4-page Case Study - Posted 3/19/2008

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EMIS

U.K. Healthcare Solutions Provider Accelerates GP Systems and Enhances Patient Care

Healthcare technology supplier EMIS is always seeking ways to enhance its solutions, driven by strong partnerships with national programmes such as NHS Connecting for Health in the United Kingdom. The company wanted to boost the performance of its EMIS Web suite, which is used to manage patient records, to help doctors make better use of their time. EMIS has redeveloped the solution on latest-release Microsoft® technologies, including the Microsoft Visual Studio® 2008 development system and Windows Server® 2008 operating system. These solutions have reduced transaction times for doctors accessing patient records from five seconds to fractions of a second. The technology also provides optimum security for 39 million patient records across a vast network of healthcare providers, and supports the company’s expansion into new areas of care.   

Situation

Improving patient care is at the top of the United Kingdom government’s healthcare agenda, and strategies such as the Connecting for Health programme, which came into operation in 2005, support this goal. Through Connecting for Health, the NHS delivers better and safer care to patients with new technology systems that link general practitioners (GPs) and community services to hospitals. Electronic patient records (EPRs), for example, offer a fast, reliable, and secure method of sharing patient information.

We’re always looking for ways to accelerate development. Visual Studio 2008 is by far the best environment we’ve worked with for increasing developer productivity. Darren Sheavills Chief Systems Architect EMIS

The NHS employs the country’s most sophisticated solutions to support this programme of healthcare reform. EMIS, based in Leeds in the U.K., is leading the way. An IT supplier in primary healthcare, the company already hosts more than 39 million EPRs within its systems, and around 60 per cent of the country’s doctors use its software each day—around 5,500 practices.

Its next-generation set of clinical modules, EMIS Web, makes up part of the state-of-the art technology programme that has revolutionised the way the NHS captures, records, and uses patient information. In a project that is among the largest of its kind, the electronic exchange of patient records is expected to link the country’s entire national healthcare network, and eliminate the delays, costs, and inefficiencies of handling paper records.

Darren Sheavills, Chief Systems Architect, EMIS, says: “EMIS Web offers a complete patient management system for a range of clinical specialities. The system includes intelligent prescribing and advanced drug safety checking, secure medical records, integrated consultation mode with advanced decision support, administration list management, appointment bookings, and advanced search and reporting modules. EMIS Web is also a highly interoperable system, integrating with partner health care products and systems. Patients can access EMIS Web portals to book GP appointments and request repeat medications using their home internet connections.”

For some years, EMIS has supported the solution using earlier releases of Microsoft® SQL Server® database software and the Microsoft .NET Framework. But its commitment to improving patient care drives EMIS to continuously explore new methods of developing its solution to better support users. “Our applications have always performed well, but with GPs more pressed for time than ever, they expect their systems to operate at a sub-second level,” says Sheavills. “Consultations are as little as five minutes in some inner-city areas and only a small proportion of that time should be spent on a computer. Doctors want to be able to concentrate on the patient.

“Waiting for screens to refresh is not acceptable in this environment. The GP can dedicate as little as 30 seconds to the computer—to view the patient record, and record the prescription and brief details of the consultation.”

Sheavills says achieving that performance over a network the scale of the NHS has always been a challenge. “It hasn’t been easy to achieve sub-second systems. There has always been a compromise between usability and speed. But this changed recently, when Microsoft introduced its latest product releases.”

Solution

EMIS has redeveloped the EMIS Web suite to take advantage of latest-release Microsoft technologies including the Microsoft Visual Studio® Team System 2008 development system and the Windows Server® 2008 Enterprise operating system. The company firmly believes that these technologies provide the levels of performance and scalability that meet and exceed industry needs.

Enhanced Development Environment
Using Visual Studio 2008, EMIS migrated EMIS Web from Microsoft ASP.NET to a Microsoft Visual C#® Windows Forms environment. Using the Windows Forms designer in Visual Studio 2008, developers built graphical user interface applications for the solution.

