ClinicStation

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Joan Breuer, Ph.D. 01/12/2010 18:06 The following additional information is from: https://solutionfinder.microsoft.com/Solutions/SolutionDetailsView.aspx?solutionid=3cdb2161-0ef9-489d-9ffe-6d6a8ff2b3cf This includes history of the EMR, early use, and clinical applications. Statistics are found in bold.

ClinicStation
Provided by: Avanade Inc.  

Short Description The University of Texas M. D. Anderson Cancer Center (MDA), 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 MDA 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 (Local language) The University of Texas M.D. Anderson Cancer Center (MDA) 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. MDA decided to re-architect ClinicStation in 2005 using Microsoft .NET and Service Oriented Architecture (SOA) for enterprise-scale use. Over a 15-month period, MDA and Avanade worked on iterative feature development with rigorous quality assurance. MDA was concerned that critical HIPAA 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 MDA 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.End Editing by Joan Breuer


ClinicStation was developed by M.D. Anderson Cancer Center in response to internal needs for an EMR and several previous failed EMR deployments. It was developed by Dr. Kevin McEnery 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.

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 McEnrery background and current work roles [4]