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Mission-critical Ajax:Making Test Ordering Easier and Faster at Quest Diagnostics
 

Mission-critical Ajax: Making Test Ordering Easier and Faster at Quest Diagnostics

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    Mission-critical Ajax:Making Test Ordering Easier and Faster at Quest Diagnostics Mission-critical Ajax: Making Test Ordering Easier and Faster at Quest Diagnostics Presentation Transcript

    • Mission-critical Ajax: Making Test Ordering Easier and Faster at Quest Diagnostics David Rapperport
      • Diagnostics Testing:
        • In the U.S., it is estimated that the cost of laboratory testing is only 3% of the total annual cost of health care. Yet, up to 80% of objective information used in diagnostic decision making is estimated to come from laboratory tests*
            • * American Society for Clinical Laboratory Science Mar/Apr 1998
    • Background
      • About Quest Diagnostics:
        • The leading provider of diagnostic medical testing in the US
        • Offer access to its services through its national network of laboratories and patient service centers
        • Quest's Care360 web-based lab ordering system is relied upon by more that 100,000+ physicians throughout the US
        • Typical application users are; Physicians, Phlebotomists, Hospital Techs, Nurses, and other Healthcare workers
    • Background
      • Quest Diagnostics’ scale
      • 150,000,000 Patients tested each year
      • 550,000 Patients tested each night
      • 41,500 Employees
      • 2,000 Patient Service centers
      • 185 Laboratories
      • Data from the Quest Diagnostics 2006 Annual Report
    • Background
      • Ordering a test is a complex task
        • Rule based ordering (77m rules currently dynamically applied)
        • Accurately specifying correct required data
        • Different regulatory requirements State, National, and International
        • Payment via Government and private payors
    • Background (application)
      • Care360 has been internet-based since May 2000
        • Cache and WebLink based
        • Proven to be very stable, secure, and scalable
        • Standard page/form mode web application
        • Frames, complete page refreshes as user progressed through steps
        • Some field level “Ajax” like validations db retrieval using hidden frame submissions and hand crafted JavaScript
        • Current scale 750,000,000 HTM
        • Six-Sigma availability over the last 5 years
        • Code base includes 600+ Cache classes and 500+ dynamic WLD active server pages
    • Ordering the old way
    • Ordering the old way
    • Ordering the old way
    • Issues
      • Ordering process is cumbersome when implemented as “traditional” web application
        • Huge, complex web pages
        • Complex tree of possible transitions between pages
    • Issues
      • Care360 should aid customers
        • Constantly inputting many orders a day
        • Speed and efficiency highly important
        • This is not buying a book….
      • The act of placing a medically and financially correct order can never be too fast.
        • BUT, designs must constantly balance “easy of use” versus “speed of entry”
    • Issues
      • Difficult for team to collaborate effectively:
        • Modifying different parts of the same pages
      • Big, complex pages cause maintenance headaches
        • Original author may not be maintaining it
        • What the page does takes valuable time to discover
      • Multiple concurrent version development
        • Many versions under development at the same time
    • A case for Ajax?
      • So, did Ajax warrant the hype and deliver the goods at Quest Diagnostics?
    • Our plan
      • Leave the main core of Care360 alone
        • Evolution versus Disruptive Innovation
        • Just add/integrate not “Rip and Replace”
      • Add a new “EZ-Order” option that applied new Ajax techniques
        • Re-design of UI
        • Broken down into small, atomic units
        • “ Container page” containing designated target <div> placeholders
        • Also modal “lightbox” pop-up <div> panels
    • EWD vs. ZEN Decision
      • CMMI – Substantial Decision Analysis and Resolution Process (DAR) Completed
        • Product Requirements:
          • Bidirectional Session Integration with WLD
          • Continue to use DMZ hardened and proven MGW Infrastructure
          • Reuse of existing backend array based method returns
          • Cache 5.0.x compatibility
          • Fast Learning Curve for current WLD Developers
          • Extremely aggressive business timeline requirement
    • Our Decision
      • EWD was selected due to it’s ability to meet the defined requirements
      • ZEN has many positive attributes but for this project it was not able to meet our required needs within the timeline
      • Additional EWD Benefits
        • Concise browser payload ~(25%) difference
        • Contextual Multi-lingual support
        • Adaptation Layer for 3 rd Party JavaScript Libraries Implementation; extjs, ejscharts, yui, dojo, etc.
        • Deployable as WebLink, CSP, PHP, or JSP application
    • Technical Solution
      • Using Enterprise Web Developer (EWD)
        • Ajax framework
          • Concept of page fragments
          • Replace the innerHTML of specified target tags
        • Compatible with Quest’s existing technical infrastructure
    • Container Page: <div> breakdown Page1 OrderDetail PatientInfo StandingOrder Patient SearchList / InfoDetail Billing InsuranceInfo GuarantorInfo Comments
    • Ajax Application Flow Container Page Fetch data Pre-page Script EWD State & Session Management Back-end Server Front-end technology (WebLink, PHP, CSP etc) Generate Page
    • Ajax Application Flow Container Page Fetch Page Fragment Page Fragment Fetch data Event Replaces DOM content Pre-page Script Pre-page Script EWD State & Session Management Back-end Server XMLHttpRequest Generate Fragment
    • Ajax Application Flow Container Page Fetch Page Fragment Page Fragment Fetch data Event Replaces DOM content Pre-page Script EWD State & Session Management Back-end Server
    • Ajax Application Flow Container Page EWD State & Session Management Back-end Server
    • Timescales and resources
      • 4 developers
      • 45 days each
      • Tasks:
          • Learn the technology and methodology:
            • Advanced JavaScript, Ajax, JSON, YUI, etc
            • EWD Toolset
          • Deliverables:
            • Phase 1 production ready
    • End Product
    • End Product
    • End Product
    • End Product
    • User satisfaction
      • User trials were fully successful
      • Full production rollout successful
      • Some initial performance issues that have been ironed out
        • Due to many more, but smaller, back-end transactions
    • User Interface improvements
      • Flow through the complexity of ordering is now much more intuitive
      • The impression is that of a much slicker, more responsive interface
        • Each event just changes a small area of screen
    • User Interface improvements
      • Not yet fully utilizing pre-emptive, asynchronous data-fetching
        • Currently using pre-fetching in application where long option lists are expected via Dynamic Select List
        • More potential opportunities for this in the future
    • System/performance: pros
      • Performance good during ordering process
      • Good scaling with load balanced app and web servers
      • JavaScript performance adequate
    • System/performance: cons
      • Application Servers work harder managing more, smaller, Ajax transactions
      • Potential client issues with any JavaScript error that can stop client processing
      • Not so good for users with latent internet connections
    • Security
      • No adverse problems experienced to date
      • Independent penetration test completed with no EZ-Order issues uncovered
      • EWD’s Ajax framework secure in our deployment
    • Development & Maintenance
      • Simplified the design and construction of the UI and the user’s work-flow
      • Allowed much better work breakdown
        • Allowed individual functions to be assigned to individuals
        • Each concentrated on his/her fragments
        • Clean, well defined interfacing of fragment modules
    • Development & Maintenance
      • Already experiencing lower maintenance overhead compared with the “classic” web approach
        • Smaller team required to support new module
        • More reuse possible
        • Faster for bug-fix and enhancements
        • No one module is overly complex
    • Business improvements
      • Marketing very pleased with the product and aggressively selling
      • Very well received at HIMMS Conference
      • Recognized by AjaxWorld at their 2008 Conference
    • Conclusions
      • Ajax is not just hype
      • Ajax really does bring business benefits