World s Second Largest HMO Achieves Real- Time Patient Information Integration

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1 Microsoft Customer Solution Healthcare Industry Case Study World s Second Largest HMO Achieves Real- Time Patient Information Integration Overview Country/Region: Israel Industry: Healthcare Customer Profile Clalit Health Services is the largest health service provider in Israel and second largest worldwide, with 16 hospitals; 1,300 clinics; 420 pharmacies; and 3.75 million members. Business Situation To fend off competitors, Clalit needed to increase its business agility, enhance its offerings, and meet a growing consumer demand for e-health services while lowering costs. Solution Clalit implemented Microsoft BizTalk Server 2002 along with Itemfield ContentMaster to consolidate data from 20 systems and 189 legacy applications into an integrated, online view of patient information. The EI solution is now processing >1 million messages per day. Benefits Empowered 3.75 million members with secure online health services Increased productivity, improved decisionmaking among 25,000 medical and administrative staff Accelerated business processes by >20x "We have reached full integration as an organization. People told us that it would be very complicated, that the risks were too high, that it would take too much time and effort. But we were able to achieve integration in months, not years." Gadi Gilon, Chief Information Officer, Clalit Health Services As Israel s largest healthcare provider, with 3.75 million members, Clalit Health Services faces the same business pressures that confront health plans across the globe: rising costs and growing consumer demand to play a greater role in financial and clinical decisions. Clalit recognized that to make the most effective day-to-day decisions, its staff and patients needed online access to relevant, useful information. Delivering this data on-demand required a low-cost and lowmaintenance enterprise integration (EI) solution. Clalit turned to Microsoft BizTalk Server 2002 and ContentMaster from Itemfield to consolidate data from more than 20 disparate systems. Up and running in months, the EI solution has had a dramatic impact. Millions of members now have online access to vital information and services. Business processes that used to take 4-6 months to implement now take less than 2 weeks. And, Clalit s 12,000 doctors and nurses are making better-informed decisions to reduce errors, lower costs, and improve the health of Clalit members.

2 Situation Serving 60 percent of the Israeli population, Clalit Health Services maintains a vast network of facilities, including 16 hospitals; more than 1,000 clinics; and 420 pharmacies spread across the country. In recent years Clalit has been grappling with the pressures of spiraling healthcare costs, as well as increasing competition from other providers. To successfully retain and grow its customer base, the organization must respond quickly to competitive offerings and continually improve its services to meet customers evolving demands while also strictly containing costs. Clalit recognized that to meet all of these business needs, the organization would have to increase its efficiency and productivity systemwide. Gadi Gilon, Clalit s Chief Information Officer, believed that the organization s 25,000 doctors and administrators could make better, faster, more cost-effective decisions if they had access to comprehensive, integrated patient information at the point of care. Improved access to clinical information would also serve customers growing demand to participate more actively in their healthcare decisions. Clalit thus wished to transform its decision support methodology from a health plan-centric model to an on-demand model driven by providers and members. The medical sector has traditionally concentrated on the supplier, says Gilon. Last year, there was a clear change in the medical informatics arena. We realized our focus was not in the right place that we needed to think from the customer s perspective. The challenge for Clalit was how to integrate all of its medical information and present it in a meaningful, useful way. The organization s technical infrastructure was born 30 years ago, and, like most legacy networks, grew into an extremely complex, decentralized, heterogeneous environment. Clalit s primary database, holding more than 3.75 million customer records, is housed in an Adabas system running on a legacy IBM Mainframe with a VSE operating system. Even more patient information is located on at least 5 other database applications of various vintages, including Microsoft SQL ServerTM 2000, Oracle, Ingres, DB1, Informix, Datacom, and Btrieve. Each of the 16 hospitals has a stand-alone IT system, which previously had very little capacity to exchange data with the others. If a patient had moved within the country at any point, some of their clinical data would be on one system and some on another, and their current provider would not have access to prior records. To further complicate matters, each of Clalit s suppliers has its own information system, many of which are 20 to 25 years old and based on proprietary technology. It could take days to receive data from suppliers, and the information came in a wide variety of forms batch processes, printed reports, faxes, or PDF files. In addition, Clalit was running 189 specialized medical applications with varying types of output. With 40 million customer interactions per year, Clalit was juggling 3 terabytes of patient data in 300 different data formats. It was very clear to Gilon that the organization could dramatically lower costs, increase productivity, and improve the quality of its services by integrating this data. But, he says, getting all the information about patients into one view seemed like mission impossible. But Clalit was determined to accomplish this seemingly impossible task. We wanted to provide medical treatment in a high quality sense, says Gilon. We wanted our providers

