Health providers in the United States manage an increasing number of chronically ill patients. Many providers still use paper charts, making it difficult to ensure that patients return for follow-up appointments. Without access to aggregate clinical data, facilities cannot measure progress in improving health outcomes for clinical populations such as diabetes, cardiovascular, and depression. The Aristos Group, a Microsoft partner, developed the Patient Electronic Care System (PECSYS®) on Microsoft technologies in order to respond to market needs for a cost-effective, user-friendly solution that would interoperate with Microsoft Office programs. Aristos has built its business on helping providers to deliver preventive healthcare for chronically ill patients and to reduce the incidence of acute medical episodes—in the process building a competitive advantage in a growing healthcare market.
Government agencies and health providers have worked for years to build better chronic care models based on disease prevention, patient empowerment, and holistic health services that help people make better lifestyle choices. Back in 1999, the Bureau of Primary Health Care (BPHC) created the Health Disparities Collaborative with a goal to help community health centers to improve chronic care management for under-insured or non-insured patients, and to eliminate health disparities. The first collaborative focused on the treatment of diabetes. However, by 2002, the BPHC had instituted more Health Disparities Collaboratives to focus on cardiovascular disease, asthma, depression, and cancer. By that time, it had become clear that the community health centers needed a technology solution to help them track and manage these growing patient populations.
So the BPHC provided funding to the Institute of Healthcare Improvement (IHI), which asked The Aristos Group, a Microsoft partner, to create a clinical information system for the collaboratives’ members. “We saw a tremendous opportunity for a chronic care management system: The members needed a specific product that standardized the format of medical data in a clinical, epidemiological database that included factors such as age, sex, and geography,” says Manny Chavez, Chief Executive Officer at The Aristos Group. “Accessing this data would help care providers compare how they are performing against evidence-based best practices, so they could take steps to improve their chronic care management protocols.” Challenges of Providing Chronic Care
One such member was CareSouth Carolina, a community health center serving approximately 36,000 patients a year in the Pee Dee region of South Carolina. “When we first started working with diabetic patients we didn’t have a system to manage them individually, or as a group,” says Ann Lewis, Chief Executive Officer at CareSouth Carolina. “When patients came in, we provided appropriate care, but we had no way of making sure that everyone returned for follow-up appointments, and there was a danger of patients falling through the cracks. Nor could we look at our population of diabetic patients and quickly determine which individuals we should be calling back for proactive intervention.”
“Dr. David Stephens, who worked with the BPHC, told us that the results of the first collaborative were disappointing because there was no standard way to collect data,” continues Allan Fabrick, Co-Founder and Vice President of Product Development at The Aristos Group. “He said the members needed a simple product that they could use to track the progress of patient care—what tests were given, when they were given, when patients should come in for follow-up appointments—and gradually build up a data repository of patient populations that showed the efficacy of treatment protocols compared to national standards.”
Need for a Chronic Care Solution
To develop a solution for chronic care management, Aristos evaluated the changing landscape of healthcare in the United States. Community health centers and other providers funded through Medicare and Medicaid reimbursements faced the challenge of serving a disproportionally high number of patients battling chronic health conditions.
“From the outset, the socioeconomic and demographic profile of our region forced us to address the management of chronic health conditions, such as diabetes, hypertension, and depression,” says Lewis.
However, Aristos saw a growing need for a chronic care management solution across the spectrum of healthcare providers, not just for the community health centers. Health facilities everywhere were struggling to find ways to improve care for patients living with diabetes, depression, stroke, asthma, and cardiovascular disease. Yet many facilities still maintained paper clinical files, so it was difficult for clinicians to look at aggregate patient data and assess the general health level and the success of treatments for different patient populations.
