Microsoft BizTalk Server
Customer Solution Case Study
Cancer Center Saves Time and Money,
Improves Care with Medical Record Solution
Overview
Country or Region: United States
Industry: Healthcare providers
Customer Profile
Located in Houston, Texas, the M. D.
Anderson Cancer Center offers clinical
trials and programs in cancer treatment,
education, and prevention. It has more
than 16,000 employees and serves about
74,000 patients a year.
Business Situation
M. D. Anderson medical staff lost
productivity because clinical and research
data were not well integrated into a
comprehensive, easy-to-use, instantly
available electronic medical record (EMR).
Solution
With expertise from partner Avanade, M. D.
Anderson used service-oriented
architecture (SOA) and the Microsoft® .NET
Framework to build an EMR application to
unify data from many departmental
systems.
Benefits
 Accurate, instantly available data
 Flexible scalability, fail-safe availability
 Methodology for continued growth
 Increased productivity
 Reduced costs
“What’s it worth to a patient to have his or her
physician at the other end of the phone with
instantaneous access to the CT scan that was
completed this morning?”
Lynn Vogel, Vice President and Chief Information Officer, M. D. Anderson Cancer Center
The University of Texas M. D. Anderson Cancer Center, integrating
research and clinical care to serve 79,000 patients annually,
wanted to improve the flow of its data. Because of its unique and
sophisticated needs, M. D. Anderson chose to build an electronic
medical record system in-house, with a service-oriented
architecture to connect and display data using the Microsoft® .NET
Framework. With the help of Microsoft Gold Certified Partner
Avanade, M. D. Anderson implemented standards and processes to
develop a sophisticated application to provide data to medical staff
using the Microsoft environment. The system—and the IT
department methodology it is built on—is flexible, highly secure, and
scalable to support future growth. Most important, however, it has
improved the productivity of M. D. Anderson medical staff, resulting
in greatly enhanced patient care.
“We have built a
software development
factory that frankly I
would stack up against
any commercial
software company, bar
none. And it’s all built
around Microsoft
product offerings.”
Lynn Vogel, Vice President and Chief
Information Officer, M. D. Anderson Cancer
Center
Situation
The University of Texas M. D. Anderson
Cancer Center seeks to eliminate cancer
through programs that integrate patient care,
research, prevention, and education. The
center provides cancer care in the form of
surgery, chemotherapy, radiation therapy,
immunotherapy, and combinations of these
and other treatments. Located in Houston,
Texas, M. D. Anderson has treated more than
700,000 people since it was founded in
1944. With more than 16,000 employees, M.
D. Anderson serves about 79,000 patients
annually.
“In cancer, the world of research and the
world of clinical care are intertwined very
closely,” says Lynn Vogel, Vice President and
Chief Information Officer at M. D. Anderson.
“Developments can move from the research
side to clinical practice even on a weekly
basis.”
Managing that flow of information can be a
real challenge, especially because, as Vogel
says, “Cancer patients have a lot of data.”
The data can include routine care, lab tests,
radiology images, clinical protocols, and
research protocols. He says, “Several years
ago you’d see patients walking around the
hospital pushing wheelchairs. The
wheelchairs didn’t have patients in them.
They had medical records in them.”
Because of this mountain of data, medical
professionals’ productivity has long been
hampered by the effort required to both find
physical records and a particular piece of
data within a record. “A nurse might have had
to go to a radiology department film library to
pull the film—and sometimes it would be off
with someone else,” says Vogel. “Or the nurse
or doctor would take half an hour paging
through a physical medical record to find a
particular lab result.”
So, early on, M. D. Anderson saw the need to
move to electronic medical records (EMRs),
which would both ease the burden of
paperwork and improve the availability of
data. In 1999, the center's Radiology
department created an application called
ClinicStation to integrate the presentation of
radiology images with clinical data stored in a
variety of IT systems. The application was
written using the Microsoft® Visual Basic®
version 6.0 development system and the
Component Object Model (COM). Over the
next six years, the center continued to
enhance ClinicStation with new features, and
it evolved into a complex workflow system.
But as M. D. Anderson sought a broader EMR
strategy to include data other than radiology
images, it found that commercial packages
didn’t fit its environment. Most such
packages were focused only on acute care
and couldn’t integrate research data.
Additionally, many had been first designed
solely for outpatients, or solely for inpatients,
and did not make a successful transition to
cover both.
In 2005, M. D. Anderson decided to develop
its own EMR environment in-house. The
solution needed to be able to adapt to the
center’s complex organization and workflow
processes. But the effort as a whole had two
additional key goals, says Chuck Suitor, the
center’s Director of EMR Development and
Support. “First, we wanted to make sure the
architecture would support us for a good long
time to come. We needed an infrastructure
that could guarantee performance,
scalability, and reliability.” The system
needed to support not only growth in
numbers of patients served and the amount
of data on each patient, but potential new
technologies and functionality.
Suitor continues, “Second, we had to ensure
that our IT organization could grow.
Historically we’d had an exceptionally small
“The Microsoft and
Avanade tools around
.NET enabled us to
easily support the latest
standards.”
Chuck Suitor, Director of EMR Development
and Support, M. D. Anderson Cancer Center
development team, three people or fewer,
and now we needed a methodology and
organization that could support a large
team.”