3 Microsoft is taking us forward with clear vision. They are consistently challenging themselves and others to create the most effective technology. Gadi Gilon, Chief Information Officer, Clalit Health Services to be able to see all the information about a patient from birth to death not more than was needed and not less than needed. And, we needed to reduce complexity in our organization, to become more agile. Solution To streamline operations, improve treatment processes, and lower costs, Clalit decided to pursue an enterprise integration (EI) solution. It envisioned creating a communication layer between their many islands of data and the users who needed to access that information. Clalit carefully considered the range of technologies available, including a Sun/Oracle solution. In the end, it chose Microsoft BizTalk Server BizTalk Server is part of Microsoft Windows Server SystemTM integrated server software designed to optimize manageability, security, and reliability while lowering the overall cost of operations. Microsoft is taking us forward with clear vision, says Gilon. They are consistently challenging themselves and others to create the most effective technology. Clalit also needed a companion technology to transform the many varied data formats into a common XML format. We were dealing with an incredible complexity of operation, including applications developed 20, 25, or 30 years ago, explains Gilon. All in all, the data that Clalit wished to consolidate was in more than 300 disparate formats, including flat files and many variants of HL7, a proprietary healthcare protocol. Clalit s IT team realized that it would take years to develop custom converters for all of these proprietary data formats. Then it discovered a much easier solution: ContentMaster, a data transformation engine by Itemfield, a Microsoft Certified Partner. According to Gilon, BizTalk Server was the best solution for Clalit, for the following reasons: Clalit had proved Windows Server System to be enterprise-capable and a core component in its infrastructure. The Windows Server System components are easy to implement out of the box they don t require a lot of development to connect with other systems, explains Gilon. The organization performed a financial analysis and determined that the BizTalk solution would have the lowest total cost of ownership (TCO), due to its interoperability with other Microsoft products, its ease of operation, and favorable licensing costs. Clalit s IT team tested SOAP, which would be a key part of the solution, and was very pleased with its performance. The openness of BizTalk Server technology had a strong appeal to Clalit for future development potential. Finally, the organization was confident in the direction of Microsoft technology. ContentMaster is a universal adapter that transforms any data format to XML with no programming. By acting as an adapter toolkit, it enables BizTalk Server to accommodate any data type, whether complex, structured, semistructured, or unstructured. ContentMaster also has all healthcare standard libraries built into it. The only way to bring all of our technologies into one was via Itemfield s ContentMaster, says Gilon. It gave us an agile, low-cost solution to a very complex issue.

