Quick and user-friendly electronic patient files for Jessa Ziekenhuis

Care providers at Jessa Ziekenhuis are there for their patients 24/7, and they need fast, reliable electronic patient files to do so. When their Electronic Health Records software C2M became more expensive, less available and harder to change, the hospital looked for a partner to rebuild it. Together, we developed GEMS: the Global Electronic Medical System.

Challenge

Electronic Health Records software that could no longer keep up

Jessa Ziekenhuis was looking for a partner to rewrite C2M, its Electronic Health Records software. The existing application was causing more and more problems:

• Rising maintenance costs: the cost of maintaining C2M increased year after year and was getting out of proportion.
• Growing unavailability: the entire application went down more and more often, which raised both costs and the risk of medical errors.
• Outdated, inflexible technology: just starting up the C2M environment could take half an hour or longer.
• A stalled backlog: the hospital had built up a list of feature requests that were no longer being implemented.

Building such a large application in a short period of time required time and expertise that Jessa Ziekenhuis didn't have in-house.

Solution

GEMS: a new Global Electronic Medical System

Together with Jessa Ziekenhuis, we built GEMS: the Global Electronic Medical System. As a complete Electronic Health Records application, GEMS had to meet high functional demands:

• Extensive EHR functionality, including a medical dashboard, integrations with several other applications and data security management.
• Parallel use of C2M and GEMS, with data changes visible in both applications, to keep the risks of the transition as low as possible.
• Support for 2,500 different users who are there for their patients 24/7.
• A great UX and quick response times.

The project itself came with its own challenges. GEMS was a large project: the first production release alone required 315 story points, and we have since delivered more than 430. The deadline was tight, with the first production release planned in less than a year. And it all called for close collaboration with the hospital.

Approach

One joint team, a strong UX focus and proven technology

Working together as one team

Together with Jessa Ziekenhuis, we set up a joint development team that worked through all iterations of the new software. The team brought together application administrators and various profiles from the healthcare sector, and used best practices from the XP, Kanban and Scrum methodologies.

A user-friendly application from day one

From the start of the project, it was clear that end users had to be able to use GEMS with minimal training, and that quick interaction with the application was crucial. That's why we invested a lot of time in a great UX and UI.

Built on innovative technology

To jump-start development, we built GEMS on the ACA Platform: our Java platform that combines a number of modern, constantly evolving tools and frameworks.

• Back-end: Java in a modular OSGi approach on an Apache Felix application server.
• Front-end: an Angular application, bundled with Webpack and delivered to end users in an Electron UI.
• Testing: a high test coverage with different kinds of tests on all layers of the application, using Protractor, JUnit, Karma, JMeter and Selenium.
• Build and provisioning: Jenkins automates the entire build, release and installation. Provisioning happens on Linux with Ansible and Docker.
• Support and monitoring: Atlassian tooling for project support, the New Relic suite for monitoring and IntelliJ for all development tasks.

Outcome

A fast and reliable EHR system for 2,500 daily users

GEMS went to production in July 2017 and followed a strict rollout schedule. Over 7 months, all departments of Jessa Ziekenhuis were trained and configured. By March 2018, the entire migration from C2M to GEMS was complete.

• Quick and intuitive: 80% of all user interactions between two different screens happen in less than 2 seconds, and end users consider the interface quick and intuitive.
• No unplanned downtime: there hasn't been any unplanned unavailability during the entire period.
• Used every day: GEMS now serves about 2,500 users on a daily basis.
• Low maintenance: since the migration, we have only carried out limited maintenance and added a number of feature requests to GEMS.

Used technologies

ACA Platform · Java 8 · Entities · EclipseLink JPA · Spring · Liquibase · JAX-RS · OSGi modules · Bootstrap · Angular · Webpack · Karma · Gulp · ESLint · Protractor · Electron · JMeter · Unit testing · Integration testing · Jira · eazyBI · Bitbucket · Confluence · Jenkins · Apache Felix · New Relic · Amazon · IntelliJ · Docker · Ansible