Business Analysis & Process Re-design
For a client in New England, HLN examined all functions of the Immunization Program and determined how to consolidate and streamline its data management activities might be to improve the efficiency of the organization. Recommended system modifications were integrated into the work plan of HLN's existing contract for development and support of the integrated child health system in the state.
HLN spent a year working closely with a major West Coast city health department to understand and document the data management requirements of its bio-terrorism response plan. Building upon an existing software development contract for bio-terrorism preparedness, HLN developed an extensive set of use cases, process flow diagrams, business rule documentation, and architectural designs for the plan's data management needs. HLN used a specialized requirements management product, DOORS by Telelogic, to create an extensible repository of requirements and business rule data to serve the project in later phases.
For a Northwestern state, HLN completed a detailed roadmap of the data exchange and information processing steps carried out by its staff in the maintenance and support of their childhood immunization registry system. This analysis focused on the data file inputs and outputs of the system. HLN documented and evaluated the current processes after reviewing available documentation (more than 180 documents, including management reports, record layouts, database schematics, e-mail correspondence, UNIX shell programs, and SQL scripts) and conducting on-site interviews. Very little formal documentation existed aside from the actual program and batch file code. Recommendations for improvement were subsequently integrated into the agencies operations practices.
Needs Assessment & System Reviews
HLN was engaged by a Northwestern state to review all aspects of its existing childhood immunization registry. The focus was on the suitability of the system's technical architecture, the state's readiness for continuing a web deployment it had initiated, and the needs of the health department which has just recently become responsible for the state-wide project. HLN conducted several on-site fact-finding visits and completed a detailed needs assessment, a strategic options matrix, and a detailed review of four leading off-the-shelf registry products. HLN also made recommendations on changes in policy and marketing tactics that would be required for a successful continuation of the registry rollout. HLN collaborated with the state's marketing consultants, conducted focus groups, and performed a "mini" survey of providers that helped inform their marketing plan. Ultimately, this state acquired the study's top-rated off-the-shelf product.
HLN developed a strategic plan for a childhood immunization registry for a Southern state that never had one before. Through intensive engagement with a wide variety of stakeholders (state officials, professional societies, providers, health plans, schools, insurance companies, hospitals), HLN developed a needs assessment to define exactly what registry features were required. HLN then proceeded to evaluate alternatives to best meet those needs and make recommendations to the State. Stakeholders were engaged through focus groups, individual and small-group interviews, a survey (web-based and paper-based), and presentations at various meetings and functions. Based on the recommendations, HLN developed an implementation plan and provided an interactive cost model for the registry. This state is now moving ahead with its registry deployment.
Software Design & Development
For several years HLN provided software development and maintenance services for the immunization registry used by a major Western state. This software, implemented with Microsoft tools and SQL Server, is still used by six regionalized registries deployed in clusters of neighboring counties. Software was provided for distribution on a password-protected website, and a version of this software is now being modified for deployment in a major mid-Atlantic city.
HLN took a leadership role in a three-vendor project to integrate the childhood immunization and lead poisoning prevention systems in a major Northeastern municipal health department. HLN worked with the executive sponsors to develop the initial conceptualization of the system, and not only developed the Oracle-based master client index but modified products across a wide variety of architectures (including client/server, web, and batch) to interface with this system. HLN now supports the operation of the new system as well as ongoing development of its products.
HLN worked with a top school of dental medicine to develop and pilot a remote dental consultation application. This Java/Oracle-based tele-health system supports asynchronous consultation between dental generalists and specialists across the Internet. Participants are triggered by e-mail messages when they have a pending case to review, or when other participants update case information or render treatment opinions. Case profiles based on specific dental specialties show the participant only the most relevant patient information. This work was funded by the National Library of Medicine.