Our data centres will ultimately hold around 39 million patient records and more than 100 terabytes of medical records information. That is why we’ve upgraded to the very latest Microsoft technologies, to guarantee the highest level of performance. Darren Sheavills Chief Systems Architect EMIS

They also used Windows Communication Foundation, another feature of Visual Studio 2008, to support integration of EMIS Web applications across the country’s vast network of healthcare organisations, from doctors’ surgeries to hospitals. Windows Communication Foundation also boosts data security because personal information is secured through built-in encryption and confidentiality features. “With Windows Communication Foundation in Visual Studio 2008, we’re getting a reliable transport mechanism out of the box, dramatically reducing the need for configuration,” says Sheavills.
“We’re always looking for ways to accelerate development. Visual Studio 2008 is by far the best environment we’ve worked with for increasing developer productivity. Code testing is also significantly improved because Visual Studio 2008 offers built-in automated testing tools.”

The company is also looking to migrate to Windows Presentation Foundation, supported by Microsoft .NET Framework 3.5, in the next year. The new programming features in this technology give developers richer control over the look and feel of EMIS Web applications. Sheavills explains that, in the past, strong design elements were compromised by the need to deliver usable code. He says: “Thanks to Windows Presentation Foundation, we can retain most of the intuitive interface features from the design stage. The tools improve collaboration across different teams, and help us to enhance productivity.”

Feature-Rich Operating System
Windows Server 2008 is being deployed at EMIS data centres. This latest release offers vast improvements to the way administrators can manage their environment. In particular, Windows Server 2008 is especially designed to support Web-based applications through Internet Information Services (IIS) 7.0. Developers use the specially designed architecture and administration tools within this technology to build and host these programs. Windows Process Activation Services within IIS 7.0, hosts the Windows Communication Foundation site at EMIS and improves the management of worker processes.

Scalable, Secure Database
EMIS Web is now supported by a Microsoft SQL Server® 2005 database environment with a view to upgrade to SQL Server 2008. It offers EMIS the levels of performance clinicians need despite the sheer number of patient numbers and NHS organisations using the technology. Using SQL Server tools such as Service Broker, developers can build scalable, secure database applications quickly. EMIS is using it to distribute patient medical records in real time between all surgeries.

“SQL Server Service Broker offers excellent security with optimum authentication and encryption,” says Sheavills. “Normally within a distribution environment, you’d need to add encryption separately but Service Broker comes built in. We have used this technology for 18 months without losing a single transaction. The technology is immune to network failure and ensures messages are always delivered in the order they are sent. The EMIS implementation of Service Broker is one of the largest data communications programmes of its kind. Millions of patient records are transferred between distributed databases using secure Service Broker services and routes. Transaction updates are immediately distributed by Service Broker between local and central servers, providing clinicians across different locations with up-to-the minute updates of vital patient medical-record information.”

Benefits

The latest EMIS Web release went live in January 2008 and is currently being rolled out to GPs across the U.K. EMIS aims to make the product available to all 5,500 practices and deploy it in new areas such as specialist clinics, and accident and emergency departments. The latest technology is set to transform the industry, ensuring doctors can focus on their patients, and securing the distribution of patient records across a wide network of health providers.

Sub-Second Transactions Lead to Better Patient Support
Today EMIS Web matches the speed of text-based systems, but with added usability that suits clinicians’ needs across all fields. Where the earlier ASP.NET environment kept doctors and patients waiting for up to five seconds while their screens refreshed, the new EMIS Web solution now offers a speed of service that exceeds industry requirements.

“Our Connecting for Health contract demands that all transactions have to be sub-2 seconds,” says Sheavills. “Windows Communication Foundation has helped EMIS to ensure all transactions are now at least sub-second—a full second faster than the contract stipulates—and, in fact, most take half that time. As a result, doctors can make better use of their time with patients.”

Using the latest technologies, EMIS has created an exceptional user experience across its huge database network and data centres. “Our data centres will ultimately hold around 39 million patient records and more than 100 terabytes of medical records information. That is why we’ve upgraded to the very latest Microsoft technologies, to guarantee the highest level of performance, no matter how many users are running on these systems.”

