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

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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