Immunization Repository for a Large Healthcare Delivery System

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Our client is one of the largest not-for-profit hospital and physician networks in the United States with over 15,000 providers and over 2 million patients under care.

Our client is engaged in development of an enterprise-wide registry of immunization records for all patients under care within 11 hospitals and affiliated outpatient clinics in order to comply with the government guidelines and improve continuity of care. Additionally, the organization is in the middle of multi-year implementation and rollout process of Epic EMR system across the entire delivery system and is intended to import real-time and legacy immunization data into EPIC.

Challenge

Hospitals and outpatient clinics in the clients’ network are running on multiple vendor and in-house EMR and ambulatory systems which are being used to store and manage immunization data. In total the entire network has accumulated more than 40 mil legacy immunization records over a number of years. The data is “dirty” – has significant structural and content variances even within the same system.

It is critical to preserve historical sequence of data across all systems. Due to historical inconsistencies in data representation and ongoing edits of current and past records by clinicians importing legacy and current immunization records concurrently presents a significant challenge. The organization decides to impose a temporary ban on edits of the current records until legacy data import is complete. This decision imposes strict constrains on the timeline for importing extensive amount of legacy data.

Solution

A joint team of First Line and client engineers, medical informaticians, analysts and hospital IT staff has worked together over a period of two years to design a sophisticated process and infrastructure to populate the immunization repository with historical and real-time data and export this data to Epic and government agencies. We have developed 13 interfaces from the client systems and outbound interfaces to Epic and state vaccination registry. The interfaces used a variety of protocols including HL7, Web Services, flat file ingestion and proprietary APIs. We have also implemented complex data transformations that accounted for specifics of individual systems and variances in structure and content of data.

In order to provide high throughput for legacy data import our engineers designed high performance parallel integration infrastruture with a routing logic to guarantee preservation of historical sequence of records.

Business User Interface

Our team has developed a User Interface layer on top of the integration infrastructure specifically designed for clinical analysts to perform data validation, monitoring and debugging of the workflow.

Outcome

Using our troubleshooting and monitoring tools the analytical team on the project has been able to identify patterns and problems in the data during dry run imports of the data in the test environment. Based on this analysis we refined and improved data transformation scripts to achieve the desired level of fault tolerance and scalability in the interfaces.

The integration pipeline designed and developed by the team has imported and processed 40 million immunization records into the immunization repository at a rate of 200 records per second with no loss of data, interface breakdowns or reaching server capacity limits. The outbound interfaces have imported all records to EPIC and sent them to the state registry. The pipeline is now continuously processing real time records from all organizations participating in the immunization repository.

Technologies

InterSystems Cache, Ensemble, Objectscript, .NET, C#, MVC, Javascript, Ajax libraries

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Client References

I want to express my gratitude for all of your team’s hard work, support and extra help. We are very grateful for all that you have done for us.
Senior Project Manager, a U.S. specialty digital design and web development agency

Your quality of work is exceptional, and your flexible approach has allowed us to build and deploy a large amount of complex functionality in a very short space of time. Kudos to everyone for their professionalism and for delivering results that exceeded our expectations.
CEO, leading social media analytics provider

We have never had a better release that we can think of. And that is all because of your hard and dedicated work. So here is a big THANK YOU to everyone from all of us!
Editor, leading Scandinavian newspaper

For a software vendor like ourselves, picking the right development partner is crucial. First Line’s technical expertise and solid project management, coupled with their proficiency in Agile methodologies, have made them an integral part of our product development group.
VP Product Development, leading enterprise software vendor

Our First Line Team has been doing a great job. All of the guys check in great code, and they have a forward thinking mindset, not a feature-to-feature approach. They are also very open in terms of sharing knowledge, which is critical to running productive distributed teams.
Application Development Director, global marketing company

We've all learned a lot from you, and it is great working with you.
Application Development Director, global marketing company

The First Line team has an excellent process and we can learn from your team and improve.
Product Owner, Strategic Software Consultancy

I would like to thank the First Line development team for their dedication and high level of quality in their work. Despite being thousands of miles apart, we have been able to work quickly, effectively, and intelligently. Your team has been a major part of why we have been successful thus far.
VP Engineering, e-learning startup

First Line is a great technology partner capable of delivering complex, ‘industrial grade’ projects. They have demonstrated strong technical competence and solid understanding of the media and publishing domain. We have also been very impressed by the management team's attention to our needs and commitment to our success.
CEO, leading European digital media company

Your effort is the #1 reason that this project is going so well. I've worked with a lot of teams over the years and there are very few teams that I trust and respect. When you are given a task or feature, I never have to worry whether or not it will be accomplished on time and I never worry about the quality - you always deliver.
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The team we put together in the last half of this year is one of the most productive, skilled and enjoyable I’ve ever worked on. It’s great to see the product brought to life, and I’m proud to work with all you folks.
Senior Architect, Fortune 100 company

The First Line Software team is professional, results driven, and proactive. I know that when we provide requirements for new functionality, they will not only deliver on the scope of what has been asked but will look beyond and give insight into how we can make our product even better. It has been a privilege to work with First Line Software, and I look forward to continuing our partnership in future.
VP, global marketing company

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