Pediatric Home Service (PHS) is an independent pediatric home health care company with locations across the country, specializing in children with medical complexities and technology dependencies. PHS helps children not only live, but truly succeed at home.

PHS first came to Emergent Software to help build a new online ordering system and extend their existing home-grown custom patient portal, specifically to integrate it with new EHR platforms they were planning to adopt. After a short discovery phase, it was determined that the existing custom software included out-of-date technology that would first require app modernization.

With our deep technical experience in designing, architecting, and developing cloud-native applications, many successful client testimonials, and the Modernization of Web Applications to Microsoft Azure specialization awarded by Microsoft, PHS found a partner with the right credentials to deliver a project focused on Microsoft software, data, and cloud technologies.

This case study tells the story of how Emergent Software worked with PHS to modernize their existing applications, integrate them with their new EHR platform, and host all the new components on Microsoft Azure.

Modernizing homegrown applications

Meeting Pediatric Home Service’s excellent standard of care means dealing in many business and technological complexities, which makes it difficult to use o-the-shelf software. For example, there may be multiple adults, including family members and nurses, logging into the patient portal to order supplies for one child. Or there could be more than one child per household. Plus, PHS operates in ten states, and billing practices differ between them. For this reason, PHS's internal software development team had developed a suite of custom software applications to support their unique operational needs.

With plans to move to a new EHR platform, the homegrown tools PHS had previously developed needed significant changes. However, without internal resources dedicated to maintaining the tools and codebase, PHS’s suite of custom applications had become out-of-date.

Upgrading out-of-date technology & reducing technical debt

Emergent’s first task was to modernize the existing application. Here are some of highlights of what was updated and the technical debt that was mitigated in this app modernization project:

  • Upgraded to supported versions of .NET
  • Upgraded Nuget & NPM packages
  • Upgraded Angular from v7 to v11
  • Upgraded Node.JS from v.11.3 to v14
  • Replaced legacy Active Directory code with Graph API calls
  • Improved security
  • Refactored inefficient code, eliminated duplicate code, removed dead code

Utilizing advanced Azure services to increase software reliability and improve security

In addition to upgrades and code cleanup, Emergent helped PHS achieve greater software reliability and improve security utilizing advanced Azure services.

Previously, when orders were submitted to the EHR, any failures that occurred on the EHR side meant the order simply errored out and went into the void (to be discovered later). In the new modern version of the application, Emergent implemented an Azure Service Bus queue for order processing — in the event of an issue with the EHR, the order will get automatically resubmitted when the problem resolves. 

Azure functions were built to replace background services which previously ran as Windows Services that were hard to maintain and troubleshoot. To eliminate the risk of sharing passwords, Azure AD Managed Identity was used for everything.

Confident deployments with CI/CD pipelines in Azure DevOps

Emergent also improved PHS's software development practices by building out CI/CD pipelines using Azure DevOps for automated deployments. With enhancements to the hosting and deployment processes, PHS is now confident in their ability to deploy feature enhancements during daytime hours without fear of downtime or disruption to patients or caregivers. 

Integrating with new EHR & improving the user experience

After modernizing the existing applications, Emergent returned to the original goal and began the extensive project of integrating the applications to their new EHR system, Brightree, while adding features and improving usability of the existing functionality.

Compatible with multiple EHR platforms

PHS recently acquired additional organizations around the country which use Brightree as the source of record for patient orders, but which had no patient portal or online ordering system. The upper Midwest location, where PHS is headquartered, also transitioned to Brightree. PHS needed their custom patient portal and online ordering software to work with multiple instances of Brightree.

Emergent successfully adapted the newly modernized portal and online ordering system to work with Brightree and be hosted in Azure, with a version that continues to run on-premises. This newly updated suite of software will help PHS scale and expand the business across the country, while also further improving the experience for patient caregivers and PHS employees.

Building a better patient and caregiver experience

In addition to modernizing the application and integrating it with Brightree, PHS also required Emergent to update the patient portal to improve the experience of customers and PHS employees alike.

First, there’s caregiver management. Since PHS is a pediatric service, the patients aren’t typically managing their own care. Rather, they have caregivers, usually family members. There can be multiple caregivers per child or multiple children per caregiver, which creates a complex workflow. Emergent’s updates to the portal allow all caregivers to be tied to the correct patient account.

We also worked on creating an employee view in the portal for an enhanced workflow. Historically, the portal was only for customers, but now PHS employees can use secure messaging to communicate with caregivers. Having caregivers, employees, and patients linked on the portal means that the experience is more connected and holistic.

Another improvement resulting from Emergent's work was to digital patient onboarding. Previously, a family would have to call PHS to get their child set up on the portal. Now, as long as they know basic information like the patient’s medical record number and date of birth, they can create their own account online. This creates a smoother experience for the families and encourages portal use, which provides an interface for caregivers to manage their patients.

All of these updates made portal use easier and more appealing for families and improved communication between PHS and caregivers.

Migrating to Azure

PHS’s legacy EHR system is hosted on-premises, so it made sense that their existing customer software was hosted there too, but support of this environment was complicated. Issues would arise with Windows services running background processes, IIS configuration with OS updates, filtering issues with on-premises web application firewall (WAF) systems, etc. PHS's strategy focused on newly developed tools and platforms being cloud-native apps.

Emergent’s cloud architects worked closely with the development team, designing and implementing robust hosting of PHS’s modernized suite of custom software on Microsoft Azure.

Long-term support & partnership

Emergent Software and PHS are glad to be long-term partners. From our initial custom software development work, our partnership with PHS has grown to include a full suite of services: We continue to meet with PHS regularly to discuss how Emergent can further help the organization accomplish strategic goals. We look forward to working with them for years to come. Emergent Software is not just a custom software development company — we’re your full stack technology partner.

Technologies Used

azure ms net angularJS

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