Customer Solution Case Study
/ / Hosted Solution Offers a Better Option for Medical Practice Management and Billing
Overview
Country or Region: United States
Industry: Information technology
Customer Profile
Based in Salt Lake City, Utah, AdvancedMD offers hosted solutions for medical practice management, billing, and electronic patient record management.
Business Situation
AdvancedMD needed to deliver a hosted solution that avoids the issues plaguing traditional client/server solutions as well as the performance drawbacks of traditional Web applications.
Solution
The company’s Web-based solution facilitates centralized management and deployment, and the use of AJAX programming techniques improves application responsiveness.
Benefits
n Low total cost of ownership
n Ease of management
n Rapid time-to-market
n High availability / “Thanks to our use of Windows, our cost model isspectacular.”
Ken Meyers, Vice President of Operations, AdvancedMD Software
In 2000, AdvancedMD Software set out to deliver a medical practice management solution that spared customers from the costs and complexity of traditional client/server applications. AdvancedMD, the company’s hosted service, provides the tools that healthcare providers need to run their practices but does so for low startup costs and a predictable monthly fee. Web-based delivery and centralized system management speed new deployments, ensure superior availability, and eliminate the need for on-site technical expertise, while the use of an Asynchronous JavaScript and XML (AJAX) programming technique provides application responsiveness similar to that of a desktop application. Through its use of Microsoft® software to deliver its Web-based service, AdvancedMD Software—and its customers—are benefiting from low ownership costs, ease of management, rapid time-to-market, and superior uptime.
Situation
AdvancedMD Software provides hosted software solutions for the healthcare industry, including AdvancedMD, a medical practice management and billing solution, and AdvancedEMR, an electronic medical records (EMR) management solution. As of May 2006, the company had under contract roughly 4,400 healthcare providers, which encompass more than 10,000 users and 5 million active patients in all 50 U.S. states.
AdvancedMD Software was founded in 1999 by a reseller for an existing practice management system, who set out to deliver a better solution than the current client/server applications. Requirements for the new solution, many of which directly reflected theshortcomings of those client/server applications, included:
n Better support for providers that have multiple offices.
n Reduced deployment costs, whether the customer has one location or many.
n Ease of use for smaller medical offices, which typically do not have an IT person onstaff.
n Ease of support for the vendor, including the ability to deploy software upgrades remotely.
n High levels of uptime because the solution is mission-critical to most medical practices.
n The ability to meet security and privacy requirements mandated by the Health Insurance Portability and Accountability Act(HIPAA).
AdvancedMD Software first considered building the new solution using Delphi technology, but that option would have resulted in many of the same deficiencies that existing client/server systems had. The company then looked at building a completely new client/server solution that could be managed and updated over the Internet but found that such a software development effort would have been too great.
“We needed the deployment and centralized management advantages of a Web-based solution without the inherent user-responsiveness issues,” says Troy Young, Vice President of Development at AdvancedMD Software. “People who regularly use our solutions must enter data hundreds or thousands of times per day, and the delays caused by continual roundtrips between the browser and a Web server to refresh the user interface would not have been acceptable.”
Solution
AdvancedMD, the company’s hosted practice management and billing solution, provides the tools that healthcare providers need to run their practices without posing many of the drawbacks of traditional client/server solutions. Economies of scale allow AdvancedMD Software to deliver the service with low startup costs and at a reasonable and predictable monthly fee, while Web-based delivery and centralized system management speed deployment, ensure superior availability, and eliminate the need for on-site technical expertise. The use of Asynchronous JavaScript and XML (AJAX), a newer Web programming model, provides application responsiveness that is more like that of a desktop application, ensuring that users are not continually waiting for their screens to refresh.
Because the AdvancedMD service is centrally hosted and delivered over the Web, it can easily span multiple offices. The only technology required at a customer location is a PC with a Web browser, eliminating the need for resident technical expertise or costly visits by a reseller or service provider. Because the service supports both practice management and billing, medical offices can easily do their own billing or outsource that function. Compared to client/server applications, AdvancedMD also helps ensure compliance with HIPAA security regulations more easily, which frees healthcare providers to focus on patients instead of technology issues.
Continued Growth
AdvancedMD Software finished development for the initial version of its hosted solution in April 2000 and started marketing the solution in September 2000. In the beginning, the service was hosted on two Web servers running the Microsoft® Windows® 2000 Server operating system with Internet Information Services (IIS) version 5.0, a database server running Microsoft SQL Server™ version 7.0, and a report server running Crystal Reports.
Sales were slow at first—due in part to the novelty at that time of a Web-based delivery model. In 2004, however, subscriber growth started to climb quickly and steadily, and AdvancedMD Software had to upgrade its hosting infrastructure to support that growth. Over a period of several months, the company doubled its hosting hardware and upgraded its database servers to the Windows Server™ 2003 operating system and SQL Server 2000.
Since that expansion, AdvancedMD Software has deployed additional Microsoft technologies to support new functionality in its service, including:
n Reporting. AdvancedMD Software has moved virtually all reporting—more than 100 standard reports—off Crystal Reports and onto SQL Server 2000 Reporting Services, which services more than 24,000 report requests per day. The company is currently upgrading to SQL Server 2005 Reporting Services and will use that component’s Report Builder feature to make it possible for customers to create their own reports.
n Integration. AdvancedMD Software used Microsoft BizTalk® Server 2002 to integrate its solution with insurance companies and more recently BizTalk Server 2006 to integrate its solution with a third-party claims-scrubbing application. The company is now migrating the insurance functions to BizTalk Server 2006, and is taking advantage of the ease of development, deployment, and management now available to expand the third-party interfacing capability of its offering.
n Proactive monitoring. AdvancedMD Software uses Microsoft Operations Manager 2005 to subject all the Windows-based servers in its data center—including hundreds of application and server elements—to highly refined levels of continual monitoring.
