Project Title: An outpatient hospital management system: Migration to the J2EE platform and enhancement of functionality

The Challenge

Artezio participated in a large-scale project of helping 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.

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 located all over the country, sometimes hundreds of miles apart.

This project involved development of a system for handling electronic medical records and scheduling appointments for a framework of outpatient hospitals and clinics to allow convenient 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.

The Solution

Artezio started off 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, Artezio 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 Database 10g. 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 Artezio.

Among end user priorities, emphasis was made on convenient entry and update of patient data. For improved data consistency, 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. Artezio utilized JasperReports, a powerful open source Java reporting tool, to produce reports in a variety of formats, including HTML, Microsoft Excel, and PDF. The system was expected to generate dozens of kinds of reports.

By design, instances of the outpatient management system, each with its own database, were expected to be installed in multiple locations, so concurrent update of the databases was an important issue. According to customer requirements, synchronization had to occur via file exchange, rather

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