Rx for Healthcare Info Management Pains

Windows NT Server and Microsoft SQL Server help provide the cure

Sherri Wender
Marketing Consultant

As is the case with most healthcare providers, efficiency and productivity are increasingly important to the United Kingdom's National Health Service (NHS). Following major reform in 1991, the previously centralized national health program is now structured so that each hospital runs as a self-managed provider, competing with neighboring hospitals for contracts to deliver health services.

This means that each institution's income depends on bidding for contracts successfully. Because the requirements for contracts may change from year to year, hospitals now must be able to meet purchasers' changing needs flexibly and rapidly. This makes it hard for hospitals to predict their long-term role, size, and information requirements.

To be successful in this new environment, managers and clinicians must have rapid access to information upon which to base both operational management and strategy. Effective information management becomes crucial.

New system needed

Until the recent reforms, regional health authorities procured and implemented information systems for hospitals. These systems were designed primarily to meet central rather than local needs. Ease of use was not a priority.

These systems, designed primarily for data collection, in general resided on minicomputers or mainframes and ran a variety of unintegrated software packages. Accessing or analyzing information and generating reports, particularly in a timely manner, was very difficult.

With the advent of health-service reforms, an increasing number of services and organizations needed to gain access to common information, and the lack of database connectivity between these systems created huge problems.

The absence of a comprehensive system for handling all patient-related information, including diagnosis, treatment, and finances, resulted in higher healthcare costs and a lack of information needed to support management decisions effectively.

In response to this problem, West London NHS Healthcare Trust was selected as a national pilot site for the development of a new breed of information system. This new system was designed to serve as the model for information delivery for the National Health Service patient information system.

The system had to be easy to maintain, scalable, flexible, secure, and user-friendly. Nurses, doctors, and administrators needed to be able to capture and have access to complete, accurate, up-to-date information about a patient. All clinicians needed access to records to help audit their areas of responsibility.

Mike Morgan, director of application development for the West London NHS Trust and a former practicing physician, was chosen to lead a three-person development team that was tasked with meeting these ambitious objectives.

Visualizing a solution

The ability to take advantage of reusable components in development to save time and money was particularly important to Morgan. After evaluating the alternatives, he decided that a solution using various Microsoft tools and server products would provide better functionality, closer integration, and more cost benefits than the alternatives.

The new system was developed with the Microsoft Visual C++ development system and the Visual Basic programming system. It runs the Windows for Workgroups operating system on the front end and the Windows NT Server network operating system and Microsoft SQL Server on the back end. The smaller installations use the Microsoft Access database management system.

The development team's positive experience with the use of Visual Basic in modeling the new system persuaded it to use Visual Basic as a key part of actual system development. "We learned quickly we had underestimated the power of Visual Basic. We thought it was only a prototyping tool, a toy. We were wrong!" Morgan said. "Both the speed of developing the application with Visual Basic and the speed of the application itself impressed us. We immediately saw what a strong complement Visual Basic is to Visual C++, so we used both."

Morgan's team developed the core tools, such as dockable button arrays, dockable forms, and custom data entry VBXes, in Visual C++ and then reused those tools in Visual Basic. "We used Visual C++ to develop our own VBXes, optimizing for speed, and then Visual Basic easily integrated the functionality written in the VBX," explained Morgan. "Using the reusable, prebuilt code in the Microsoft Foundation Class Library, or MFC, definitely shortened the development process for us."

In addition to taking advantage of MFC, Morgan's team made extensive use of open database connectivity (ODBC) and OLE object technology. "The built-in ODBC support was important to us," Morgan said. "OLE object technology was also a significant part of our development efforts. For example, we were impressed with the PivotTable dynamic views functionality in Microsoft Excel and wanted to emulate that in our reporting system. We started to design the same functionality and then realized that with OLE object technology in Visual Basic we could just embed the PivotTable. We were able to add a tremendous amount of functionality without having to redevelop."

Morgan's developers also wanted to make all the windows include ToolTips and wanted resizable windows. So they bought off-the-shelf VBXes and added that functionality in Visual Basic in a day. "We also created a ‘specialist' integrating functionality so it is easy to reshape and remold the application without having to recompile," he added.

