The March 2012 issue of Database Trends and Applications features an article written by Joyce Wells titled Trauma Database Improves Remote Access With New Web Interface.
Clinical Data Management facilitates data entry with Revelation's OpenInsight for Web
Clinical Data Management (CDM) is a company headquartered in Colorado that provides clinical information database software, enabling medical institutions to report and compile data on patient care. Established in 1986 by Skip and Beverly Tinnell, Registered Nurses, CDM has made a commitment to improving the quality of patient care by providing state-of-the-art, user-friendly products, and as a result, its software is used by over 350 government agencies, hospitals and clinics nationwide and also internationally.
CDM's flagship product, TraumaBase, is a trauma care registry used by healthcare providers to input data for collection by corporations and government agencies as well as for the evaluation of care by the medical teams themselves. Details such as a trauma patient's initial vital signs, how fast treatment is begun, and other aspects of a patient's care from the point of arrival at a medical facility are all recorded in the TraumaBase database.
A longtime user of Revelation Software, dating back to Revelation G and continuing through OpenInsight, CDM was pleased with both the quality of the products and the service from Revelation. However, CDM had come to realize it needed to provide a web interface for data entry to better support its customers and also stay current with evolving technology requirements.
That need was answered when Revelation launched the OpenInsight for Web (O4W) Development Toolkit, a web development toolkit that makes it possible for OpenInsight developers with limited or no HTML, XML or JavaScript experience to develop feature-rich web pages.
Modern Approach
Now with eTraumaBase, CDM's new web-enabled version of TraumaBase, remote clinics and facilities such as those in rural or mountain regions that have access to the web but only minimal support from IT professionals can input their data easily online. These clinics may only be open during part of the year, such as the ski season, or may only see one or two trauma patients each week and do all of their data entry at the end of the quarter. In fact, such a facility might not even be expert in trauma care, but could provide the first trained medical care when, say, someone falls off a ladder, and the X-ray finds there is a skull fracture. Making it easier for them to participate in reporting the details of trauma care enriches the data pool, enabling government agencies and the facilities themselves to better ascertain whether best practices are being followed and where improvements can be made.
While such facilities were able to do this data entry before O4W made eTraumaBase possible, it could be complicated, says Jody Summers, director of technical services and software engineer at CDM. Large Level 1 and 2 Trauma Centers (nationally designated hospitals capable of treating the most severely injured patients) typically have a local installation of the software and are able to submit flat files into the database that they create on their own, but rural and low-volume facilities have IT environments that are not stable or well supported. "People might get a new computer and not realize that they have disposed of a computer with a database that they touched maybe only once a quarter, but then that machine is gone," he explains. "Having this O4W-based solution has brought stability to these users."
The introduction of O4W could not have come at a better time, says Summers. The states, agencies and companies that purchase CDM's registry and make it available to care facilities were asking for a web interface but it had to be provided in a cost-effective and efficient manner, says Summers.
Summers called Revelation in late 2009 and said that, in order to facilitate web access, his company would have to make a sizable financial commitment to hire a web developer who knew nothing about the Revelation software on which the company was based unless Revelation could offer an alternative.
"And that's when they said yes, we have this O4W we have been working on and it is about to be released," recalls Summers. A developer from Revelation came out to Colorado for 3 or 4 days and CDM was able to quickly turn from the direction they were headed in - which was heavy on web development - and move towards O4W. "The reason it stood out was that it was web development that Revelation programmers could do. Our long-time programmer who goes all the way back to Rev G and AREV and who had very little web development training was able to grasp it and program with it and make changes that function."
Advantages
Beyond facilitating data entry, there are additional advantages that eTraumaBase offers. Inevitably, each year, states make changes to the information they want, requiring new fields to be added, or they make coding changes for procedures that need to be input into the system. Now, those changes are automatically updated in the eTraumaBase system by CDM without users requiring any technical support.
The ability to easily update choice options is a big benefit as is the ability to set up yes or no fields, say Summers. "It is actually set up dynamically within our system so we have one lookup table."
For example, if a state wants to start tracking a certain injury associated with a new type of vehicle such as a motorized scooter, with O4W, CDM can go to one place to change the choices. "And, because O4W is dynamic we don't have to touch the web side. Those choices appear as soon as the next person refreshes the screen," says Summers. "With O4W, we update the screen and everybody gets it; everybody is standardized."
Beyond the U.S., eTraumaBase has also been used by trauma care doctors, nurses and medical students traveling to places as far flung as Nigeria, Qatar and Bhutan. And, CDM is piloting a program in which larger U.S. facilities with more advanced IT support, also submit their flat files through O4W so there is one centralized location for data collection. Up until now, those hospitals were sending in files using a secured FTP site, and then CDM handle them from there.