Aristos determined to build a solution that would help health facilities realize a new vision for preventative healthcare. “Health facilities that provide chronic care management need a patient electronic care system they can use to measure an individual patient’s progress—using evidence-based measurements and best-practices guidelines—against an appropriate disease registry, or patient database,” says Chavez. “To address this issue, we had to build our solution using technologies that were standards-based, interoperable with our customers’ existing solutions, easy-to-use, and, of course, affordable.” Solution
The Aristos Group chose to build its chronic care management solution, called PECSYS®, for Patient Electronic Care System, on Microsoft technologies. Originally, it turned to a Microsoft event-driven programming language, Microsoft Visual Basic 6, for its ease of use because it was under a tight deadline for the BPHC. “We had three months to build a prototype and nine months to deliver a finished product before the collaborative’s next meeting,” recalls Ken Fabrick, Co-Founder and Executive Vice President at The Aristos Group. “Microsoft Visual Basic 6 offered a rapid development environment and enabled us to complete the project in half the time that it would have taken using other tools. We used the Microsoft Access database and completed PECSYS version 1, the genesis of a multicondition patient registry, to meet the deadline. The contract with IHI allowed any member of the collaborative to use PECSYS at no additional cost.”
||Our mission is to produce leading-edge solutions for the medical community to help providers improve patient outcomes. We built PECSYS on Microsoft technologies to help us get there.
Chief Executive Officer, The Aristos Group
To ensure that its solution would be readily adopted by health facility staff, Aristos developed PECSYS to work with Microsoft Office programs, the standard productivity software in the health industry. PECSYS interoperates with Microsoft Excel and Microsoft Word programs so health facilities don’t have to train their staff. Reports and drill-down information can be exported to Excel to create call lists and customers can merge Excel data into Word templates to send letters to patients and colleagues.
“It would be difficult to walk into a health facility and try and make the staff work with a different type of office productivity software,” says Allan Fabrick. “To replace paper case notes, we created an electronic provider interface that clinicians can use during a patient visit to fill out templates in Word and save it to the database, so it’s there for the next visit. They can bring up their notes, which are stored in PECSYS, and prepare customized Word handouts for patients.”
Scalable Database for Larger Customers
By 2004, PECSYS had evolved into a multitier, client/server/database solution. But when BPHC added a Health Disparities Collective focusing on cancer, Aristos realized that the Access database that supported PECSYS would no longer scale to meet the needs of larger community health centers. The company had to find database technologies that would suit a wide range of collective members, from single-physician practices to community health centers with many thousands of patients.
“We needed different database technologies to meet the needs of customers of varying sizes,” says Allan Fabrick. “We used Microsoft SQL Server 2005 Express Edition, which is free* and can handle two gigabytes of data, for our smaller customers. For larger community health centers that were tracking a significant number of patients, we offered a version running on Microsoft SQL Server 2005, because it is a cost-effective and user-friendly database solution, and we knew IT staffs would be familiar with it.”
Using a carefully designed relational database such as Microsoft SQL Server 2005 database management software was critical to providing flexible tools for medical providers and others to extract information about patient populations and/or individual patients. “With Microsoft database technologies, we can offer easy-to-use reporting tools and drill-down features that provide clinicians with the flexibility to explore patient data relationships unique to individual patient populations,” says Ken Fabrick.
In 2009, when Aristos upgraded PECSYS to run on Microsoft SQL Server 2008 database management software, the developers took advantage of a number of performance and security enhancements. “The SQL Server 2008 whole database encryption feature provided an added level of security that previously required a third-party product,” says Ken Fabrick. “And the index tuning tools and enhanced indexing capabilities decreased overall data access times.” A Web-Enabled Version
Today, Aristos is working on creating a web-enabled version of PECSYS, rewriting its flagship product using the Microsoft .NET Framework 4. “Microsoft continues to offer the best development environment to keep up with our customers’ requirements,” says Allan Fabrick. “The load balancing and fault-tolerant features built into the .NET Framework will make PECSYS more scalable and reliable when used for very large patient populations.”
CareSouth Carolina is looking forward to an updated version of PECSYS because it will interoperate seamlessly with the browser-based electronic health records solution that it has chosen. “Another benefit of choosing a product that runs on Microsoft technologies is that it’s likely to work with any third-party solution out there, so we have the benefits of lots of choice without worrying about interoperability issues,” says Randy Carlyle, Director of Health Services at CareSouth Carolina. “Everyone took to PECSYS quickly because we didn’t have to adapt to the software; instead, the software worked with us.”
