Patient navigation programs are established to guide patients through the healthcare system in order to assure early detection and prompt treatment of medical conditions, as well as assist with social and financial support. Patient navigators need direct access relevant patient data in order to function, but grapple with myriad disparate systems within health care organizations. Still relatively unproven, funding for patient navigation programs falls heavily on public sources and grants. Therefore, scientific data is required to validate program efficacy and justify continued funding.
We were asked to take over application development for a pilot patient navigation program at three hospitals. Data policy required separate applications in-house at each hospital, but de-identified protected health information (PHI) was to be submitted to the parent instition for reporting and analysis. Their original platform was developed in Microsoft Access by end users, but they hit several walls with their planned goal to expand to twenty hospitals — data security concerns, design synchronization, and maintainability, among others.
We had to achieve buy-in from both end users and hospital administrators. Patient navigators needed to benefit from additional data entry. Administrators needed assurance that the new platform was secure and cost-effective.
In order to incentive data collection by patient navigators, we built in useful functionality to support their daily activities. To alleviate security concerns, we upgraded from Microsoft Access to an ASP.NET MVC web application backed by Microsoft SQL Server. Each hospital hosted their own sandboxed instance of the database, with all costs born by the client so as not to cost the hospitals a dime.
We designed our distributed database to reduce support overhead over a 20+ hospital installation base. We built a custom installer to ease deployment and software upgrades. Our deployment framework kept the data structure synchronized across the entire distributed database and ensured that the collected data could be combined into a unified dataset for analysis.
In addition to application development, we provided detailed documentation to end-users and system administrators, as well as training to patient navigators (although most users picked it up intuitively).
- Microsoft SQL Server
- Microsoft Access
- ASP.NET MVC
The patient navigator system we built was used by our client to collect 10 years of cancer outcome data from over 20 hospitals. The resulting epidemiological studies revealed dramatic improvements in cancer outcomes where patient navigator programs were in place, and were published in at least two academic papers. This success was used to secure continued fundings for these much needed programs. We were able to fill a knowledge void at our client, whose departmental expertise was limited to basic Microsoft Excel and Microsoft Access, for a project that was too small a priority for their internal MIS department. We overcame the challenge of a distributed database (20+ independent instances) by providing a reliable and largely self-supporting application.
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