The healthcare system is a critical component of California’s healthcare infrastructure, providing essential services to the California citizens. It serves over 18,000 users, including state staff, counties, and healthcare providers, enabling them to manage patient eligibility, records, service provider authorizations, and system reporting. The system also facilitates the electronic submission and management of service authorizations.
However, this system is currently in maintenance mode, and there is an urgent need for continued maintenance and operations (M&O) to ensure its functionality and support. Any failure in these applications could have a significant impact on providers, government staff, and clients across all 58 counties in California. The system’s reliability is crucial for the management of medical case information and the timely provision of healthcare services to California’s most vulnerable citizens with special healthcare needs.
The business problem, therefore, is to ensure the continuous, reliable operation of this system by providing comprehensive technical support and application maintenance services. This includes addressing system “fixes,” program policy changes, incident reports, data repairs, change requests, software maintenance change requests, and compliance with HIPAA and state and federal statutes. Additionally, there is a need to maintain system operations, including capacity planning, performance monitoring, backup and recovery processes, technical support and monitoring administration. The system’s availability, help desk support, and adherence to performance service level agreements are also critical components of addressing this business problem.
The proposed solution offered by Radian Solutions for this healthcare project included program management and a comprehensive range of technical support and maintenance services. The scope of services included:
- Technical Support and Application Maintenance: Provide support for system fixes, program policy changes, incident reports, data repairs, change requests, and software maintenance change requests.
- System Operations Support: Monitor system capacity and performance, maintain backup and recovery processes, and ensure system availability.
- Help Desk Support: Offer help desk support for counties, service providers, and DHCS staff, including system navigation assistance and problem documentation.
- Policy Support: Support program policy by researching and maintaining familiarity with program policies and updates.
- Training and Documentation: Maintain and update System User manuals, training webinars, and reference materials.
- Unscheduled Support Services: Respond to unscheduled system support requests on a priority basis, with defined response times based on the severity of the issue.
- Compliance with Response Times: Adhere to specified response times for addressing system inoperability and module errors.
- SMCR Procedures: Follow a structured process for handling Software Maintenance Change Requests, including meeting with State staff, preparing written descriptions of the problem and proposed solution, and conducting design walkthroughs.
- Testing and Implementation: Write test scripts, update SMCR progress status, and follow final testing and implementation procedures.
- Change Management: Participate in regular change cycle updates, develop and maintain a Release Management Plan, and document all source code changes.
- System Improvements: Recommend system changes to improve maintainability, scalability, and performance, and research upgrades to hardware, software, and technical infrastructure.
Overall, the proposed solution aims to ensure the continued operation, reliability, and security of the system, which is critical for managing medical case information for the Statewide Healthcare Program.
The benefits and impacts offered by Radian Solutions for this project are summarized as follows:
- Enhanced Technical Support: Radian Solutions provided ongoing technical support and application maintenance services to ensure the smooth operation, which is crucial for managing patient eligibility, records, and service provider authorizations.
- System Maintenance and Fixes: The contractor will address incident reports, data repairs, and change requests, ensuring that the system remains up-to-date and functional, reducing the risk of system downtime or data integrity issues.
- Operational Support: System operations support, including capacity and performance monitoring, will help maintain the system’s efficiency and reliability, ensuring that it can handle the demands of over 18,000 users.
- Help Desk Support: The provision of help desk support for counties, service providers, and state staff will improve user experience and ensure that any issues or questions are promptly addressed.
- Policy Support: Radian Solutions supported program policies by maintaining familiarity with program policies and updates, which will help ensure that the system aligns with current regulations and requirements.
- Training and Documentation: Maintaining and updating the System User manuals, training webinars, and reference materials will ensure that users have access to the latest information and guidance on using the system.
- Improved System Integrity: By addressing system fixes and maintenance activities, Radian Solutions helped ensure the integrity of the application and the data it handles, which is critical for the medical case management of California citizens.
- Enhanced User Experience: The technical support, help desk support, and updated training materials led to a better user experience for state staff, counties, providers, and other stakeholders, making it easier for them to manage and access important health care information.
- Increased System Availability: Meeting system availability requirements and providing timely responses to system issues will increase the reliability of the system, ensuring that it is available to users when needed.
- Compliance with Regulations: Ensuring compliance with HIPAA and State and Federal Statutes will help protect patient privacy and maintain the security of health information.
- Long-term System Improvement: Recommendations for system changes, upgrades, and improvements will help enhance the maintainability, scalability, and performance of the system over time, ensuring its long-term viability and effectiveness.
Rational Unified Process (RUP)
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