Looking to the Cloud
For Aristos, the next logical step for PECSYS is to take the solution to the cloud. Fabrick notes that Windows Azure, the Microsoft cloud services development, hosting, and management environment, and SQL Azure, the cloud-based database service built on SQL Server technologies, provide a logical fit for many health providers and could provide a cost-effective platform for Aristos to move PECSYS to the cloud.
“For community health centers operating within strict funding guidelines and with minimal resources available to maintain an on-premises infrastructure, offering PECSYS as a cloud-based solution would be very attractive,” says Ken Fabrick. “By rebuilding PECSYS as a .NET application, we have the option to deliver our solution as a service in Windows Azure, or as a specific web application.” Made for Chronic Care Management
Today, PECSYS incorporates more than 250 best practices and maps to the requirements of a proactive, chronic care model. At the core of the solution is a registry of patient and clinical information that care providers can use to see a detailed view of an individual patient’s progress as well as get information about populations of patients. Caregivers can use the system to track an individual patient’s care plans and to set reminders about needed services. For patient populations, the solution generates a disease management registry built on evidence-based best practices that caregivers can use to identify groups of patients that need additional care.
The solution also provides advanced reporting functionality. During a patient visit, clinicians can use the system’s Dynamic Encounter Note, which produces a page from the most current data about the patient's vitals, conditions, medications, vaccinations, risk factors, referrals, laboratory, and other test results. The PECSYS Patient Summary Report shows patient information at a glance. Using the system’s drill-down functionality, clinicians can see not only which patients in a particular group achieved a positive health measure, such as a normal blood pressure reading, but also, and more importantly, which patients did not. PECSYS generates a Reminder Matrix Report to ensure that staff members contact patients who need to come in for a follow-up appointment. The solution’s Reliability Index Report can be used by clinicians to see how well they are providing care across established guidelines for treating different conditions, with options to set their own guidelines.
To eliminate duplicate data entry and reduce errors, PECSYS is interoperable with the systems used at major medical laboratories, such as LabCorp and Quest Diagnostics. “SQL Server is highly configurable, and includes the ability to encrypt the entire database, helping to ensure patient data confidentiality,” says Ken Fabrick.
That means healthcare providers like CareSouth Carolina don’t have to worry about interoperability with the systems used by other medical facilities that serve its patients. “At CareSouth Carolina, the system our lab contractor uses interoperates with PECSYS so that every day there is a seamless flow of lab results into our system,” says Carlyle.
Also, Aristos is working with developers of major practice management systems and electronic medical records solutions to facilitate automatic import of data from those systems into PECSYS. “The more that PECSYS interoperates with other healthcare solutions, the easier it is for our customers to exchange patient information electronically, facilitating the exchange of information and streamlining healthcare delivery,” says Ken Fabrick. Benefits
The Aristos Group has built a successful business on bringing to market a Microsoft-based chronic condition management solution that helps care facilities address the increasing number of patients with long-term health challenges. Along the way, the company has increased its market share, opened up new markets, and established itself as a leader in patient-focused, chronic care management solutions. “Our mission is to produce leading-edge solutions for the medical community to help providers improve patient outcomes,” says Chavez. “We built PECSYS on Microsoft technologies to help us get there.”
Increased Market Share
By the time the collaboratives disbanded in 2006, many collaborative members were using PECSYS as the foundation of their chronic care management. No longer funded by the BPHC, Aristos decided to continue to self-fund research and development of the PECSYS product, bringing together expert users from among the original collaborative members. “We have created unique features such as Reminder Matrix and Reliability Index reports and charting features that combine annotation and goal setting,” says Ken Fabrick. “Today, PECSYS has been used in more than 75 percent of all federally-qualified community health clinics.”
CareSouth Carolina has one of the largest PECSYS databases in the country, housing data on more than 14,452 patients. “We are using PECSYS to track and manage those of our patients suffering from diabetes, cardiovascular disease, depression, asthma, obesity, and some cancers,” says Lewis.
