From Legacy to Leading Edge: A Texan Primary Care Provider’s Journey to 42% OpEx Reduction with Movate and Azure Serverless.

In the fast-paced world of healthcare technology, the shift from traditional legacy applications to loosely coupled serverless solutions is not just a technological leap but a strategic necessity. This is the transformative story of a Texas-based primary care provider that embraced innovation, leading to a paradigm shift in operational efficiency. By steering away from on-premises legacy systems, the organization slashed operational costs by more than 42% and achieved unparalleled scalability through a seamless migration to serverless architecture in Azure.

Customer’s Legacy Landscape and the Pain Points:

Our protagonist, the primary care provider, operated a legacy. Net-based application running on on-premises Hyper-V VMs, supported by a 4-core SQL Server backend. This system boasted direct integration with an on-premises scan server. Diagnostic labs delivered patients’ medical reports in physical paper copies. An administrative associate would generate an 11-digit unique document serial number, print the barcode, attach it to the physical medical report, and scan it. The digitally scanned copy would then land on a shared file server, with an SFTP process scanning the file server location at regular intervals to transfer the PDF file to an electronic file cabinet. The mapping of the scanned medical reports with patient ID and other patient information was maintained in the MS SQL Server backend database.

The Net-based web interface empowered doctors, nurses, the billing department, and front-office administrators to locate medical reports using patient ID or demographic information. The MS SQL Server database also stored scanned copies of customer identity documents and the latest medical insurance card in blob object format. The organization has been managing physical report copies since its inception in 2001.

Due to the sheer volume of physical and digital document copies, the organization frequently faced the following challenges: 

• Aging infrastructure impacting performance: The primary care provider utilized a customized version of ‘iTag’ as an Electronic File Cabinet. Despite a high annual maintenance contract, this proprietary product exhibited reliability issues, often becoming unresponsive for documents older than a couple of years and requiring frequent reindexing. The indexing process was time-consuming, and the vendor was not sufficiently responsive in resolving issues. When the electronic file cabinet was unavailable, administrative staff frequently had to locate the physical copy of the document from the storage room to meet operational requirements. Although ‘iTag’ supports encryption-at-rest, it lacks the capability to provide an audit trail for document deletions from the electronic file cabinet.         

• High operational costs due to ‘iTag’ and MS SQL Server licensing: Under the per-user license model of ‘iTag’ and the per-core license model of MS SQL Server, the organization incurred a monthly expenditure of around $12.5K to support nearly 200 users across the state. Due to the per-user license requirements, front-office admin users often shared the credentials, presenting a potential security risk for the organization. 

• Complex file storage and retrieval mechanisms: Over time, the volume of physical reports experienced exponential growth. Each healthcare center maintained a dedicated locker room to store physical documents, introducing a risk of misplacement if a record was incorrectly filed. Despite the diagnostic labs being able to transmit electronic copies, the organization favored the physical format due to constraints associated with ‘iTag’ and the necessity to access records during periods of ‘iTag’ unavailability. The organization was resolute in its commitment to eliminating the hazards associated with physical record management.     

In a strategic pursuit of innovation, the medical service provider forged a transformative partnership with Movate to revamp their operational landscape. The objective was distinct: eradicate the constraints of a physical document library, enhance scalability by eliminating per-user license constraints, and concurrently reduce operational costs—all while steadfastly adhering to compliance obligations mandating preserving patient medical records for a lifetime.

Movate’s Solution and Accelerators:

The scope of work demanded the resolution of three critical puzzles. Firstly, the colossal medical record library needed migration from on-premises to the cloud. Secondly, the challenge involved building a robust application architecture that would optimize performance and scalability while overcoming per-user-based licensing obstacles. Lastly, a seamless transition to the new system was imperative, necessitating the sunsetting of the existing legacy environment while strictly adhering to HIPAA compliance requirements.

• Onetime Migration of Existing Medical Records: The legacy ‘iTag’ system employed a proprietary partitioning algorithm to store PDF files, which, though visible in the file servers, were encrypted using its algorithm. The absence of the encryption key, an expired support contract, and licensing agreement constraints hindered the digital copy extraction efforts. We initially attempted to retrieve documents through the application UI, but it proved ineffective, especially for older medical records, as the system became unresponsive. Confronted with this challenge, we swiftly pivoted to a strategy of digitizing the extensive physical document library. 