HLN worked closely with a not-for-profit maternal and child health services agency scattered across a dozen work sites to determine the functional requirements to replace its aging case management software. The new client-server system employed Oracle database technology deployed on a Windows platform with the Internet as its wide area network. HLN analyzed the existing data and performed the conversion of the old databases to the new system and conducted post-conversion quality assurance activities. A year later, HLN was asked to study the system again and convert the entire application to a web-based version with screens matching newly designed paper data collection forms that had been instituted by the organization, with enhanced functionality tracking many new types of information. This version was completely re-written as a Java Servlet application running under Linux with an upgraded Oracle database.
HLN was contracted by a not-for-profit collaborative to develop software for a personal digital assistant (PDA) which interacts with an immunization registry. HLN led a collaborative design team for this project that consisted of technical and program representatives from six state and municipal projects. The result was a product general enough, with clearly-defined interfaces, to be able to accommodate this diverse set of registry products and serves as both an alternative data entry tool as well as a clinical decision support application. In addition to a PalmOS-based PDA component, the software includes a desktop-based "conduit" which interacts with an XML-based web service to facilitate electronic data upload from the PDA to the registry using HL7 messages.
Specialized Healthcare Applications
A major not-for-profit health plan in Southern California was considering developing and deploying a web-based pediatric tracking system for the providers in its network. HLN developed a survey focusing not only on the providers' desire to have certain features, functions, and pediatric information available online, but also their technical readiness to access a web-based application. This survey required extensive knowledge of not only issues in pediatric health, but also background on the local healthcare landscape, and technology and office practice issues as they relate to the private provider setting. HLN completed the survey - along with extensive follow-up to ensure as close to full response as possible - and provided results and analysis sufficient for the health plan to move ahead with their project.
HLN was contracted by a major Northeastern municipal health department to assist in the planning of its Health Alert Network (HAN), a CDC-inspired rapid notification and training system to prepare the healthcare community to react in the event of an emergency. HLN consultants conducted extensive research, led meetings and focus groups, conducted research, and developed materials that ultimately produced a final report of observations and recommendations. HLN assisted the department in writing and evaluating an RFP for the system's acquisition and deployment and, once a contract was awarded, HLN provided guidance and oversight during the implementation of the system.
HLN conducted a technology assessment for the newborn hearing assessment program in a New England state which wanted its antiquated MS-DOS-based patient tracking, follow-up, and reporting system analyzed against a set of modern technical and functional standards. HLN recommended the replacement of the system and completed its redevelopment with screens and workflow reminiscent of the original application but customized based on the client's requirements and brought up to current technology standards.
HLN designed, developed, tested, and deployed a smallpox pre-event system for a major Northeastern municipal health department, as well as provided critical operations support during its hurried deployment. The challenge of this project was to provide a CDC-compliant tracking system for the immunization of quick-response teams in hospitals and health centers capable of handling a smallpox exposure should it occur. The system that was developed needed to manage integration with input files from an external data entry vendor; assistance in developing an alternative data entry form to the one promulgated initially by the CDC; configuring and supporting the two host platforms themselves (Linux/Oracle); and creation of a mirrored database to support data query distinct from the operational database. HLN staff also participated fully in several CDC-sponsored national forums for discussing and developing this system.
HLN was contracted by a not-for-profit foundation in a Southwestern state to evaluate a healthcare data integration project its board had been funding for several years. The objective of the study was to understand from key stakeholders how the project met their needs, or how it might better meet their needs in the future. As a project that developed outside of the frame of the National Health Information Network (NHIN), HLN also assessed how new activities might enlarge the project's appeal and relevance in the national health system integration arena.
System Planning & Operations
Over a number of years, HLN migrated a major public health system for a large municipal health department first from HP-UX to IBM-AIX, and then to Linux, as the agency's hardware standards changed. Along with this migration came several changes to the network infrastructure which required careful cooperation with both the agency's network engineering and operations staff and the municipal IT organization as well. The migration to Linux significantly reduced the cost of ownership for this system and increased system performance several fold.
HLN developed a detailed system architecture for a major Western municipal health department as part of its support for bio-terrorism preparedness. A sophisticated set of options was required to account for a variety of scenarios possible during emergency conditions. Information security and high availability were key objectives met by the recommendations.