4-page Case Study
Posted: 4/23/2009
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Montefiore Medical Center IT Team Uses Collaborative Tools to Create an Innovative Healthcare Application

Tracking patients over long periods and pulling important trends from dispersed data sources are significant challenges for healthcare professionals. An IT team at Montefiore Medical Center in New York City created an application that physicians, nurses, and healthcare administrators can use to evaluate data to help improve medical outcomes and services to patients. By using Microsoft® Visual Studio® Team System 2008 Team Suite, Montefiore physicians and developers worked in an efficient development environment to create that application, called “Clinical Looking Glass.” It lets users access and analyze data in a few hours, instead of the many weeks required in the past. Montefiore is marketing the application to other healthcare organizations to help improve health outcomes and patient services and to create a source of potential revenue for the medical center.

Situation

Montefiore Medical Center, the University Hospital and Academic Medical Center for Albert Einstein College of Medicine, is based in New York City. Montefiore provides healthcare services at four acute-care hospitals, as well as through a network of 25 ambulatory care centers and numerous community-based programs throughout the Bronx and nearby Westchester County. Specialties include cardiology and cardiac surgery, cancer care, tissue and organ transplantation, children’s health, women’s health, surgery, and the surgical subspecialties. Montefiore also conducts research in areas such as diabetes, headaches, obesity, sleep disorders, and geriatrics.

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* Visual Studio speeds up the pace of development of Clinical Looking Glass so it serves our internal users even better while providing a compelling solution for other healthcare providers.  *
Dr. Eran Bellin
Director of Outcomes Analysis and Decision Support, Montefiore Medical Center, and Vice President of Clinical IT Research and Development, Emerging Health Information Technology
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In 2001, Montefiore transformed its IT department into a for-profit subsidiary called Emerging Health Information Technology that, in addition to managing the medical center’s technology, designs and implements solutions for other regional healthcare organizations. The type of needs that Emerging Health IT meets with its solutions includes such things as tracking the care given to individual patients over time—which for years has been one of the most difficult challenges for healthcare providers. Today, most medical centers have IT systems that can keep good records on individual patients. But even if health practitioners can quickly and efficiently gather patient information, particular health issues, trends, or results of specific therapeutic routines can be thoroughly understood only when seen through the data patterns revealed in the study of large groups of patients.

“Primary care physicians often do not have the time or the tools to track groups of patients to gain insights from what has happened to the patients as a group,” says Eran Bellin, MD, Director of Outcomes Analysis and Decision Support at Montefiore and Vice President of Clinical IT Research and Development at Emerging Health IT. “One consequence is that patients can be over-treated with expensive therapeutics and diagnostics without any benefit, sometimes even resulting in dangerous scenarios such as high cumulative radiation exposures or other measurable negative side effects of well-intentioned therapy.”

David Fletcher, Director of Product Development for Emerging Health IT, adds that when practitioners want to understand some trend or medical problem, they typically form a team to report to an internal quality council. “For example, suppose they want to better understand how we’re taking care of patients who develop pressure ulcers. The team will extract charts and compile data, and might use the services of a statistician or other technical personnel. It might take six to eight weeks to gather the information, conduct an analysis, and then write up and distribute the results. All this to answer a single question. The process is time-consuming and labor-intensive. It can be frustrating and an extra burden on schedules that are already quite full.”

The Emerging Health IT team began to look at both the challenge and the opportunity at hand. Says Bellin, “Our goal was to create an easy-to-use tool that, with just a few hours of training, any authorized doctor, nurse, or administrator could use to analyze data and build reports on treatments and other healthcare issues in a matter of hours or even minutes, instead of weeks.”

Solution

Montefiore’s Emerging Health IT team created a solution that it calls Clinical Looking Glass (CLG), which was designed with the support of an array of Microsoft® products and technologies, including Microsoft Visual Studio® Team System 2008 Team Suite. CLG helps physicians and other hospital staff quickly and accurately track patient care and perform quality checks on a patient’s course of treatment through efficient compilation and analysis of related data.

CLG integrates data from a variety of other health information systems that Montefiore has engaged. These include GE Centricity Enterprise, GE Centricity EMR, and GE Centricity Ultra Laboratory Information Management System. CLG also integrates population-based data such as mortality information from the Social Security Administration. Using CLG, a physician, nurse, or administrator can pull out and compare test results and other kinds of information from medical records located across the organization. A doctor treating diabetic patients can, for example, use CLG to check tests done for hemoglobin A1C levels and then identify those patients whose blood sugar level is not adequately responding to treatment for follow-up.

