and leverage upcoming technology applications like ipad thereby increasing its target customer base Quick deployment on ipad resulted in capturing a wider customer base and increase customer satisfaction because of it s on the go accessibility.

Client Testimonial While this project had its share of challenges, Xoriant team as a whole has done a highly commendable job in designing and developing this critical healthcare application. I am extremely delighted to work with this team. They are not only great individual contributors but work very well as a team. Their commitment to the product is extraordinary. Although the medical process are quite complex in nature, team has done a wonderful job to understand and implement it as a software application. Their timely deliveries have enabled us to launch the product successfully and well ahead of the competition. -- CEO & Owner