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Databases everywhere…


In a galaxy far, far, away there existed a very unique application with a very unique database.  I do feel that the original incarnation of the application should be at the minimum in a reference book and perhaps, the Smithsonian.  The design came from a time when architects were not happy with what Microsoft had to offer and tried to do their own thing.  On a side track, was the push towards model driven development and modeling business processes into applications.

Heh, I got to play in all of those environments and gathered a bit o’ knowledge from the experience.  So, I had an antique application that enhancing wasn’t in the picture.  It was based on a “bound” technology and the only resolution was a complete re-write.  I can hear the collective groans over the time this was going to take.   Four years…that was the resource cost.  Why?

Knowledge about the industry:  Medication management is a very important and critical process.  It must be exact.  That is the first criteria.  Now let us add in the rest:

  • Regulatory
  • Compensation
  • Changing fact and measurement dimensions
  • Volatile environment

Regulatory:

This is a known, known in the design wheel.  Our product must comply with any regulatory requirement from CMS, DEA and even state and local governments and agencies.  So we have to have a dynamic security profile that can be applied in any connection consideration as well and data I/O.

 

Compensation:

Here we have a changing environment where data analytics will play a key role for current and future compensation.  Our data structure is designed around the object model that represents the business environment.  There have been historical requests that I have been unable to respond to because of the legacy database.  One of my main goals was to ensure all data entered was structured so that it was suitable for a data warehouse and analytical treatment.   Ah, the joys of writing from the ground up.

Changing Fact and Measurement Dimensions

One of the challenges we had to consider was the constantly changing dynamics of the medical reporting needs.  CMS and others, are pushing for quality care.  That has always been a major consideration in design.  The biggest question to answer?  What design will allow easy extension on the focused area of change and can maintain a consistent database model?  That is always a key focus.  Database changes are extremely costly.  The underlying physical database has to be:

  1. Isolated from the application
  2. Only accessed from the logical layer

Because of this, structures to manage the dynamic changes in the business requirements were engineered into the design.  This allows us to add new  values and fields without have to modify the database.

Volatile Environment

The last consideration I had to take into account was the constant changing government requirements around healthcare.  As we all know, currently, this is still in a state of change and varying requirements.  So any system designed around this has to be flexible in adapting to new changes.  This is where “from the ground up” gives us a real advantage.   We were able to engineer around all of the current requirements, provide for future changes and base it all on what is needed.

Summary:

We have built an application that will manage all care administrations that a care facility will need but also an application for anyone who has need to report on health care management.  The scope of what we have to track has gone beyond “give 1 pill a day” to:

  • How is Mary Feeling Today?
  • Has Mary gone for a walk?
  • How much has Mary consumed in food weight?
  • How much has Mary’s excrement weighed?

As you can see from the sample questions, we can produce a lot of useful and interesting information.  That is just the tip of the iceberg.  There is a whole wealth of medication information that can be derived from the results of both the medication and vital measurements.

I am really excited that we are reaching the final evolution of the new application and I can convert my existing customers over.  We have implemented so many improvements and made sure the application has flexibility for future enhancements with a short turnaround.

Lastly:

I have learned more about health care management, resident care and ongoing needs than I ever knew existed.  We all will experience some form of elder care.  If anyone I know goes under care, I want them to be under our system because I know we will be monitoring all the key points and the resident and their family will have an open pipeline for secure communication.

More to come… 🙂

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