Overview
Exigence implemented a web-based, HIPAA-compliant front-end to the HKS OTTR patient information management system.
Note
This project took place before Exigence was incorporated. However, it included both of Exigence’s co-founders as project co-leads, and it’s success led to the formation of Exigence with the idea “that was fun, let’s do this some more”.
So, when we say “Exigence” in this case study, we really mean “the co-founders of Exigence”.
Problem
HKS provides its OTTR (Organ Transplant Tracking Record) software to over 30 transplant centers, serving over 180,000 patients around the world.
OTTR works well in hospitals as it uses:
- A Windows-based desktop rich client (increased productivity over thin-client solutions)
- Both Microsoft SQL Server and Oracle backends to integrate with existing IT infrastructure
However, HKS needed a web solution to complement their traditional desktop-based approach as:
- Doctors wanted to check patient information remotely in critical situations (e.g. when a transplant organ has become available and decisions need to be made immediately)
- Competing web solutions were disrupting HKS’s new sales process
HKS attempted to develop a web solution in-house, but had minimal success as their programmers were:
- Top-notch desktop Objective C programmers but new to web technologies
- Busy supporting existing products
Solution
HKS turned to Exigence to jumpstart their web solution due to:
- Lower risk—the Exigence co-founders have years of experience with web technologies
- Lower cost—HKS could avoid hiring a full-time staff just to develop a prototype concept
Exigence put together a team of 4 developers, 1 designer and over a 3-month period spearheaded several managerial and technical issues.
An Agile Approach
Given the short timeframe, Exigence proposed it would be more efficient to develop the requirements as the project progressed rather than take a large chunk of time up-front to figure out exactly what HKS needed
Weekly demo meetings were held with project stakeholders to gather feedback on features, allowing very quick feedback and turnaround to feature requests and changes as HKS got to see exactly what they were getting within 2 weeks of project start.
A J2EE-based Solution
- Exigence determined the transactional nature of EJBs involved too much unneeded overhead, but that the standards of J2EE provided a good long-term solution
- Exigence also re-used many existing open source infrastructure components to save HKS time and money implementing them on their own (for example, Exigence selected Hibernate as an off-the-shelf data layer, where as HKS’s Objective C desktop client had a custom data layer with 20,000+ lines of code).
HIPAA-compliance
Exigence used state-of-the-art Aspect Oriented Programming (AOP) technology to ensure that anytime patient information was used on a webpage, the current user of the web application had explicit permission to view that patient’s data.
Complex database schema
The OTTR database schema has evolved during 10+ years of active use to serve many different needs.
Exigence successfully learned the pertinent aspects of the schema and used a data layer to hide many of the schema and vendor-specific SQL complexities.
Results
After 3 months, Exigence successfully delivered a solution that provided read-only access to both Microsoft SQL Server and Oracle OTTR installations.
HKS was very pleased with the end-to-end functionality demonstrated by the Exigence prototyping effort and moved to make it part of their long-term portfolio by:
- Hiring Exigence on a small follow-up project to add some essential features such as licensing
- Bringing one of the Exigence team members in-house to provide long-term support for the codebase
- Adopting some of the Agile managerial techniques introduced by Exigence for their own in-house QA team
Statistics
- 30,000 LOC
- 4 Developers, 1 Designer
- 83 LOC/day
Take Aways
- We work well on new technology projects, introducing new technology and methodology best-practices into existing IT environments