The CLG system has different permission levels to protect patient confidentiality while accommodating the needs of users to access varying types of information. In order to access the system, each CLG user must have permission from a supervisor, who annually renews the authorization. For instance, a doctor may be given the full identities of patients to allow him or her to follow up on treatments given to specific individuals, whereas an administrator who needs to understand how a commonly prescribed treatment regimen affects budget projections might have access only to anonymous aggregate profiles.

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* The source-code control features in Visual Studio helped smooth out a lot of the coordination involved in the builds.  *
Dr. Eran Bellin
Director of Outcomes Analysis and Decision Support, Montefiore Medical Center, and Vice President of Clinical IT Research and Development, Emerging Health Information Technology
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“We use CLG in a myriad of ways, from determining whether medical devices like inferior cava filters really protect against clots, to determining the efficacy of treating certain drug complications, and to assessing length-of-stay outcomes with different transfusion therapies for complications of sickle cell disease,” says Henny Billet, MD, Associate Director of Hematology at Montefiore and Professor of Clinical Medicine and Pathology at Albert Einstein College of Medicine.

CLG provides an intuitive user interface that enables simple actions like defining patient groups and listing clinical data elements and cross tabulation, as well as more sophisticated actions like outcome definition and retrospective study design using statistical models for group comparison. Data cubes can be requested and created on demand for data aggregation and cross tabulation, which in the past was a batch process requiring the involvement of an IT administrator. CLG provides flexibility and ease of use for non-IT users.

Because CLG is a fully object-oriented application, a user’s analytic objects—such as medication sets, diagnosis code sets, patient groups of interest, and clinical outcomes such as lab values or mortality—can be reused throughout the application. Also, the CLG system produces reports in templates that resemble medical manuscripts, making the output format familiar to physicians and research-oriented end users.

Clinical Looking Glass was developed over several years. Planning began in 2001, and CLG went through a proof of concept and several early iterations that were created using object-oriented programming and then current Microsoft technologies, such as early releases of the Microsoft .NET Framework. In August 2008, the Emerging Health Information Technologies team released Clinical Looking Glass version 3. That version was built in a rich development environment that includes:

  • Microsoft Visual Studio Team System 2008 Team Suite, which provided the Montefiore developers with an integrated set of tools for the architecture, design, development, database development, and testing of the application through its various iterations. The Visual Studio programming languages used by Montefiore included Visual Basic® 2008, Visual C#® 2008 and Visual C++® 2008.
  • Visual Studio Team System 2008 Team Foundation Server, which provided the Montefiore team with a server-based platform for storing all CLG code. It also keeps records of all changes and tracks code checkouts in a Microsoft SQL Server®–based database.
  • The Microsoft .NET Framework version 3.5 SP1, used for designing the user interface and Web-based components of CLG.
  • Microsoft SQL Server 2008 Enterprise database management software, used for storing and managing the data being analyzed by a user.
  • SQL Server 2008 Integration Services, which is used for importing data from other Montefiore IT systems.
  • SQL Server 2008 Analysis Services, which lets Montefiore staff members create data cubes used in the online analytical processing of information.
  • Internet Information Services version 7.0, a Web platform technology included in the Windows Server® operating system that Montefiore used to host CLG as a Web application.

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* We use CLG in a myriad of ways, from determining whether medical devices like inferior cava filters really protect against clots, to determining the efficacy of treating certain drug complications, and to assessing length-of-stay outcomes with different transfusion therapies for complications of sickle cell disease.  *
Dr. Henny Billet
Associate Director of Hematology, Montefiore Medical Center, and Professor of Clinical Medicine and Pathology, Albert Einstein College of Medicine
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By early 2009, approximately 340 users received training, a password, and authorization to use the CLG system. As part of a continuing commitment to support the CLG user community, the Emerging Health IT team used Microsoft Office SharePoint® Server 2007 to integrate into the solution a wiki-based user forum containing information about CLG and specific user applications of CLG.

Benefits

Using the Microsoft development environment enabled the Montefiore IT staff members to tightly manage all aspects of the application’s life cycle. Visual Studio Team System 2008 Team Suite provided important features and benefits, including source-code control, workflow management that helped streamline the processes for following up on bugs, and release management. As a result, Montefiore was able to create a powerful, innovative solution that is helping the medical center constantly improve the quality and provision of healthcare.

“The ability of CLG to mine vast amounts of medical record-keeping to help deliver concrete outcomes data is a clinical researcher’s dream,” says Billet. The Clinical Looking Glass solution is now being marketed to other organizations to help enable broad-scale improvements in health outcomes and patient services, as well as open up a potential revenue stream for Montefiore.

Provides Strong Controls for Source Code and Development Workflow

A sophisticated solution such as CLG, which evolved over a number of years and went through many iterations, required strong controls over the source code and the development workflow.