Using the right content and security settings, such as those found in Windows Communication Foundation, the common patient record can be shared among a greater number of healthcare organisations to dramatically improve standards of patient care. Darren Sheavills Chief Systems Architect EMIS

Secure Solutions Protect Patient Interests in 5,500 Practices
EMIS Web has the tools it needs to protect processes and prevent security breaches or loss of data. According to Sheavills, features such as Windows Communication Foundation in Visual Studio 2008 deliver both scalability and security of data, which has only become possible with latest-release Microsoft technologies.

“More than 5,500 local practice surgeries need to integrate their records with local data centres. Few organisations have taken this on or succeeded,” he says. “EMIS Web is successful because we have used the right technologies for the job, which include Windows Communication Foundation and SQL Server Service Broker. I don’t know of any other technology that allows you to distribute the amount of data we’re distributing between databases securely.”

Internationally Recognised Systems Support NHS Needs
EMIS can now make patient records available to the wider healthcare community, including consultancy and outpatient clinics, nursing, child healthcare, social services, and departments such as physiotherapy. “Using the right content and security settings, such as those found in Windows Communication Foundation, the common patient record can be shared among a greater number of healthcare organisations to dramatically improve standards of patient care,” says Sheavills.
The company aims to make patients the custodian of their records rather than the doctor. “Our systems are now fast, secure, consistent and easy to use, and, as a result, we are in a strong position to branch into new areas that haven’t previously been considered.”

The organisation also plans to target an international market with the EMIS brand. “We already have a large contract in Canada for EMIS Web, and we’re actively looking for business outside of the U.K. This is possible because we have the right system, running on internationally recognised user interface and interoperability standards,” says Sheavills.

Cutting-Edge Technologies Support National Healthcare Programmes
EMIS works closely with Connecting for Health, and holds significant responsibilities as an accredited supplier of software to the NHS. The strategy fits closely with the company’s own—to make patient data available wherever it’s required. It also works with around 30 other partners that develop software components for healthcare. These sit alongside EMIS Web on the desktop—integration that is made possible by the company’s use of Microsoft solutions. “We are proud that the EMIS Web product suite is interoperable with standard industry technologies,” he says.

The new technologies also support the company in its involvement with a number of national government projects such as GP-to-GP records transfers, online bookings, and electronic prescription transfers. The company is frequently a forerunner with the latest rollouts. “We work closely with Microsoft development teams to find new solutions and improve existing ones,” says Sheavills.

EMIS is also the main partner for the Microsoft Health Common User Interface, which provides developers with guidance for the development of safer, easier-to-use health applications. The company is using these guidelines, as well as 2007 Microsoft Office system components, to standardise the look and feel of EMIS Web across all modules to improve the experience for clinicians. “We are using these tools to create a far more advanced interface. People widely use Microsoft Office applications, so they can use our solution with little or no training.”

Windows Server 2008, SQL Server 2008, and Visual Studio 2008

Windows Server 2008, SQL Server 2008, and Visual Studio 2008 provide a secure and trusted foundation for creating and running your most demanding applications. Combined, the products offer advanced security technology, developer support for the latest platforms, improved management and Web tools, flexible virtualisation technology to optimise your infrastructure, and access to relevant information throughout your organisation.

For more information about Windows Server 2008, go to:
www.microsoft.com/windowsserver2008

For more information about SQL Server 2008, go to:
www.microsoft.com/sql/2008/default.mspx

For more information about Visual Studio 2008, go to:
www.microsoft.com/vstudio.

For More Information

For further information about Microsoft products and services, please visit
www.microsoft.com/uk

or call 0870 60 10 100*

For hearing impaired customers with a Minicom, contact: 0870 50 30 400*

*Lines are open 8am–6pm, Monday to Friday. Please note, numbers prefixed 0870 will be charged at national call rates. For details of national call rate charges, please contact your telecommunications provider.
 

For more information about EMIS products and services, visit the Web site at:
www.emis-online.com/

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published March 2008