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CASE STUDY
E-Prescribing SaaS System
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Proprietary & Confidential
NOVOBI, LLC. (www.novobi.com)
Email: info@novobi.com
Phone: 888-778-3895
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Contents
Introduction
Functional Requirements
Non-Functional Requirements
System Design
Surescripts Integration Summary
Software Development Process to Manage Risks and
Control Quality
Risk Management
Quality Assurance
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Introduction
The Project is to build a Software as a Service (SaaS)
ePrescribing system that meets all the industry
standards/compliance and is scalable to be able to serve
thousands of prescribers.
The Client is a leading MSO and IPA group in South
California. The group has been offering excellent services
to physicians and patients for over 15 years.
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Functional Requirements
Phase 1: core ePrescribing functionalities
All Surescripts integration components
Directories version 4.4
Prescription Routing version 10.6
Medication History version 10.6
Benefit Eligibility and Formulary version 1.0
Allergy Management
Medication Management (e.g. prescribers favorite meds)
ID Proofing (verify prescribers identity automatically)
Future plan: expand to be a Meaningful Use Compliance
EHR and support Controlled Substances
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Non-Functional Requirements
Reliability & Security:
Meets all Healthcare and IT industries security/reliability
standards and compliance for a mission-critical healthcare IT
systems.
Practices data will be separated
Scalability:
Horizontally-scalable SaaS architecture
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Non-Functional Requirements-Cont.
Maintainability:
Loose-coupling components architecture
Minimum 70% code coverage for business functions
Performance:
Meets the IT and Healthcare standard response time
Has automatic performance test running on production
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High-Level System Design
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Model View Controller (MVC)
architecture
Object Relational Mapping (ORM)
Service layer includes several high-cohesion
components: integration services, security
services, account services, etc.
A separate component for Surescripts
integration to minimize Surescripts upgrade
effect in the future.
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High-Level System Design Cont.
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SaaS architecture allowing each tenant to
have its own URL and separate database
schema
Sensitive data will be encrypted
Cluster architecture in both application
servers and database servers.
Hot backup/restore
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Server
System Architecture
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Client
Web Browser
Controller View
Model
Business Services Integration Services
SQL Server
Microsoft Entity Framework 4
HTTPS
Surescripts
Servers
MVC 3
HTTPS
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Technologies
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.Net Framework 4.0
MVC 3
ASP.NET
AJAX
C#
Web Services
HTTP/HTTPS POST with XML content
EDI/EDIFact/X12
Entity Framework 4.0
Microsoft SQL Server 2008 R2
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Surescripts Integration
Surescripts is the nations ePrescription network.
The system needs to integrate with Surescripts on the 6
components below:
Directories: manage Pharmacies and Prescribers in the network.
Prescription Routing: send/receive e-prescription related messages.
Medication History: retrieve patients medical history.
Benefit Eligibility: verify the insurance coverage status of a patient.
Benefit Formulary: manage medications effectiveness and value using
formulary suggestion from PBMs/insurance companies.
E-Prescription Activity Reports: provide tracking and compliance/fraud
prevention/efficiency analysis.
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E-Prescribing Process
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Source: Surescripts
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Stakeholders
Surescripts Certification Project Manager
Surescripts Certification Team
Surescripts Certification Review Board
Participant
PBMs
Surescripts Implementation Project Manager
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Surescripts Artifacts
Implementation & Directories guide
Connectivity and message specifications for Rx Routing,
Medication History, and Eligibility.
Directories specification to add, update and download
prescriber and pharmacy data
Certification Requirements (Includes Qualitative
Requirements and Application Certification Requirements)
Identify application level workflow or items that are
mandatory for transaction on the Surescripts network
Certification Test Scenarios
Test cases used by the Certification Team for final
certification testing of the Participants application
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Certifications
Prescription Routing
New Prescriptions (retail/mail-order pharmacy) the ability to route
new prescriptions to community and mail-order pharmacies.
