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Mission-critical Ajax: Making Test Ordering Easier and Faster at Quest Diagnostics
- 1. Mission-critical Ajax: Making Test Ordering Easier and Faster at Quest Diagnostics David Rapperport
- 2. 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
- 3. 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
- 4. 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
- 5. 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
- 6. 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
- 7. Ordering the old way
- 8. Ordering the old way
- 9. Ordering the old way
- 10. Issues Ordering process is cumbersome when implemented as “traditional” web application Huge, complex web pages Complex tree of possible transitions between pages
- 11. 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”
- 12. 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
- 13. A case for Ajax? So, did Ajax warrant the hype and deliver the goods at Quest Diagnostics?
- 14. 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
- 15. 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
- 16. 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
- 17. 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
- 18. Container Page: <div> breakdown Page1 OrderDetail PatientInfo StandingOrder Patient SearchList / InfoDetail Billing InsuranceInfo GuarantorInfo Comments
- 19. 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
- 20. 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
- 21. 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
- 22. Ajax Application Flow Container Page EWD State & Session Management Back-end Server
- 23. 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
- 24. End Product
- 25. End Product
- 26. End Product
- 27. End Product
- 28. 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
- 29. 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
- 30. 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
- 31. System/performance: pros Performance good during ordering process Good scaling with load balanced app and web servers JavaScript performance adequate
- 32. 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
- 33. 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
- 34. 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
- 35. 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
- 36. Business improvements Marketing very pleased with the product and aggressively selling Very well received at HIMMS Conference Recognized by AjaxWorld at their 2008 Conference
- 37. Conclusions Ajax is not just hype Ajax really does bring business benefits