Call Navigator – Hippa Compliant Remote Discharge Software
The Problem
Hospital readmission rates have long been a concern for healthcare providers, as they can lead to increased costs and reduced patient satisfaction. However, a growing number of hospitals are turning to remote discharge nurses to help reduce readmission rates and improve patient outcomes.
Altrix Group initially approached us to replace one of their main clients (a mid size hospital in the St. Louis, IL area) to replace their old, antiquated discharge management software. The idea was to create software the was owned by Altrix Group that they then managed and res old to their clients as a solution to their needs for remote discharges. The software was to be designed in a way where adding additional facilities would be relatively simple and just require a single new service for things to integrate seamlessly.
Creating software from scratch is always a challenge but luckily its what we at DataOne Digital specialize at. For most projects we would take an agile approach where we would get the idea and do some very primitive designs and begin developing as soon as the architecture was set. This was not a common project though, for this software we had a 4 month deadline to design, create and deploy the software. On top of everything it had to be HIPPA compliant as well as pass individual hospital security inspections and have a handful of hospital specific requirements such as using a shared identity provider for certain hospital employees to gain access.
This was a big job for such a tight timeline. One thing we refuse to be at DataOne Digital is one of those software service providers that over promises and under delivers, Too often do we see clients burnt out by this and is something you will not find at DataOne Digtal. With that in mind we had to go to Altrix and talk about either a more realistic timeline or a reduction in features. Due to business requirements, our deadline had to stick and we were able to scale down the features just enough that everyone, including the hospitals were happy with the MVP with the expectation of more coming in 2023. Our updated requirements meant our software needed to only be for follow up calls by nurses to call patients and ask questions from a discharge template and then follow up with them. Lastly all of the analytics on the success of the calls and the changes to a patient had to be logged and analyzed in a dashboard that hospital managers could access and use to make decisions.
With that in mind we got busy designing the software. Keep reading to see exactly how we did it or if your a nerd like us skip to the end to see the technical stuff!
*Certain data is hidden for compliancy reasons
Process & Results
When building software there are 2 common methodologies that you will see in most software companies, one is the agile methodology, and the other is known as the waterfall methodology. Despite what a few fanboys might tell you, neither is inherently better than the other, it truly just depends on the project requirements. In the case of Call-Navigator the answer was clear, we needed to start with waterfall and we could reevaluate after Altrix Groups primary client needs were met.
Our first step was to begin by gathering all the requirements needed to build the software from start to finish. This was simplified since we had to to make due with specific import data provided by the hospitals. This import data then had to be transformed and used as the primary source of data in the entire application. Next came the design phase and this was honestly one of our favorite parts of the entire project. Here we create UML and class diagrams that laid out the entire application. Additionally we created had to design our deployment architecture and begin worrying how exactly we make the application HIPPA compliant and meet the budget we estimated that monthly server cost would run. If you’ve never seen a UML diagram here is an example but we can’t show the real thing here due to security concerns.
Process & Results Cont.
With what we thought was all the requirements defined , a design approved by Altrix Group, and a solid architecture designed by our software engineers we got to work building the software. As the site started to come to life we had our first hurdle which was to describe the deployment architecture to the variety of hospital security teams. Many wanted specific features integrated that we had not expected. DataOne Digital handled all communication with the Hospitals in regards to technical and security concerns to the App. After some explanation most teams gave the okay that if designed as specified things would be fine, a few others required additional things such as SFTP servers and using integrated SAML providers as well as wanting specific VPN requirements.
Part of our job at DataOne Digital is to handle everything needed to create an app, we love working with dedicated product managers when available, but if not that’s okay as well because we work with our clients and act as the IT arm for your business when you hire us.
After constant communication with both Altrix Group and the Hospitals we were incredibly close to being done, we just had one thing left to do before going live, Test!! We are big believers of testing and quality at DataOne Digital. There is not point to pay money for a product that is not going to last or work as you want. We had 1 month to test and have Altrix Group help test and give any final feedback before the official production release which would immediately go live to the hospitals. In that time we found a handful of minor issues and a few changes to improve the user experience where made.
Ultimately we were able to deliver great software that met all the requirements on the timeline we promised and stayed within the budget we estimated! Additionally our hosting cost where correct within 5% of what we estimated. This was genuinely such a fun project to work on, our people love what we do and projects like this that really make an impact makes us proud to be part of DataOne Digital.
Technical Specs
This application was to be a cloud based Saas. We initially had considered building the application using Laravel 8.0 but our client Altrix Group had made comments that a mobile companion may added in the future. They also wanted the app to be quick and reactive and able to handle large amounts of data.
We ended upgoing with an Angular 13 frontend that was supported with a .net core 6.0 C# web api, for our database we went with mysql.
We started local development with an in memory database that works with Angular, and then we simply mocked up our services to call that fake database, this meant all we had to do was update our api endpoints and thing’s should just work, and surprisingly for the most part it did just that. For the backend we created the C# api that handled all of the front end request. In the begging we created a custom JWT flow to handle authorization, we relied on this for a lot of fancy role based access as well as some interesting ways to validate possible security issues that lock down the system which I’m not going to get into here.
Additionally we had to integrate AWS into everything! We used AWS since its the simplest way to handle HIPPA compliance in our opinion. We hooked up custom AWS cloudwatch for our logging as well as SES for emails and AWS Cognito to handle custom identity providers.
For deployment of course we used AWS. We had considered a serverless approach but wanted more control and ended up using docker and EC2 to run the API. Everything was neatly tucked behind a load balancer. There were a handful of other fun things we had to solve such as how to monitor dead emails for SES and putting the Angular application into an S3 bucket that then had a Cloudfront distribution in front of it.
The last thing I want to mention is how we made deployment super easy. We have used terraform in a handful of projects but decided to use gitHub actions a try and it did not disappoint. It was so simple to setup and did everything we needed to get the docker image out as well as updating s# and even invalidating the Cloudfront cache! Our moto is to automate everything possible and I feel we really were able to accomplish that this project.
If your a developer with a project in mind or just want to reach out in search of employment opportunities, we are always looking for smart and talented developers. Just drop us a message and ask if we are hiring! Or just reach out and say hey, it’s always nice to meet like minded individuals!