Prescription Renewals (retail/mail-order pharmacy) the ability to
electronically route prescription renewal requests and responses
with community and mail-order pharmacies.
Directories the ability to register and download provider
information
Prescription Benefit & History
Eligibility/Formulary the ability to request and receive eligibility and
formulary information from payers and PBMs.
Reporting the ability to provide utilization summaries for the
prescription benefit service
The ability to request and receive prescription history from Payers
and PBMs.
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Certification Process
1. Introduction & scheduling :
First come, first server
A dedicated Cert. PM will be assigned
2. Certification preparation
Certification testing concentrates on message format and
application workflow including displaying information.
The Surescripts Certification Team is primarily responsible for
creating certification testing scenarios and test cases
3. Certification testing
Pre-certification readiness review & resolve issue list
Full certification testing via web conference with Cert PM
4. Certification approval
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Certification Process (cont)
Certification testing
Two 2-hour certification sessions per service shall be available to the participant to
complete certification testing
Participant shall execute all the certification test scenarios, as applicable to the
service implemented, as long as there are no application issues which would impede
completion
The Cert PM will capture screens shots and review the application workflow
(including display), the message structure, as well as message contents, and verify
these against the expected results
If any issues arise at any time during certification testing, detailed information about
these issues will be logged in an issues list and shared with the Participant. The
Participant will have two weeks to resolve the issues. It is the responsibility of the
Participant to ensure that these items are corrected and tested on its side
An additional 2-hour follow-up testing session may be scheduled in cases where a
Participant had testing issues. The Participant must demonstrate during this final
testing session that all the identified issues have been resolved, no new issues have
been introduced, and all tests were completed successfully
If the timeline to execute all test scenarios or resolve all issues is not met or if
unresolved issues still remain, the Participant shall fail certification
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Certification Process (cont)
Certification approval
A Certification Requests will be sent to the Certification Review Board by Cert
PM
Certification Decisions by Review Board
Appeal by Participant in case of denial
PBM Joint Demo
Participants certifying for Surescripts Benefit and History Services need to
complete an additional step before receiving their final certification notice.
The Participant will need to demonstrate their application (Medication
History, Eligibility and Formulary functionality) to the representatives of
some of the PBMs.
Final Certification E-mail and Certificate
Representation on Surescripts Website & Production Move
A Surescripts Implementation Project Manager will contact certified
Participant to initiate production move
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Certification Workflow
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Source: Surescripts
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Overview and Examples of
Certification Requirements
See next slides
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Directories Requirements
Directories v4.4 Participant
Messages
Surescripts Response
Messages
Requirement
DirectoryDownload DirectoryDownloadResponse Required
AddPharmacy Status Error Required for
Pharmacy types only
UpdatePharmacy Status
Error
Required for
Pharmacy types only
AddPrescriber AddPrescriberResponse
AddPrescriberLocationResponse
Error
Required for
Prescriber types only
AddPrescriberLocation AddPrescriberLocationResponse
Error
Required for
Prescriber types only
UpdatePrescriberLocation Status
Error
Required for
Prescriber types only
GetPrescriber GetPrescriberResponse Optional
GetPharmacy GetPharmacyResponse Optional
GetProvider GetProviderResponse Optional
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Prescription Routing Transactions
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Source: Surescripts
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Prescription Routing Requirements
Prescription Routing 10.6 Messages
(Sender and Receiver)
Requirement
NewRx Required
Refill Renewal Request Required
Refill Renewal Response Required
Rx Change Request Optional, Provisional Certification
Rx Change Response Optional, Provisional Certification
Cancel Rx Request Optional, Provisional Certification
Cancel Rx Response Optional, Provisional Certification
Status Required
Error Required
Verify Dependant upon setup
RxFill N/A Coming soon
Census N/A Coming soon
Resupply N/A Coming soon
EPCS is not a transaction type; it is a service level that is optional
All applicable shall* requirements in the Prescription Routing guide are required
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Medication History and Eligibility Transactions
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Source: Surescripts
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Requirement Example
Receive Eligibility Information
3.1 The Participant shall ensure an eligibility request is associated with a patient encounter.
3.2 The Participant shall ensure an eligibility request is sent no more than 3 calendar days
before the patient encounter.
