OnTrac

OnTrac Resident Manager is an electronic health record system that covers needs of Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs). It includes modules that lighten work of nurses and automate internal procedures in medical facilities. The system is HIPAA-compliant; it means that the patient record is protected according to the rules required by HIPAA Administrative Simplification Regulations.

  • PROGRAMMING
  • UX/UI
  • WEB DEVELOPMENT

History

In 2009 Regan Chorlog became the head manager of OnTrac Resident Manager. His responsibility was to find capable engineers and manage their work.

He hired software teams from El Paso, Singapore and Slovakia. Several developers worked with the code base, but none of them were able to take sole responsibility for the project. As a result, the application quality degraded quickly. The application logic became over-engineered, unstable and full of run-time errors. Unit tests were abandoned. Common Rails patterns were routinely violated.

Finally, in June 2010, Regan found Anadea Inc. And here is where our story begins. It took some time until Anadea built enough trust and remained one and only development team of OnTrac Resident Manager.

Other software teams left the project one by one. The only other team who was engaged in the project simultaneously with Anadea was another software company from Ukraine. We found it possible to cooperate with them because they had the same rules and followed the same approach.

Later, in 2012, Regan Chorlog acquired OnTrac Resident Manager and became its only owner, because he believed in the project success more than his companions did.

  • Regan Chorlog
    Regan Chorlog

Visual design

When we received the project, it did not have any design at all. A black header, no footer, no styles. Black letters on the white background.

Probably, it was not too critical for an enterprise system, because such an application should be functional rather than nice. But any user prefers a better look certainly. And after we created TraCare module, we realized that such a big and functional page should have a great design. This design was created by our designer Olga Sukhinina.

OnTrac: active residents

Her task was to create a modern Web 2.0 design for pages with a rich set of functions. The design should be attractive but practical. It should show a list of all active residents in a way that would allow nurses to find needed persons and perform allowed actions easily.

Olga created a user interface that satisfied these requirements and we got a nice and functional application. Also, we got an attractive header with smooth menus and rounded buttons. Everything according to the Web 2.0 rules.

Minimum Data Set 2.0

Enterprise automation is never easy. EMR/EHR systems depend on many US Healthcare standards. Most of these standards can be found at the Centers of Medicare and Medicaid website, but as it often happens, an official description is never clear or comprehensive.

Our first major task was MDS 3.0 standard which had to be launched no later than on October 1st, 2010. The date was set by the US Centers of Medicare and Medicaid (CMS) and could be changed under no circumstances. It was quite a challenge!

MDS 3.0 standard was a new and modern update for the MDS 2.0. MDS stood for "Minimum Data Set" and meant data of clinical assessment related to residents of medical facilities. We believe that the word "minimum" supposed to mean something small, but practically it meant a form with more than 800 fields that had to be validated with more than 200 rules! Every resident should have one or two assessments every week and we had to validate the documents before sending them to CMS.

That was not the only trouble. MDS 3.0 needed the application to calculate a RUG IV (Resident Utility Group) with a complicated algorithm defined by the US government. The algorithm was not finalized and CMS changed it several times before it became applicable. Alexander Kichatov structured this algorithm, set up a test suite and developed automated tests for RUG IV logic which proved to be an invaluable contribution into the project.

But the biggest issue was users. Even head nurses did not know how this new standard should actually work. They did not have experience with the new assessments and could not even understand which type of assessment should be sent to CMS this week. This was why Regan asked us to create a "recommendation" feature that was to remind users what event was scheduled next for every resident. The application had to lead users in the right way rather than follow their instructions.

Care plan

Another notable feature of OnTrac Resident Manager was Care Plan. Developing Care Plans was one of the biggest headaches for the nurses. Every resident had to have a hierarchical Care Plan that could consist of 30-60 lines of recommended procedures. Care Plans had to be updated very often (though not as often as resident's assessments). Hierarchy of Care Plans had four levels: Plans, Groups, Approaches and Disciplines. It was very difficult for users to edit Care Plans. They had to edit them too often and spend an unacceptable amount of time on that.

The engineers developed a special "Care Plan" page that was very fast and handy. The page was split into two parts. The first one was the Care Plan itself, the second part was a place for a CP library and facilitated the editing. The page had a javascript which allowed a user to edit the plan with a minimal number of clicks without sending requests to the server.