AdvancedMD Software is working to upgradeits remaining Web servers to Windows Server 2003 with IIS 6.0 over the next several months, and its database servers to SQL Server 2005 over a similar time frame. “With Microsoft software, we’re able to scale out each tier of our solution separately, as required to support business growth,” says Ken Meyers, Vice President of Operations at AdvancedMD Software. “And with Windows Server 2003 and SQL Server 2005, we expect to be able to support more customers and users per server, as well as take advantage of some tremendous new manageability features.”
HIPAA Support
For healthcare providers, the AdvancedMD service helps address many of the challenges
associated with establishing and maintaining HIPAA compliance, including:
n Transaction sets. All transactions supported by the AdvancedMD service arein compliance with HIPAA-designated standard ANSI formats.
n Security and backup. Electronic data is stored in a world-class data center that has eight levels of security, including biometric access, bulletproof glass, 24-hour monitoring and patrol, locked server cages, and sophisticated firewalls. Secure Sockets Layer 128-bit encryption is used to safeguard data transfer, and users are automatically logged off after a period of time to prevent unauthorized access to patient data. AdvancedMD stores a record of all users logging on and off the system, as well as a record of all changes to patient data. Overall, the AdvancedMD managed Web solution addresses 32 of the 47 HIPAA Security requirements, whereas typical client/server applications address only 10 to 12 items.
n Privacy. Because access to patient data is based on administrative rights and user roles, that data is accessible only to authorized parties. The solution also provides a set of helpful tools for managing patient consent, including electronic form storage and automated reminders.
Benefits
Through its use of Microsoft software, AdvancedMD Software is realizing several key business benefits, including a low total cost of ownership (TCO), ease of management, and high availability. Many of those benefits are passed on to customers in the form of lower costs, the elimination of technical complexity, and service availability. Taken together, the advantages provided by AdvancedMD Software’s hosted solution have fostered a 98 percent customer retention rate and are helping the company sustain a 100 percent annual growth rate.
Low Total Cost of Ownership
Healthcare providers that use AdvancedMD will benefit from lower costs. Traditional client/server practice management solutions can cost U.S.$25,000 to $100,000 to acquire and set up, and can accrue additional costs for continued support and upgrades. In contrast, the AdvancedMD service costs $4,000 per practice to get started, and a $359 monthly subscription fee includes all maintenance, upgrades, and support.
AdvancedMD Software is able to deliver its solution at a reasonable cost because its own IT infrastructure costs remain low, even through a period of rapid growth. “Thanks to our use of Windows, our cost model is spectacular,” says Meyers. “The Microsoft licensing model for application service providers is a big plus, because we can fund our infrastructure growth out of cash flow.”
Ease of Management
Ease of management is another key benefit for AdvancedMD users, who do not need to concern themselves with maintaining a technology solution in-house. The same benefit applies to AdvancedMD Software—just four people administer the company’s entire hosting infrastructure, even though the facility is located hundreds of miles away from corporate headquarters.
“Ease of management is another strong contributor to our low TCO,” says Young. “One reason we never looked seriously at Linux is because of its tool set. The tools provided in the Windows platform are a world apart from what you can get with Linux, and the amount of time and money saved by developing and managing with a richer tool set is huge. There’s no way we could have saved money with Linux.”
Rapid Time-to-Market
Because the AdvancedMD service has a Web-based delivery model, new customers can be up and running on the service in just a few days. AdvancedMD Software can just as easily expand its infrastructure to support its rapid growth by adding a few more cost-effective, industry-standard server computers to whichever tier of its hosted solution requires the added capacity. Similarly, with integrated server software from Microsoft, AdvancedMD Software can easily add the new functionality required to continue fueling its business growth.
“Over the past 12 to 18 months, we’ve seen tremendous growth in sales to large billing-service providers,” says Meyers. “With tools like BizTalk Server, we can easily integrate with IT systems and data formats used by new customers and bring those customers online that much faster. In addition, larger customers typically have more advanced reporting needs, and SQL Server Reporting Services provides everything we need to meet our customers’ reporting requirements.”
High Availability
Because of the superior reliability of its IT infrastructure, AdvancedMD Software is able to provide customers with virtually uninterrupted service. One of the keys to that level of uptime is Microsoft Operations Manager (MOM) 2005, which the company uses to continually monitor all Windows-based servers in its data center. If a server exhibits abnormal behavior, MOM automatically sends an e-mail alert or pages a system administrator. In this way, the company can detect potential issues before they turn into problems that can affect service levels.
“Excluding scheduled maintenance each Tuesday evening, we have achieved an average uptime of better than 99.995 percent over the past three years,” says Meyers.
(The remainder of this document describes the technical architecture of the solution and the challenges faced in building it.)
Architecture Synopsis
The AdvancedMD service is based on a scalable, multilayer logical architecture. The solution was initially developed with Microsoft Visual Basic® development system version 6.0 to run in an Active Server Pages (ASP) and Component Object Model (COM) environment. It is now being upgraded to run on the Microsoft .NET Framework using the Microsoft Visual Studio® 2005 development system, which provides a single, integrated development environment for all solution components, including BizTalk Server and SQL Server.
Figure 1 illustrates the logical architecture for the hosted AdvancedMD service.
Presentation Layer
Older Web pages for the AdvancedMD service are based on ASP and run on IIS 5.0, whereas all new Web development is based on the Microsoft ASP.NET classes in the Microsoft .NET Framework. (The .NET Framework is an integral component of Windows that provides a programming model and runtime for Web services, Web applications, and smart client applications.) Development of AdvancedEMR, the company’s other hosted solution, began in April 2005 and is based entirely on ASP.NET.