3.3 The Participant shall request eligibility for a patient only once during a 3 calendar day
period unless an error is encountered in the eligibility retrieval process.
3.4 Information returned in the Eligibility response (e.g. Member Unique ID) shall be used
within 3 calendar days of receipt.
3.5 PBM and the Participant shall be able to process an eligibility request/response that has
both the subscriber and dependent levels populated.
3.6 Participant/PBM must be able to process any valid 270 request and 271 response (valid
data elements and values, including optional elements, supported by ANSI X12 must not
cause processing failure at the end-point)
3.7 Application shall alert the user if a given field in the application allows for more
characters than the X12 standard transaction allows for that data element.
Definition: A calendar day runs from 12:00 a.m. to 11:59 p.m. Central Time, regardless of the
location of the patient encounter.
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3.8 The Participant application shall display the following information returned
in the eligibility response for an active coverage:
- PBM/Payer name
- All pharmacy coverage types (e.g. Retail) with associated eligibility status
(e.g. Covered/Not Covered)
- Health plan name returned in the Plan Coverage Description data element in
the 2110C1 loop.
3.9 The application shall allow the user to switch between all active, eligible
coverage types.
3.10 The application shall make the patient demographics returned in the 271
available for the prescriber to review
3.11 The Participant application shall display an alert indicating there is a
difference between the patient demographics sent in the 270 and those
returned in the 271. The alert shall be based on the demographic change flag
set in the 271.
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Requirement Example
Display Eligibility Information
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Requirement Example
Formulary and Benefits
4.1 The Participant shall implement and maintain a comprehensive,
industry-accepted drug information source that is map-able to NDC
drug codes and updated at least monthly.
4.2 The Participant shall implement within its application updated
formulary information published by PBMs within one week of its
availability.
4.3 The application shall identify, based on the drug file it utilizes, if a
drug is:
a. brand or generic and
b. over the counter or prescription-only.
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Risk Management and Quality Control
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Major Risks
Client does not have a well-defined process and their team are not familiar
with popular tools like JIRA toolset, MS Project, Mockup Tools, etc.
The team are at 3 locations (Vietnam, California, Michigan).
Team have experience in EMR/e-prescription but not specific about Surescripts
integration.
Risk Management and Quality Control Strategy
Have a well-defined Microsoft Project plan and update the progress regularly
Use GUI mockups (interactive design) to quickly capture/verify requirements
Have a well-defined Scrum/Agile process with constant collaboration and
knowledge sharing
Update progress often. Ask questions early. Address high-risk tasks first.
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Project Planning with Microsoft Project
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Quality Control Continuous
Integration & automated test suite
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Tests are constantly added when new features are developed
Unit/Integration tests and UAT tests are executed automatically for
every code commit. Ensure system features working properly while
the system grows
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Quality Control with Unit Test
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Project Management - Planning
Break tasks to detail level, arranged into milestones
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Project Management - Tracking
Monitor progress with hour burn-down chart for each release
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Interactive Design using Mockups
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Using Balsamiq mockup tool to capture/verify requirements
before implementation
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Accomplishments
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The system passed both Prescription Routing and Medication
History Benefit Eligibility certifications in the first attempt.
The team iterated through numerous Graphic User Interface
mockups to achieve the design that impresses the Surescripts
reviewer and prescribers.
Service layer is fully tested. Code coverage over 70%
All major functionalities have automatic tests in Selenium
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Thank You!
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For more information, please contact us at
Email: info@novobi.com
Phone: 888-778-3895