Staying Current with Technology
And, in addition to helping CDM reach remote clinics with its trauma registry, the availability of eTraumaBase has also helped CDM retain the clients it has. "The nature of the industry is that you have to keep growing and adopting new technologies." Not providing web-based data entry, for example, was an issue when CDM had to submit an RFP or an RFQ and found it necessary to explain how, despite its lack of a web interface, its software was still beneficial. "Everybody is moving to a web and cloud mentality and if they don't hear the right buzz words, they wonder if you are not keeping up," he observes.
Looking back at its adoption of O4W, which CDM implemented in the first quarter of 2010, Summers says the only surprise has been how fast it has taken off and how many more bells and whistles have been added. "The project initially started out with us needing just a very simple data entry screen so someone could plug in data and hit ‘save' and then maybe run a couple of reports." But the more it has gone on, the more requests the company has had for features such as additional auto-populate fields and specialized trauma coding built into the software in a user-friendly way. "And we have been able to make it all happen - because it is all Revelation-based and we have a great Revelation programmer who knows Revelation so well."
The December 2012 issue of Database Trends and Applications features an article written by Joyce Wells titled Australian TV Shopping Network Gives Lead Role to Revelation Software.
TVSN is a 24x7x365 television shopping network that sells clothing, health and beauty aids, electronics, home furnishings, collectibles, and jewelry, in Australia. Customers can place orders at any hour of the day or night any way they desire, by phone or online. Since TVSN is always open and always on, downtime is just not possible. Originally only available on cable TV, at 8:30 am on Monday October 24, 2012, TVSN in combination with Network Ten Australian flipped the switch to make television shopping available to anyone in Australia who has a television. As a result, TVSN now reaches 6.5 million households.
TVSN has relied on Revelation Software since the late 1980s when it was called Demtel, a telemarketing company that was one of the first to run infomercial-style ads Down Under, using a Revelation G application in the call center and warehouse.
During the mid-1990s, the company was purchased by a new owner and the concept of a home shopping channel on Australian cable television was born. To create the new home shopping network, the company turned to International TV Shopping Systems (ITVSS) another longtime Revelation organization, which was founded by Kyle Amadio and his business partner Emmanuel Carydis in the late 1980s. ITVSS had a product that met some of the requirements for the new network, recalls Amadio, and so the partners were invited to do a simple integration. After that proved successful, they were provided with a wish list for a home shopping channel and told that they had six weeks to create the system, which involved rewriting the Revelation G system in Advanced Revelation and extending it with new functionality.
“We signed a contract on October 16, 1995 and we had to deliver a home shopping system on December 8, 1995,” says Amadio, observing, “The only way it could have been delivered was with Revelation’s technologies and we have been pretty well there ever since.” The original application has evolved into a highly integrated vertical application for home shopping, and there is now a team of six or seven people who work on site plus three or four contractors scattered around the country and in New Zealand to provide added support.
While Amadio and his partner are not employees of TVSN, their company ITVSS is a strategic partner, and highly integrated into the TVSN business, which was acquired by Innovations Direct Pty Ltd. in 2004.
Full E-Commerce Platform
To accommodate the business growth and create a full e-commerce platform for viewing and purchasing products from TVSN, says Amadio, “We have had to extend the system from being a relatively simple screen-based application to a multi-channel processing system. We obviously have the call center which is all web-based, an Interactive Voice Response system called the Easy Order, which is for automated telephone ordering, and the website.”
Originally based on a simple accounting program running on DOS PCs, the ordering process first consisted of customers phoning in purchases to TVSN which had more than 60 agents in a call center, says Amadio. “We had Novell servers back then that were highly reliable running on 16 megs of RAM and basically we have grown the system from having 50 screens and 200 tables to nearly 500 screens and 1,000 tables.” Some of the tables have seven, eight, or nine million rows. “We have tested the system with up to 18 million rows and the response times are completely linear with the hashing system,” he says. In addition, he notes, “We probably had 20 or 30 reports and now we have 300 to 400 reports. And, the connected users have gone from about 60 or 70 connected users to 200 connected users and up to 1,000 concurrent web users now.” There are two and a half million full-time equivalent viewers; and storage for about 18 years of data in the databases, he adds.
Back in the early days, 100% of the orders were placed through the phone system. Now, about 45% of all orders go through the website, and 25% go through the Interactive Voice System and the balance or roughly 30%, goes through the call center. As a result, TVSN has been able to operate with a smaller call center staff. “The business is 20 times the size it was and they have got a third of the people in the call center,” notes Amadio.