“Source-code control was the key feature that really spurred our use of Visual Studio Team Suite,” says Bellin. “It was critical that we be able to control everyone’s access to the code and have clear policies for checking code in and out. The source-code control features in Visual Studio helped smooth out a lot of the coordination involved in the builds.”

The Montefiore team also benefitted from Visual Studio Team System Team Foundation Server, which was integrated with the Montefiore intranet to help facilitate the development process. Team Foundation Server played a crucial role in streamlining the overall workflow, says Fletcher.

“Proper workflow management on a project like this is critical to success because of the multiple iterations we’ve gone through,” says Fletcher. “The tight integration of Visual Studio Team Suite with Team Foundation Server improved our knowledge management by enabling us to build a repository where all our design documents could be stored in a central location. This allowed us to maintain clear records on what was done in each release.”

Helps Manage Application Releases

Release management was another important process improvement that Montefiore gained by using the Visual Studio Team System Team Suite. The Montefiore team now has longer lead times in which to prepare for adding new features.

“In the past, we would have treated each component of the application as an independent product. All new ideas for each component would be stored in manual and electronic files, and work would be packaged by component, requiring several different work plans for the same team,” says Fletcher. “With the Visual Studio tools, we’re able to consolidate all application components into one team project, using the project areas to refer to each application component and the project iterations to refer to sequential, three-month development cycles. Visual Studio Team System Team Suite provides the tools we need to gain greater visibility and to coordinate our activities across the CLG application life cycle, from architecture to development to database development to testing.” The result, Fletcher says, is that all disciplines within the team are coordinated by a common work plan that encompasses the work being carried out on multiple areas or components of CLG.

“New ideas are now submitted as change requests in the main team project,” Fletcher continues. “These change requests are tentatively packaged into future iterations. In effect, the Microsoft tools help provide the team with a 12-month prospective release plan that provides a greater ability to think through how the features will be incorporated.”

Presents New Potential Sources of Revenue

Developing Clinical Looking Glass in Visual Studio Team System Team Suite has helped Montefiore create a more streamlined development process that is accelerating the pace of innovation on the application. That, in turn, is making it easier for the institution to market CLG to external parties.

“We have a grant with the U.S. Department of Defense to develop a proof of concept using Clinical Looking Glass to help the department in its healthcare delivery system,” says Bellin. “It would involve a very large population—not just soldiers, but also their family members and retired service personnel. Visual Studio speeds up the pace of development of Clinical Looking Glass so it serves our internal users even better while providing a compelling solution for other healthcare providers.”

For More Information

For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:
http://www.microsoft.com/

For more information about Montefiore Medical Center, call (718) 920-4321 or visit the Web site at:
http://www.montefiore.org/ 

Microsoft Visual Studio 2008

Microsoft Visual Studio 2008 is the world’s most popular development environment for designing, developing, and testing next-generation Windows®-based solutions and Web applications and services. By improving the development experience for Windows, the Web, mobile devices, and Microsoft Office, Visual Studio 2008 helps organizations deliver a variety of solutions more productively than ever before. Visual Studio Team System expands the product line with new software tools that enable greater communication and collaboration throughout the development life cycle. Interaction between developers and designers is enhanced through the use of Visual Studio 2008 and Microsoft Expression® Studio. With Visual Studio 2008, businesses can deliver modern service-oriented solutions more efficiently.

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

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.
Document published April 2009
Solution Overview



Organization Size: 17000 employees

Organization Profile

Montefiore Medical Center is a full-service, integrated health delivery system in the New York City region. It includes four hospitals, a large home healthcare agency, and a 25-site medical group.


Business Situation

Montefiore’s Emerging Health IT team wanted a tool that could quickly deliver medical and statistical data on treatments and outcomes to help doctors improve the quality of care and services to patients.


Solution

The team created “Clinical Looking Glass,” designed with Microsoft® development tools, including Visual Studio® 2008 Team System, to help physicians evaluate patient treatments and outcomes quickly and easily.


Benefits
  • Provides strong controls for source code and development workflow
  • Helps manage application releases
  • Presents new potential sources of revenue

Software and Services
  • Microsoft Visual Studio Team System 2008 Team Suite
  • Microsoft Office SharePoint Server 2007
  • Microsoft Visual Studio Team Foundation Server
  • Windows Server 2008
  • Microsoft Internet Information Services 7.0
  • Microsoft .NET Framework 3.5
  • Microsoft SQL Server Analysis Services
  • Microsoft SQL Server Integration Services

Vertical Industries
Health Provider

Country/Region
United States

Languages
English

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