The nurses were very happy to have this page. The head nurse of one of the facilities wrote:

  • "Mr. Regan, just wanted to let you know how your software has made my job easier. I have been an MDS coordinator since 1998 and have worked with several different software companies. OnTrac was easy to operate and manipulate between MDS and Careplan. I loved the main page, being able to print from that page was a time saver. Developing the care plan was fast and simple, not a lot of steps to get bogged down in and last but not least Mr Regan worked with us to make it what we needed to do our job as efficiently as possible. I give this software 5 stars, great product."

Refactoring and optimization

During the development we had to spend significant efforts on optimization of the application. The logic had been very slow before Anadea joined the project. Anadea engineers had to implement new features along with improving the speed of the old pages.

Initially, the pages with the list of residents needed about a minute to load and recalculate all recommendations. The automated tests were taking two hours to pass. In such circumstances, the engineers had to stick to Agile principles strongly. They were performing code cleanup, refactoring and speed optimization before every new feature installation. Testing mechanisms were updated in a way that allowed tests to pass in 10-15 minutes instead of initial 2 hours.

List views grew into a feature called "TraCare view". A TraCare page was created to show a list of residents with information about them, enabled actions and recommendations in regard to documents that should be created next. To increase rendering speed, the engineers used fragment caching - a core Rails caching mechanism that allowed to refresh only those parts of a page which were no longer actual. Fragment caching allowed to increase rendering speed of the biggest pages of OnTrac from 50 seconds to 2-3 seconds.

Other features

OnTrac Resident Manager was supposed to generate invoices automatically using information about procedures of physical therapy and occupational therapy received by the residents. Later the generated invoices were to be covered with receipts. We also developed several billing reports which were desperately needed by the facilities.

Along with Healthcare standards and billing we added many other features. Here is a list of OnTrac key features, implemented or essentially modified by Anadea Inc:

  • Census
  • Care Plans
  • Electronic Health Record module
  • Incidents and Accidents
  • Report Generation
  • Admin and Owner Dashboards
  • Comprehensive MDS 3.0 and RUG IV
  • TraCare - Automated Assessment
  • Care Area Triggers (CAT) and Care Area Assessment (CAA)
  • CAA Direct - Link to Care Planning
  • Billing: MDS Direct RUG Transfer
  • Case Mix Indexing
  • Automated HCPC Importing
  • HIPAA 5010 Compliance
  • Accounting module

Team

The first Anadea engineer who started working on OnTrac Resident Manager was Vadim Kondratiev. He updated Rails version, cleaned up and fixed test environment. After these steps, the project was ready for further work.

A couple of months later another Anadea engineer, Alexander Kichatov, joined the team. Also, Vlad Pranskevichus spent three months on the accounting module installation in 2012. Vadim Kondratiev was the manager of the project. His previous experience in ERP and accounting appeared to be essential for this job.

While the software engineers worked on the code base, Regan was in the front line working with nurses in medical facilities. As it always happens with enterprise automation, work with people was the most difficult part of the process, because users stood against any changes in the everyday procedures they were accustomed to. But Regan did his best to roll-out the system in the facilities he was responsible for and proved himself a practical customer.

The team kept close communication with the customer. The engineers talked with Regan every day. They discussed the project state, most required features and feedback received from nurses. As an ex-roll-out engineer, Vadim knew how to deal with end users, to get over their inflexibility, to react to numerous situations. Regan shared the difficulties the nurses were facing in these facilities and specificity of their work with the US government.

  • Vadim Kondratiev
    Vadim Kondratiev
    Sales Manager
  • Olga Suhinina
    Olga Suhinina
    UX/UI
  • Aleksandr Kichatov
    Aleksandr Kichatov
    RoR
  • Vladislav Pranskevichus
    Vladislav Pranskevichus
    RoR
Site address:
Virtu-Care.com
Release date:
November, 2012
Technologies:
MySQL
Ruby on Rails

Customer’s Impression

We have a long term relationship with Anadea and receive the highest quality results. We have no reason to go anywhere else for our development needs. Our reputation as a SaaS provider is highly respected and Anadea plays a big role in keeping it that way. Thanks you for all your hard work!
— Regan

 We were happy to read these words. They were a natural result of our work with the customer shoulder to shoulder. This way of cooperation predetermined success of several project releases rolled out in seven Skilled Nursing Facilities.

Finally

Active development of OnTrac Resident Manager was suspended after a release of the accounting module in November 2012, but we still have great relations with Regan Chorlog.

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