Radians

Health Care Legacy Migration Project
Client: Department of Health Care Services, State of California

The State Health and Human Services department is facing significant challenges in managing and processing post-adjudicated claims and encounters the existing system infrastructure requires substantial enhancements. These initiatives demand not only the expansion of system capabilities but also ensure its compliance with evolving data standards and healthcare regulations.

Business Problem
  • Integration and Compliance Challenges: The current system must be upgraded to support new healthcare initiatives and comply with federal HIPAA transaction standards. This involves significant code changes and system enhancements to incorporate other initiatives seamlessly into the existing framework.
  • Data Management and Quality Control: The current system must efficiently handle an increased volume of data from medical, dental, and pharmacy transactions while maintaining high data quality standards. The system needs to effectively extract, transform, and load (ETL) encounter data into the State department’s enterprise data warehouse for use by downstream applications, requiring sophisticated data processing capabilities.
  • System Maintenance and Operations: With the addition of new functionalities and data standards, the system requires continuous maintenance and operational support to ensure its reliability and performance. This includes the need for specialized IT consulting services to address system modifications, troubleshooting, and the implementation of new databases and ETL processes.
  • Knowledge Transfer and Training: The integration of new technologies and processes necessitates the training of state staff. There is a critical need for comprehensive documentation, training materials, and knowledge transfer to enable in-house teams to maintain and operate the enhanced system effectively.
Proposed Solution

Our solution encompasses a range of services aimed at enhancing the capabilities to meet the requirements of new healthcare initiatives and ensure seamless operation and integration within the State department’s technological ecosystem.

  • System Enhancement and Integration: Implement code changes and system analysis to support the current system in accommodating new initiatives and internal and external systems.
  • Operations and Maintenance: Provide ongoing maintenance, operational support, and modifications to the current system, ensuring high availability and compliance with departmental and healthcare standards.
  • Development and Coding: Develop and implement services and components with high-quality, secure code adhering to the state standards. Understand and integrate new system requirements in collaboration with system stakeholders and team members.
  • Database Management and Migration: Implement new databases on AWS, utilizing both relational (PostgreSQL) and non-relational (DynamoDB) technologies. Migrate existing databases from Microsoft SQL Server to AWS-supported databases, ensuring data integrity and system compatibility.
  • ETL Processes and Serverless Computing: Write and maintain code for ETL processes in a serverless environment using AWS products and services, enhancing data processing and integration capabilities.
  • Testing and Quality Assurance: Develop and execute comprehensive test cases, including unit, integration, system, and regression testing. Perform issue triage, troubleshooting, and analysis to maintain system reliability and performance.
  • Documentation and Training: Create and update training documents, user manuals, administration guides, and troubleshooting documentation. Provide hands-on training to end-users and the state staff, facilitating knowledge transfer and capacity building for system maintenance and operation.
  • Business and System Analysis: Perform business and system analysis as required, identifying areas for improvement and ensuring the system’s alignment with State department’s objectives and federal standards.
  • Capacity Building: Train state staff on system maintenance, operations, and modifications to ensure sustainable system management.
  • Collaborative Engagement: Work closely with the State’s project management and technical staff to ensure a deep understanding of requirements and seamless integration of services.
  • Agile Methodology: Employ an agile development approach, allowing for flexible and iterative enhancements, quick adaptation to changing requirements, and continuous improvement.
  • Knowledge Transfer: Focus on training and documentation to equip state staff with the necessary skills and knowledge to independently maintain and operate the IT systems.

Radian Solutions has provided the State department with a comprehensive, efficient, and sustainable IT solution. Our approach combines technical expertise, collaborative engagement, and a focus on capacity building to ensure the State not only meets current needs but is also poised for future challenges and opportunities.

Benefits & Impact

Radian Solutions brought a multifaceted array of benefits and impacts, encompassing improvements in system capabilities, compliance with regulations, and enhancements in data management and utilization.

  • Enhanced System Capabilities: By integrating services with other internal and external systems, the project significantly broadens the scope and functionality. This ensures the system remains relevant and capable of meeting evolving healthcare and regulatory requirements.
  • Improved Data Management: The project’s emphasis on Extract, Transform, and Load (ETL) processes, coupled with the migration to modern database technologies in AWS, will streamline data management. This leads to more efficient data processing, storage, and retrieval, facilitating better decision-making and reporting.
  • Compliance and Data Quality: Ensuring compliance with HIPAA and other federal standards is paramount. The project’s focus on adhering to these standards while enforcing the State department’s data quality requirements will improve the reliability and security of data transactions and storage.
  • Operational Efficiency: The addition of the Radian team to maintain and operate the health care system as needed enhances the system’s operational efficiency. It ensures that the system is well-maintained, up-to-date, and capable of supporting the dynamic needs of the healthcare department.
  • Stakeholder Engagement and Support: Working closely with the State department’s project management and technical staff will foster a collaborative environment, ensuring that system modifications and support are closely aligned with user needs and expectations.
  • System Reliability and Uptime: Continuous maintenance, troubleshooting, and support will enhance healthcare system’s reliability and uptime, ensuring that critical healthcare data is always accessible when needed.
  • Data Accessibility and Utilization: By improving the system’s data processing capabilities and compliance with standards, healthcare system will make healthcare data more accessible and usable for various stakeholders. This can lead to better healthcare outcomes and more informed policy decisions.
  • Future-Proofing: The migration to cloud-based technologies and the implementation of serverless computing positions for scalable growth and adaptability to future technological advancements.
  • Cost Efficiency: Over time, the project could lead to cost savings by streamlining operations, reducing the need for manual interventions, and leveraging cloud efficiencies.
  • Knowledge Transfer and Training: The commitment to training State’s designated staff and transferring knowledge and artifacts ensures that the state retains expertise and reduces dependency on external consultants over time. This builds internal capabilities and supports sustainability.

In summary, the project not only aims to enhance the technical and operational capabilities of healthcare IT system but also seeks to ensure that the system can support current and future healthcare initiatives in a compliant, efficient, and scalable manner. This will have a lasting positive impact on the quality of healthcare data management and the ability to utilize this data for the benefit of the state’s healthcare system.

Standards & Frameworks
  • Systems Development Life Cycle (SDLC)
  • Accredited Standards Committee (ASC) X12 Standards
  • National Council for Prescription Drug Programs (NCPDP) Standards
  • Health Insurance Portability and Accountability Act (HIPAA) Standards
  • Agile Methodology