4 Itemfield s ContentMaster gave us an agile, low-cost solution to a very complex issue. Gadi Gilon, Chief Information Officer, Clalit Health Services Current architecture of the Clalit Health Services enterprise integration solution. Client Systems (Microsoft Visual Basic 6.0, Microsoft ASP, Microsoft ASP.NET, Microsoft MS Java applications) Microsoft MSMQ Legacy File System Itemfield ContentMaster Microsoft BizTalk Server 2002 Adabas Unsynchronized Messages Microsoft SQL Server 2000 Itemfield ContentMaster Connectors Web Services UNIX Architecture & Implementation Clalit s EI solution is composed of two companion processes: Synchronized messages real-time, ad hoc user requests for data are processed via Web services. Clalit designed and developed an interface with Microsoft Visual C#.NET 2003 development tool to generate and receive these messages. Various programs at the clinics, developed in Microsoft Visual Basic 6.0 development system, Active Server Pages (ASP), and Microsoft ASP.NET, as well as Java clients and legacy Microsoft MS-DOS applications, call the Web services. Unsynchronized messages, which are generated through ongoing, routine data integration processes, are orchestrated by BizTalk Server. SOAP IBM Mainframe -DOS, and Synchronized Messages Siebel CRM System ContentMaster is responsible for parsing, splitting, and filtering all incoming and outgoing messages. For example, if a pharmacy sends a patient query from its proprietary, HL7- based system, ContentMaster receives and assesses the message as follows: If the message is not clean enough, ContentMaster stops it and generates a BizTalk Server message alert, including a full description and hot link to the design time environment to allow for rapid correction. If the message is too large, ContentMaster divides it into smaller components. ContentMaster then parses the message, converts it to XML, and passes it on to BizTalk Server. BizTalk Server manages the business process, sending the query to the sources of data and orchestrating the response. ContentMaster converts the response back into the appropriate data format to send back to the querying pharmacy. Clalit installed 14 servers in 7 different locations to run BizTalk Server. Implementation of BizTalk Server was very quick and very reliable, comments Gilon. What we anticipated was exactly what happened. BizTalk Server sits on Microsoft Windows 2000 Advanced Server, as does ContentMaster. In just 8 months, Clalit installed the system and got 3 newly integrated business processes up and running through the solution. In the next year, it implemented an additional 10 automated processes, and by the third year, it had put 40 to 50 new business processes into play. In the biggest of these projects, Clalit built a new central database on Microsoft SQL Server 2000 and set up a process to automatically transmit and store all consolidated clinical data.

5 It used to take us 4 to 6 months to implement a new query. Since installing our BizTalk solution, to analyze and develop a new query takes just a week and a half including QA. Rabeh Mansour, EAI & DBA Team Leader, Clalit Health Services The BizTalk Server and ContentMaster solution has proven extremely reliable for Clalit. The system is load-balanced and clustered and has been very, very reliable, comments Gilon. And, it s extremely secure. We got the high level of security we needed for our queries through Microsoft Windows Server System components such as Active Directory and Certificates of Authorization, without having to purchase additional programs. The EI solution is now processing 1 million messages per day, and performing several hundred data transformations per second. Clalit has now integrated 20 different systems, as well as 5 external business partners. Benefits It is impossible to quantify the enormous impact of Clalit s BizTalk Server EI solution, which has affected 3.75 million members and 25,000 care providers; increased productivity across the entire organization; and revolutionized Clalit s business processes. Among the many positive results of the implementation are the following. Accelerated Business Processes, Increased Agility Clalit Health Services faces constant challenges from competitors. Because we re the biggest, we re the ones to beat, explains Gadi Gilon. In this competitive marketplace, we need the flexibility to respond quickly to these challenges. Gilon says that the EI solution has given Clalit the ability to change strategic directions very quickly. The IT department can now implement new processes more than 20 times faster than before. It used to take us 4 to 6 months to implement a new query, says Rabeh Mansour, EAI & DBA Team Leader for Clalit. Since installing our BizTalk [Server] solution, to analyze and develop a new query takes just a week and a half including QA [quality assurance]. Before, to deploy each new query, we would have to send a technician to make the change on 10,000 workstations or develop a special implementation program, adds Gilon. Now we don t have to change the system itself we just have to change the query. So, our delivery time has gone from weeks to minutes, and we save a tremendous amount of manpower. Increased Productivity, Lowered Costs Clalit Health Services has dramatically improved its organizational productivity as a result of its BizTalk Server implementation. We can now do more with less, says Gilon. We didn t add people we became more agile. The impact is particularly pronounced within Clalit s IT division, according to Ilan Yacoby, Chief Technology Officer. He states that the BizTalk Server implementation has lowered costs by 30 percent from the organization s previous proprietary solutions, increased development efficiency by 15 percent, and reduced querying errors by 15 percent. Gadi Gilon elaborates, Because of our use of Web services and the Microsoft.NET Framework, our development time has decreased in a very significant way. Many of our manual processes are now automated, and we have eliminated inconsistencies within our network, which used to consume a lot of energy. The ROI is very, very clear, Gilon concludes. Itemfield s ContentMaster also generated significant savings for Clalit, both in time and in costs. Thanks to ContentMaster, we saved over a year of work for four programmers, states Yacoby. ContentMaster also eliminates the work of one person per year on ongoing