The platform has extended to the point where there are many other technologies integrated as well. For example, he says, “We use a lot of .NET. In the old days, we had to write things in Assembler and now because of our .NET capabilities, we can build out specialized Win32 components in .NET.”
Revelation Has Starring Role
Today, TVSN uses a mixture of Revelation’s flagship product OpenInsight, a database development suite that provides Windows, Web 2.0 and .NET tools to develop and deploy mission-critical applications, with Revelation’s Universal Driver Heavy, Sybase ASE, and Microsoft SQL Server, all centrally controlled by OpenInsight, which is the application layer for the entire business, including the call center, warehouse, studio, website and customer service department.
The application servers sit on top of VMware and the database servers themselves run on raw hardware. “We have built the data mart and data warehouse technologies in Revelation software. We have built a powerful ETL tool using Revelation tools so we can push data out to a dimensional data warehouse,” says Amadio. And, because of the new OECGI connectors that Revelation has built, Amadio and his team have been able to provide web service technologies for RF scanning systems in the warehouse, achieving greater efficiency.
Currently standardizing on OpenInsight version 9.3.1, parts of the system are transitioning from Advanced Revelation 3.1.2, a major project that has been running for several years already. ITVSS has had to develop new tools and frameworks to accommodate the functionality Advanced Revelation provided to users.
“Just like QVC and HSN in the United States, it is a 24x7 business. It never stops and it is highly integrated. If anything goes wrong, the business stops so everything we do has to be done in a very careful way,” says Amadio.
As might be expected, order volumes can peak sharply when there are highly sought-after items available for purchase and also at certain times of the year when shopping volumes are heaviest.
Many innovations have been provided along the way by Revelation. The OpenInsight socket server/OECGI connector, introduced in 2010, increased the website performance dramatically. “We can have as many web servers as we want and we can have an unlimited number of application servers which are connected to the web servers, which then point down to the database. We can just turn on extra application servers and we register the servers with each layer, and from then on the socket server will start talking to them, and the transactions will be balanced across the instances.” It is a simple round robin approach that is high effective, says Amadio.
The OECGI socket is an example of the type of innovation that, Amadio says, has helped elevate the platform his company provides to TVSN. “That single piece of technology has completely transformed the way we write code. Traditionally, with AREV or OpenInsight, it was strictly client-server. You would have a form, you would execute a process, the programmer would do something, and it would update the database and then you would wait - until the response came back. It was sort of point to point processing.”
But when there are 10,000 or half a million rows of data to process, that type of processing is inefficient compared to what they can do now. “We can spawn off batches of work and have four or five instances of a process running in an asynchronous manner.” The OECGI socket server has allowed ITVSS to develop a highly flexible and powerful environment using the same basic programs but wrapping them inside the asynchronous code wrappers. “That alone was a major turning point,” says Amadio.
Agility is Key
While ITVSS uses .NET for a number of situations, it is primarily used when speed is not the core criteria. “The problem with .NET is that it is extremely complex code and compared with Revelation’s products, it is quite slow,” says Amadio. “We also use some PHP for some of the web coding, but for the core high performance development we use OpenInsight because it is quick to train developers and productivity is extremely high.”
This agility is a critical aspect to Revelation Software, he emphasizes. “If you have a business application that you are trying to add features to, the biggest risk to projects these days is that it takes so long and people get bored or they move on - and you lose continuity of the developers or you have to bring in new people and train them.”
Revelation products are fast to work with and training developers is “a breeze” because it is not a highly complex language, he explains. “It is powerful but the syntax is relatively straightforward and that is a key point. Dollar for dollar, you probably get three to four times the productivity out of a Revelation OpenInsight team as you do for a .NET or Java team. And that is a big, big issue – just getting work done quickly.”
Beyond the technology, says Amadio, the people at Revelation are extremely responsive. “We are all focused on the same objective. Mike Ruane runs a boutique database application development environment company and he loves what he does. It is all about delivering a solution for the end user.”
ITVSS has built out a system for TVSN where everything is done in real time, says Amadio. “We have real-time sales, real-time profit, real-time margins, real-time new customer acquisition, and everything is recorded to the second. From the point of view of our product, our customer order placement, the subsequent transactions happen automatically, flow through the system, and end up on KPI screens.”
Unlike traditional businesses where they might have a monthly or weekly meeting, TVSN displays profitability to the second and there are monitors scattered throughout the building for everyone to see what the intended target is, and what the margin is. “It is a highly reactive and interactive business, and what happens on the channel and on the web is immediately affected in the performance. The way we achieve that is by virtue of the fact that the tools are so flexible and fast.”
The business has grown rapidly since 1995, and Revelation has supported it all the way, says Amadio. “While other businesses have to spend tens of millions on ERP implementations, TVSN has not had to do that.”
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