“We are tracking more patients in our clinical registry at greater detail than some large hospitals, using a solution built on Microsoft technologies to store and extract and report on valuable patient demographic data,” says Carlyle. “It’s made all the difference to our ability to provide the best possible chronic care.”
||The inherent flexibility and interoperability of Microsoft technologies means that we can tailor PECSYS to help us reach new market opportunities in fields such as bio-terrorism, military, and veterinary sciences.
Co-Founder and Executive Vice President, The Aristos Group
Aristos is increasing sales to other health facilities, and it uses PECSYS’ interoperability with Microsoft products as a major selling feature. “When we talk to a potential customer, we tell them PECSYS aligns with Microsoft products, eliminating any interface issues now or in the future,” says Ken Fabrick. “Customers love that they can export PECSYS data into Excel and can print out documents in Word. There’s no learning curve and no support required from IT.” Developed New Markets
Because PECSYS was designed from the outset to be a multicondition registry, Aristos developers can easily modify the solution to meet unique requirements and expand its market. “Today, we are selling to organizations responsible for prisoner health, to mental health community clinics, and to regional physicians’ organizations,” says Chavez.
Aristos can customize PECSYS by adding new functionality and creating new reports that map to each facility’s unique requirements. “The inherent flexibility and interoperability of Microsoft technologies means that we can tailor PECSYS to help us reach new market opportunities in fields such as bio-terrorism, military, and veterinary sciences,” says Ken Fabrick. “In fact, any organization that needs to quickly gather, analyze, and generate reports based on multiple medical data points can use PECSYS as a standalone product or interface with other data collection products.” Improved Insight into Patient Data
Customers are attracted to PECSYS because Aristos built its solution around a central SQL Server patient registry database that they can use to aggregate clinical data into patient populations that can be mined for information. PECSYS takes advantage of the reporting and analytics support within SQL Server 2008 to make it easy for customers to gain new insight into chronic conditions. They can also measure their outcomes against industry standards, and take action to improve their treatment protocols. “SQL views are accessible as read-only tables from SQL Server to allow users additional opportunities to analyze patient data,” says Ken Fabrick.
“I can extract data into Excel and look at outcomes based on race, gender, or age. I can analyse the population’s aggregate depression severity scores and manipulate the data in Excel to gain insight into patterns,” says Liz Kershner, Director, Behavioral Health, CareSouth Carolina. “With this kind of information we are fine-tuning and improving the care we deliver.” Reduced Healthcare Costs
With this level of self-serve patient data analysis, PECSYS customers can monitor patient populations closely to improve health outcomes: by treating patients often and early, they can provide proactive care that keeps then out of the hospital. “At CareSouth Carolina, we are achieving a 78 percent reduction in average cost per diabetic patient,” says Lewis. “Our clinics are saving money because even though we treat more patients more frequently—we have seen a 106 percent increase in the number of patients seen since we began in 1999—ambulatory care at our clinics is far less expensive than care provided at emergency wards and hospitals. But more importantly, PECSYS helps us improve the quality of life for patients by helping to prevent the serious health crises that arise when chronic care isn’t managed properly.”
Created a Competitive Advantage
PECSYS was the first multidisease registry developed in the United States and over the years, Aristos has used its flagship product to build a reputation for patient-focused technology that health facilities can use to make a difference in their patients’ lives. That’s because PECSYS is built on industry standard, commonly-used Microsoft technologies that easily fit into health facilities’ work environments to deliver solid results.
“We use PECSYS and Microsoft Office Excel to ensure that no patient misses an appointment or goes without proper follow-up care, which is a key factor in the successful chronic care model,” says Kershner. “It’s very easy for chronically ill patients, especially those battling depression, to quit on you, but with PECSYS we don’t let this happen.”
“When we first envisioned PECSYS, we needed a fast development tool that would be acceptable to hundreds of organizations,” concludes Ken Fabrick. “Only Microsoft products fit our criteria. We pushed Visual Basic to its limits and worked with Microsoft technical experts to help break through some unique situations. Today, we are consolidating our relationship with Microsoft and taking advantage of marketing opportunities that it provides us, such as speaking at the Health and Human Services Alliance Assembly in Washington, DC. With Microsoft’s backing, we plan to keep PECSYS at the forefront of innovation.”
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