6 We believe this is the first time a true medical CRM system has been created. When people talk about CRM in the health sector they are mainly talking about insurance data but real clinical information is lacking. We have created a comprehensive medical view of the situation of each customer. Gadi Gilon, Chief Information Officer, Clalit Health Services maintenance, producing a return of 300 percent annually in that aspect alone. Customer Empowerment The EI project has also empowered Clalit s members by establishing a secure e-health system. Our customers can now log in to a secure site and get all their medical information and lab results, and evaluate the information themselves, explains Gilon. This empowers them as consumers and also eases the burden of communication on the organization. Clalit s members now have secure access to a wide range of services: Lab results, presented graphically Scheduling tools Self-service account management Newsletters Insurance sales Self-management of medical files 60,000 members are already using these services online via the Internet. And, all 3.75 million members can use the automated kiosks installed at Clalit s clinics. They simply swipe a magnetic card to sign in, and all their clinical orders and lab results are automatically waiting eliminating considerable paperwork on both ends. Soon we will be automating prescriptions in this way as well, adds Gilon. Thanks to our BizTalk [Server] solution, eventually all paper will be eliminated. Improved Quality of Care Perhaps most important, the BizTalk Server EI solution has had a major impact on Clalit s delivery of medical services. We have created a new working environment for our caregivers, explains Gilon. This is the first time our medical staff has been able to access clear, meaningful information in a short time. The most valuable thing to a doctor is time. Our physicians can now get all the relevant information about a client in one place at one time, without having to reinvestigate. In the past, he continues, they would have had a lot of information papers, faxes but it was not integrated. Now that they can apply intelligence tools to do things like compare between lab results, they can improve both the speed and quality of their diagnoses. And, it s easier for them to trust the information they re getting. Conclusion Clalit Health Services is very proud to have accomplished a mission impossible. We have reached full integration as an organization, says Gadi Gilon. This is something people couldn t believe. People told us that it would be very complicated, that the risks were too high, that it would take too much time and effort. But we were able to achieve integration in months, not years. Gilon concludes, We believe this is the first time a true medical CRM system has been created. When people talk about CRM in the health sector they are mainly talking about insurance data but real clinical information is lacking. We have created a comprehensive medical view of the situation of each customer. Clalit is continually making improvements in its systems to further increase productivity. The organization is now in the process of migrating to Microsoft BizTalk Server 2004 and Microsoft Windows ServerTM 2003.

7 For More Information For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) In Canada, call the Microsoft Canada Information Centre at (877) Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) in the United States or (905) 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: Microsoft Solutions for the Healthcare Industry Microsoft offers the healthcare industry an advanced set of flexible, cost-effective tools that connect employees, information, services, patients, and business partners, turning the accelerating pace of change into competitive advantage. For more information about Microsoft solutions for the healthcare industry, go to: For more information about Itemfield products and services, call (917) or visit the Web site at: For more information about Clalit Health Services, call +972 (3) or visit the Web site at: Microsoft Corporation. All rights reserved. This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Microsoft, Active Directory, BizTalk, MS-DOS, Visual C#, Visual Basic, Windows, the Windows logo, Windows Server, and Windows Server System are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. The names of actual companies and products mentioned herein may be the trademarks of their respective owners. Document published July 2004 Software and Services Products Microsoft Windows Server System _ Microsoft BizTalk Server 2002 _ Microsoft SQL Server 2000 _ Microsoft Windows 2000 Advanced Server, with Active Directory Microsoft ASP Microsoft ASP.NET Microsoft Visual Basic 6.0 Microsoft Visual C#.NET Microsoft Message Queuing Itemfield ContentMaster Technologies Microsoft.NET Foundation Services SOAP Web services XML Hardware IBM, HP 2-way servers with 2 GB memory Partners Itemfield