Outpatient hospital management system Migration to J2EE and

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					Outpatient hospital management system: Migration to J2EE and
enhancement

Project goal                                  Technology profile
Migration of two modules of an outpatient     • J2EE platform
hospital management system to the J2EE        • Apache HTTP Server 1.3
platform and development of additional        • Apache Jakarta Tomcat
modules                                       • Apache Struts
Industry                                      • Hibernate
Healthcare                                    • Oracle 9i Database Enterprise Edition
Project Scope                                 • Oracle9i Application Server
80 man-months                                 • Microsoft Active Server Pages (ASP)
Duration                                      • Microsoft ActiveX controls and COM
18 months                                     • Microsoft SQL Server 2000
                                              • Microsoft Internet Explorer 5.5
                                              • Microsoft VBScript
                                              • DHTML


Background

A large share of LANIT International’s business comes from large Russian IT system integrators who
contract out software developments portions of large multi-faceted IT projects to best-of-breed outsourcing
providers that possess relevant technical expertise in required technologies and target specific vertical
markets. This project was a typical example of such an arrangement between LANIT International and a
leading system integrator that in turn had been hired by a large Russian federal government department to
automate and computerize its internal system of outpatient healthcare facilities intended primarily for active
and retired employees and their family. LANIT International won the contract because it was a recognized
leader in developing custom Web applications based on the J2EE platform and had a proven track record of
developing applications for the healthcare industry.

Challenge

Hospital automation is a daunting task, because Russian hospitals are often very large and diversified – a
legacy of the Soviet approach to healthcare. They employ thousands of physicians, specialty doctors,
nurses, pharmacists, lab assistants, technicians, and administrative support. Adding complexity to the
situation is the fact that facilities comprising a hospital hierarchy are geographically separated, sometimes
hundreds of miles apart.
This project involved development of an intranet system for handling electronic medical records and
histories of patients and scheduling appointments for a framework of outpatient hospitals and clinics to allow
on-line access to information for nearly four hundred medical doctors and therapists who handled
approximately half a million outpatient visits in 2003. The customer also expected the system to include
access management functionality which allows matching of the patient to a location where the service can
be conveniently and appropriately provided. The main organizational and technological focus for the
customer was the transition from paper based patient medical records to electronic medical records. The
other goal was to streamline medical appointment scheduling in order to remove inefficiencies and improve
personnel and patient experience.

Solution

The system integrator provided LANIT International with an existing solution that already supported many of
the features that the customer was interested in. The solution was based on Microsoft technology including
Microsoft Active Server Pages (ASP), Microsoft ActiveX controls, COM, VBScript, and Microsoft SQL Server
2000. Business logic was embedded in ASP and database stored procedures and triggers. During the first
phase of the project, LANIT International transitioned the entire solution to the J2EE platform and enhanced
it with few missing features. Java Server Pages (JSP) replaced the ASP code. The Microsoft SQL Server
database supporting the application (200+ tables) was migrated into an Oracle 9i database. For clearer
business logic, the Model –View- Controller architecture was employed with a presentation layer
implemented with JSP and JSTL technologies, a controller layer based upon Struts controller servlets and
actions, and a model layer relying on Hibernate -- an object/relational persistence and query service for
Java. All of these are open-source and free implementations of J2EE, thus helping to bring down software
license cost for the customer and LANIT International. Further, in the development environment, Apache
Jakarta Tomcat open source servlet container was used; however, in the testing and production
environments, Oracle 9i Application Server was the customer’s choice. Among end user priorities, emphasis
was made on convenient entry and update of patient data. For improved data consistency, thorough input
data validation was performed using client-side scripts, server-side checks, and database triggers. A
database of reference data was compiled to include a disease directory, a list of buildings, offices, a
physician and specialist directory, etc.

The system provided for flexible security policy regulating user access to data and functions for various
categories of users including doctors, nurses, patients, hospital support staff, and system administrators.
The system has an extensive audit trail capability where all changes to the database records were logged
and could be viewed by a user with a special privilege. An important customer requirement was to
implement extensive reporting. The system features dozens of reports that may be conveniently viewed and
printed from a pop-up Web browser window. Speaking of project management, LANIT International found it
useful for this project to engage elements of the extreme programming approach that included collective
code ownership, programmers working in pairs, iterative development, frequent communication with the
customer and emphasis on pervasive unit testing. Last, but not the least, a lot of effort was invested in
making the user interface easy to customize to enable non-programmer system administrators to adjust the
system’s look and let users with certain privileges access exactly those kinds of data they needed (which
may change from time to time) in order to minimize distraction and keep users focused on their task.

Results and further plans

After completing the migration phase, the system’s performance and functionality was tested internally by
the LANIT International testing department and then the system was deployed at a customer’s outpatient
hospital and a diagnostic center for acceptance testing. Currently LANIT International proceeds with
planning for the second phase of the project that sets a goal of adding more functional modules and creating
an integrated suite of solutions for the healthcare industry. New functionality includes automation of
inpatient and physical therapy facilities, financials, and medical personnel management. As a separate
development, LANIT International aims to make a customized solution for medical record management to
support regulatory requirements put forth in some countries, such as Health Insurance Portability and
Accountability Act of 1996 (U.S.) that suggests strict guidelines regarding the privacy and security of patient
records and information.