To streamline the digitization process, we established an SFTP gateway and implemented an event-based file copy to replicate scanned images from the on-premises scan server to an encrypted Azure Blob Storage. Our prioritization involved scanning the medical records of the last six months, employing a batched approach based on document age. Simultaneously, we configured an event-driven pattern with Azure Blob Storage to leverage the Optical Character Recognition (OCR) capability of Azure AI Vision, extracting metadata from documents and creating a search index using JSON metadata and the object key in Cosmos DB. This dual strategy, encompassing manual scanning and automated metadata extraction, progressed concurrently with the development of the central architecture.

• Re-Architecture and Rebuilding: As the organization lacked access to the ‘iTag’ application source code, the Movate team rebuilt the application using React.js, ensuring that the UI look and feel precisely mirrored the existing application screens. This approach ensured a seamless transition for existing users, allowing them to adopt the new system from day one without encountering a learning curve. The application found its new home in Azure WebApp, where Azure Functions, serving as a serverless compute capability, efficiently searches for document keys in Cosmos DB and retrieves documents from Azure Blob Storage. This setup offered users the familiar options of viewing, downloading, or printing documents reminiscent of the legacy electronic file cabinet or the ‘iTag’ application.

Simultaneously, we migrated the on-premises MS SQL Server database to a SQL Managed instance in Azure. Leveraging an active Software Assurance agreement with Microsoft, the Movate team facilitated additional savings of nearly 40% by utilizing Azure Hybrid benefits to port on-premises core-based SQL server licenses to SQL-managed instances. 

• Application Transition and Legacy Sunset: With the newly rebuilt application seamlessly integrated into Azure WebApp, the transition from the legacy ‘iTag’ system marked a significant milestone. The user-friendly React.js-based UI, meticulously designed to replicate the familiar screens of the original application, ensured a smooth adoption process for existing users. As we bid farewell to the legacy application, users can effortlessly navigate the new system from day one, minimizing any disruptions. Notably, the organization opted for a secure data transfer approach, preferring to receive the medical reports from the lab over Fax rather than allowing external entities to push data directly into their environment. The new application can autonomously retrieve data from the Fax server, automatically process and persist it to Azure Data Lake, built using Blob Storage. This end-to-end integration streamlines operations by eliminating the need for barcode generation and the document scanning process. Leveraging Azure Blob Storage’s Geo-redundant storage (GRS) capability, with at least 99.99999999999999% (16 9’s) durability, further obviates the requirement to store and maintain physical record copies. This enhances efficiency and ensures robust data management and resilience in the cloud environment.  

Movate Value Additions:

Due to PCI DSS compliance, the organization couldn’t store patients’ payment card information, impacting direct debits and requiring manual calls for payment collection. Now, with the new system, fully compliant with PCI DSS and HIPAA, the primary care provider securely stores payment card details, initiating direct debits based on individually collected consent. This streamlined process ensures regulatory adherence and boosts payment collection efficiency, delivering a seamless and secure experience for both healthcare providers and patients.

Customer’s Financial and Business Benefits:

The results spoke volumes. The synergy between Azure’s prowess and Movate’s expertise delivered:

• A 42% reduction in monthly operational costs, with monthly spending plummeting from $12.5K to a mere $7.2K.
• Seamless scalability with no user-based license charges, ensuring a flexible and cost-efficient working environment for the primary care provider. 
• A remarkable 30-35% reduction in manual efforts on tasks such as creating barcodes, scanning physical documents, locating paper documents from the vault, and reshelving them.
• The complete elimination of physical document storage marks a pivotal shift towards a paperless operation. 
• An impressive 97-99% improvement in reliability and high availability, backed by Azure’s robust SLA guarantee, ensuring system uptime and performance that organizations can rely on.

Conclusion:

The transformative journey of this Texas-based primary care provider unfolds as a compelling testament to the transformative power of cloud innovation. The strategic adoption of serverless cloud architecture and Movate’s expertise spearheaded a remarkable 42% reduction in monthly operational costs, propelling the healthcare provider into a new era of efficiency and scalability. This story highlights the potential of strategic cloud adoption, showcasing how forward-thinking solutions can reshape an organization’s IT landscape. As the digital horizon continues to evolve, businesses of all sizes can take a cue from this success story, considering how Movate’s expertise and serverless adoption can pave the way for their own cost-efficient, scalable, and innovation-driven future.

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