ClinicStation

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ClinicStation was developed by The University of Texas M.D. Anderson Cancer Center in response to internal needs for an EMR and several previous failed EMR deployments. It was developed by Kevin McEnery, M.D. and Charles Suitor as an expansion of a successful radiology PACS initiative [1]. It was first deployed as a web application in 1999 with about 30 clinical applications. It was rewritten as an n-tier service-oriented architecture (SOA) back-end coupled with a desktop application in 2007 and today has about 70 clinical applications [2]. The SOA enables ClinicStation to expose more than 40 different data sources (internally developed and commercial software) to clinicians within a single interface [3]. It also enables other M.D. Anderson applications to draw on ClinicStation data, such as the RadStation (for radiology), PathStation (for pathology), ResearchStation (for research) and ClinicStation Outbound (a web portal for patients and outside physicians). ClinicStation has scaled from around 1,500 users in its early stages to over 8,000 today.

In June, 2013, M.D. Anderson announced that clinicstation would be replaced by Epic Systems in 2016 .

History

The University of Texas M. D. Anderson Cancer Center (MDACC), a world-renowned cancer center, needed to get complete, up-to-date patient data to medical professionals in a useful and timely manner. Commercial electronic medical record (EMR) systems could not accommodate their complex workflows. Using Service-Oriented Architecture (SOA), Avanade helped MDACC build an EMR system that aggregates both clinical and research data from more than 40 disparate applications, providing physicians and nurses a complete, current view of the data associated with each patient. With the system’s flexibility, the center can allow departments to pursue whatever software applications best suit their needs, presenting the data from those applications in a single comprehensive tool. With its scalability, the center can grow in its ability to serve more patients and incorporate new types of data into each patient’s record. Most importantly, providing physicians with comprehensive EMRs has improved prod

Solution description

The University of Texas M.D. Anderson Cancer Center (MDACC) seeks to eliminate cancer through programs that integrate patient care, research, prevention and education. Patient data includes routine care, lab tests, radiology images and data derived from their participation in clinical and research protocols. As such, medical professionals’ productivity has been hampered by the effort required to find both physical records and particular pieces of data within a patient’s medical redcord. In 1999, MDA created ClinicStation to integrate the presentation of radiology images with clinical data stored in a variety of IT systems.

This innovative application ultimately became the cornerstone for the Institution’s Electronic Medical Record (EMR) system. MDACC decided to re-architect ClinicStation in 2005 using Microsoft .NET and Service Oriented Architecture (SOA) for enterprise-scale use. Over a 15-month period, MDACC and Avanade worked on iterative feature development with rigorous quality assurance. MDACC was concerned that critical PHI,protected health information, and other secure information was protected and auditable at every step in the process, thus ClinicStation’s security infrastructure involves a shared token server to authenticate a user and client application and takes advantage of WSE 3.0 for Microsoft .NET.

Avanade re-architected ClinicStation through a full use case definition effort to develop functionality requirements and provide documentation necessary for future system maintainability. Avanade helped re-tool the MDACC software development staff from VB 6.0 to C# and developed a detailed curriculum and training on the ACA.NET SOA framework, which is built on C#. Avanade then developed an EMR “training sandbox” that demonstrates how to develop new EMR functionality with coding standards and best practice guidelines. ClinicStation has set a new standard for enterprise-class interoperability in the healthcare industry. The majority of major healthcare institutions in the U.S. have elected to implement commercial EMR systems from enterprise-scale software vendors.

It is estimated that less than six major healthcare providers in the United States have attempted a custom-developed EMR, regardless of underlying technology platform, and even fewer have succeeded. MDA’s custom EMR implementation is an unparalleled example of Microsoft .NET and SOA-based technologies successfully deployed at scale within the healthcare industry.

ClinicStation serves about 10,000 unique users a month, up to 4,500 simultaneously. The users include staff, referring physicians, consulting physicians and even patients, who have their own portals to relevant data. End-users gain access to patient data from more than 40 back-end systems operating on a variety of disparate platforms through the SOA framework.

ClinicStation

Offers 75 services, reflecting various types of data. Its use is intensive: 125 million service calls a month, with peak utilization topping 3,000 service calls a second providing access to more than 80,000 patient visits every year.

ClinicStation was internally developed with a core development team of just three individuals at an estimated cost of $200,000. The system architecture is scalable, with economical, non-mainframe servers deployed in the rules-tier. The application is efficient to maintain with automated monitoring tools observing system performance and notifying personnel when problems arise.

As many as 8,000 users rely on the system at any given time. System performance provides access to any requested document usually in less than 1 second. Enterprise training costs are negligible largely due to what users acknowledge is a very intuitive user interface. A recent upgrade was successfully accomplished with five email messages informing users of new features. No formal training sessions were scheduled, allowing personnel to focus on their primary responsibility of patient care [5].

Awards

In 2002, the ClinicStation project was the recipient of the 2002 NASCIO Recognition Award under the category of "Innovative Use of Technology" [6]. This award recognized ClinicStation's effective utilisation of a web services data access model to leverage existing clinical databases into an integrated clinical display.

In 2009, ClinicStation also received the 2009 21st Century Achievement Award for Healthcare presented by the Computerworld Honors Program [7].

ClinicStation Outbound (CSO)

In 2009, a modified variant of ClinicStation was released to allow patients to gain access and view their medical and laboratory reports [8]. This version, called ClinicStation Outbound (CSO), made M.D. Anderson the first Comprehensive Cancer Center in the nation to offer protected web-based access to medical information; thus allowing patients to be more involved in their treatment beyond the treatment facility. It also enables authorized referring physicians to obtain patient records and follow-up on the treatment protocol, thereby eliminating time delays involved with mailing and/or faxing patient records. For this project, M.D. Anderson's EMR team linked up with Avanade once again to create this external portal which is a subset of the parent ClinicStation application. Patients can view their personal information via CSO by creating a unique login account and they also have the choice to opt of using CSO if they choose and receive their records as hard copy documents.

References

  1. George Wiley. Radiology Without Walls. Imaging Economics Feb 2003 [1]
  2. University of Texas M.D. Anderson Cancer Center "ClinicStation Case Study" 2009. [2]
  3. Cancer Center Saves Time and Money, Improves Care with Medical Record Solution. Microsoft Case Studies [3]
  4. Dr. Kevin McEnery background and current work roles [4]
  5. Electronic clinical data, diagnostic image retrieval enhances cancer-center efficiency [5]
  6. NASCIO Awards [6]
  7. Computerworld Honors Program [7]
  8. ClinicStation Outbound project [8]
  9. Template:Note Epic journey leads to Wisconsin [9]