Accuro Healthcare Solutions wanted to increase the maintainability and performance of the code for its Web-based CarePricer® application. It chose to use Microsoft® Visual Studio® Team System 2008 Development Edition and replace stored procedures and dynamic SQL statements with the Language Integrated Query functionality in Microsoft .NET Framework 3.5. Development is now 500 percent faster, enabling frequent updates to meet customer needs.
As healthcare costs rise, and as more people pay a larger share of their own healthcare expenses, patients want to know what their medical expenses will be before those expenses are incurred. Hospitals want to provide that information to give better service, increase their cash flow, reduce bad debt, and ensure compliance with regulatory requirements.
||Our development depended on the quality that Visual Studio delivered every day. Our investment in new technology really paid off in a superior, high-performance solution.
Vice President, Development, Accuro Healthcare Solutions
One of the leading tools that hospitals use to estimate expenses for their patients is the Web-based CarePricer application from Accuro Healthcare Solutions. The healthcare provider sends historical claim data to the Accuro data center, where the application analyzes the provider’s charges based on historical insurance claims, reimbursement information, and patient benefits, and returns an estimate for the patient’s out-of-pocket expenses, which the provider then shares with the patient before services are provided.
Accuro CarePricer, originally created using Microsoft® Active Server Pages (ASP) and later upgraded to ASP.NET version 2.0, requires a huge amount of information and processing. Accuro maintains 13 terabytes of data in 1,000 Microsoft SQL Server® 2000 databases. The original Accuro CarePricer required 50,000 lines of code and 750 stored procedures and dynamic SQL statements.
“The code was getting big, which is typical for a large application that’s modified and extended over time,” says Wade Wright, Vice President, Development, Accuro Healthcare Solutions. “As the solution grew, code maintainability was definitely our biggest problem.”
Enhancing the application to respond to business needs—particularly customer requests—was increasingly difficult, time consuming, and expensive because Wright and his developers needed to confirm that any changes they made wouldn’t break code elsewhere. The size and structure of the application also affected response times. Accuro maintains service level agreements with customers for five-second Web page updates; the application’s performance was right at that limit.
Wright and his colleagues knew they needed to enhance code maintainability, including ways to help ensure faster and more reliable development and better performance. Wright attended a local user-group meeting for Microsoft technologies and heard a presentation on Language Integrated Query (LINQ) support in Microsoft .NET Framework version 3.5 and Microsoft Visual Studio® Team System 2008 Development Edition. The new technology held the promise of providing exactly those benefits desired by Accuro, by giving its developers a consistent programmatic approach for managing and using data.
Accuro updated its CarePricer product line using Visual Studio Team System Development Edition and .NET Framework 3.5. With LINQ, Accuro eliminated stored procedures and dynamic SQL statements from the application. Developers could write queries natively in C# without having to use the more-specialized SQL data languages, and they checked the statements at compile time, which enabled them to spot and correct errors sooner than they could before.
The development team also used LINQ to adopt technologies in Microsoft SQL Server 2005—to which Accuro is upgrading from SQL Server 2000—without having to rewrite code to accommodate them. For example, Accuro incorporated paging mechanisms in SQL Server 2005 with simplified syntax for requesting new pages. “With LINQ, we could adopt these advances without changing code based on whether the server was SQL Server 2000 or SQL Server 2005,” says Wright.
Accuro anticipates using other Microsoft technologies with CarePricer, such as the Microsoft Silverlight™ browser plug-in for delivering the next generation of media experiences and rich interactive applications for the Web, including video, animation, and stunning user interfaces.
By adopting Microsoft development technologies including Language Integrated Query and Visual Studio Team System 2008 Development Edition, Accuro increased its development speed by 500 percent compared with using previous Microsoft technologies, according to Wright. Accuro was able to develop the new version of its Web-based CarePricer estimating application with a development team just 20 percent as large as the company has traditionally used to develop comparably sized solutions.
“Our development depended on the quality that Visual Studio delivered every day,” says Wright. “Our investment in new technology really paid off in a superior, high-performance solution that meets our requirements for security in healthcare.”
With LINQ replacing stored procedures and dynamic SQL statements, Wright and his colleagues were able to reduce code size by 40 percent. The smaller code makes the solution easier to upgrade in response to business needs, so Accuro can update it more frequently. Web page updates are now up to 10 times faster, ensuring that Accuro can meet agreements for performance. Help-desk costs are expected to drop by 20 percent.
“With LINQ, we’re getting tremendous ongoing maintainability of code and the ability to develop new functionality quickly,” says Wright. “As we move customers to this new technology, we can make changes and satisfy clients more quickly than ever.”
Even more significant than faster development is the new attitude toward development that has come with the use of LINQ and related Microsoft technologies. “One of the beauties of LINQ and Visual Studio Team System Development Edition is that we gained the freedom to do things right, because they don’t take forever to do,” says Wright. “Before, people were a bit scared to touch the code because they didn’t know what they might break. Now, we make the changes we want. If a change is needed, we see it immediately, fix it, and continue.”
Accuro has also seen unanticipated benefits from the use of LINQ and Visual Studio Team System Development Edition, such as an increased ability to attract development talent. “Developers want to use the latest Microsoft technologies,” says Wright. “When we had openings for this project, I had to turn people away. These technologies are a great recruitment tool, and a great way to motivate and retain talented personnel.”
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 with Visual Studio 2008 and the Microsoft Expression Suite. With Visual Studio 2008, businesses can deliver modern service-oriented solutions more efficiently.
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