Technical info and server products ease integration

The Microsoft Developer Network played an important part in the process of creating the new system by providing the developers with technical information and resources—such as source-code examples and articles about developing software under Windows NT in its Development Library, and software development kits (SDKs) via its Development Platform. In addition, the developers benefited from the support of the Microsoft Public Sector team in the United Kingdom.

Windows NT Server and Microsoft SQL Server, both part of Microsoft BackOffice, also eased the development process. Explained Morgan, "We wanted to get to where we could manage all of our resources in an integrated fashion from the desktops throughout the whole system. We don't view networking as separate. The benefits of an integrated desktop and file-server operating system rapidly became apparent."

After looking at the cost/benefit of Microsoft SQL Server and comparing it to other solutions, Morgan said his team realized that it could get better performance and save money with a dual Pentium AS running Windows NT Server and Microsoft SQL Server.

"One of the pluses of Windows NT Server is that APIs are the same for both client and server. Additionally, because of the nature of medical records, total security is critical—Windows NT Server gives us a reliable, secure foundation," Morgan pointed out. "Using Microsoft SQL Server Programmer's Toolkit, we found it easy to integrate SQL Server with other data and systems. Windows NT Server and Microsoft SQL Server can scale to as many or as few PCs as desired, which eliminates the need to have a total hardware change."

Voilà, Unity

In January 1994, at a development cost of only £200,000, Unity, as the new system is called, was completed.

The system, which has undergone extensive pilot testing, integrates information from the wide number of data sources. When fully installed it will run with 4 servers and more than 100 client PCs; each server manages from 1 to 2 gigabytes of data.

"Without the flexibility of a product like Unity, it would not be possible to develop healthcare information systems capable of responding at the same rate of change as we're experiencing with healthcare reform. The key to Unity is the rapidity with which you can change information," pointed out Laurence Pearce, manager of information strategy and development for the West London NHS Trust.

Unity contains two main programs: a toolkit and the information desktop. The toolkit maps the information requirements of an organization into an object-oriented model, providing direct benefits to end users. Rather than mapping information requirements directly to database structures, the toolkit builds up a reference of where elements of information may be accessed. This allows Unity to integrate data from a large number of platforms and enables users to query across multiple platforms transparently.

Once the object model and security issues have been established, the toolkit builds a template that configures the information desktop that each user sees. This information desktop is dynamic and self-building so that when new information is added to the system, it can automatically be made available to end users.

The transition from one database to another is seamless to the user. Because all types of information, including multimedia, are handled in an identical manner, the user sees only one consistent view of the organization's information. The system is designed for easy setup and maintenance, since the front end is automatically created for each user based upon the defined data objects and the user's access rights within the system's flexible configuration. It is also easy to extend and modify—any number of new data sources can be added to the system, which are then automatically available to users.

Users can easily customize their desktops to display information that is relevant to them. Custom address books, toolbars, and drag-and-drop reporting make it easy even for novices to use.

Bucking traditional systems

Morgan views a flexible approach as dramatically different from the traditional systems approach. "Previously you would sit with the user and work through what the system needed to do. You'd get specifications, and then a year later you'd have a system that was no longer what was needed. You couldn't keep up to date. Now it's easy."

In addition to providing a flexible, secure environment, Unity has reduced costs and improved efficiency and quality. At the pilot site, the elimination of overlapping administrative costs has saved £200,000 annually, a figure that is expected to rise to £300,000 by the third year.

Users find the system easy to learn and use, which reduces training costs. Quality-of-care improvements will lead to a better service at lower cost. According to a recent study, if the savings estimated at the pilot site were replicated across the NHS, the total amount saved could be as much as £100 million in as little as five years.

This approach to handling information in an object-oriented fashion has created interest within a number of other industries that face similar problems in data integration and management. In response to this demand, Morgan has independently taken Unity forward as a commercial product. Through his company, Open Mind Design Ltd., he intends to make the solution available to solution providers and end users in a large number of industries.

For more information

For more information about Microsoft products, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Customer Support Centre at (800) 563-9048. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. Dr. Mike Morgan can be reached at (44) 181 568 1297 for information about Unity.

Sherri Wender is a marketing consultant who focuses on the software and telecommunications industries. She spends her free time studying the behavior patterns of her three cats.