Thus, M. D. Anderson didn’t need just a stateof-the-art EMR application. It needed an
integrated set of technologies that would
support continued, disciplined development
of a system flexible enough to serve as the
foundation for its IT strategy for years to
come.
Solution
One lesson M. D. Anderson took from the
success of ClinicStation was the value of a
service-oriented architecture (SOA), which
treats services as components that work
together to accomplish business goals.
Indeed, that early version of ClinicStation,
with its presentation of various types of data,
had anticipated the industrywide move to
SOA. “That experience laid the groundwork
for us to move into SOA in a formal way,” says
Vogel.
In early 2005, M. D. Anderson decided to
build its new solution on SOA and the
Microsoft .NET Framework. The .NET
Framework provides a programming model
and runtime for Web services, Web
applications, and smart-client applications.
The center selected the Microsoft
environment because it wanted a set of
technologies to provide a foundation
supporting numerous existing heterogeneous
systems and into which its different
departments could integrate commercial
software applications. “Such an ambitious
project was only feasible with these kinds of
tools now available that literally weren’t
available even three or four years ago,” says
Vogel.
A first step was to re-architect the
ClinicStation solution using the new
technologies. ClinicStation expanded to serve
as the foundation for substantial future
development. That expansion, however,
required that the center develop common
standards, tools, libraries, processes, and
methodology to run a disciplined software
development organization.
To assist in the development and knowledge
transfer, M. D. Anderson chose in October
2005 to partner with Avanade, a strategic
global joint venture of Microsoft and
Accenture that specializes in solutions based
on the Microsoft platform. Headquartered in
Seattle, Washington, Avanade helps
companies develop large-scale SOA systems
to integrate heterogeneous IT environments.
“The Microsoft and Avanade tools around
.NET enabled us to easily support the latest
standards in SOA,” says Suitor. “Also,
Avanade had experience in building largescale development teams, which was
something we were very interested in.”
M. D. Anderson used Avanade assets
including the ACA.NET architectural
framework, Avanade Connected Methods
(ACM) project management methodology, and
ACA Lifecycle, which integrates ACM with the
Microsoft Visual Studio® Team System
development system and Visual Studio 2005
Team Foundation Server. The center also
used application simulations from iRise, of El
Segundo, California, to help construct new
components.
In July 2007, M. D. Anderson completed the
initial ClinicStation architectural rewrite. In
the new system, still called ClinicStation, the
SOA provides a common access framework
for more than 40 back-end systems. M. D.
Anderson takes a “best of breed” approach
that gives different departments the
prerogative to choose commercial software
applications that address their specific
needs. ClinicStation uses Microsoft BizTalk®
Server 2004, part of the Microsoft Application
Platform, to support viewing data and
communicating with these back-end systems,
allowing access to the data in place. Other
components of ClinicStation also take
advantage of other Microsoft products
including Microsoft SQL Server™ 2005
database software; Microsoft Office
SharePoint® Portal Server 2003; Microsoft
Operations Manager 2005; the Visual C#
2005 language (as part of Visual Studio
Team System); Internet Information Services
version 6.0 for hosting Web services; and the
Windows Server® 2003, Windows® XP, and
Windows Vista® operating systems.
The new system serves about 10,000 unique
users per month, up to 4,500 simultaneously.
It offers 75 services, with 125 million service
calls per month, and peak utilization topping
3,000 service calls per second. Its security
infrastructure involves a shared token server
to authenticate a user and client application.
The security takes advantage of Web Services
Enhancements 3.0 for Microsoft .NET, a
Microsoft technology that provides
developers with the latest advanced Web
services capabilities to keep pace with the
evolving Web services protocol specifications.
Benefits
With its new EMR system development, M. D.
Anderson has improved the accuracy of its
data and quality of employees’ decision
making; provided a scalable foundation for
continued high-performance growth;
increased the productivity of its medical staff;
and lowered costs. “At the end of the day all
of these benefits really accrue to the patient,”
says Vogel.
Accurate, Instantly Available Data
ClinicStation now provides medical personnel
with more data, more quickly and accurately.
The original ClinicStation had a very rich set
of features, and the newly written version had
to ensure that every feature was as good or
better than the original.
“Our care pattern involves intense two-day or
three-day encounters with patients, who see
various specialists and get all the diagnostic
tests they need,” says Suitor. “But physicians
want to have access to information on a
patient when they are seeing the patient. So
if newly created data was not instantly
available, it would slow down the decisionmaking process in this series of
appointments. This system makes everything
instantly available to everyone.”
Furthermore, that data is accurate. “Every
time you move a piece of data from point A to
point B, you have a risk,” says Vogel. “The
risks are that you’ll lose the data, or that
point B will become out of date from point A.
The SOA framework, where services expose
or present data, eliminates those problems.
When a physician looks at image data or
clinical data in ClinicStation, he or she is
really looking at that data as it exists in the
host system.”
Flexible Scalability, Fail-Safe Availability
“We have created what we call a virtual
repository here,” says Vogel, “and it makes
the flexibility of adding new systems and new
data sources extremely easy. That flexibility is
facilitated by the SOA framework, because we
don’t have to move data around.”
The new architecture has dramatically
increased performance. “It’s really quite
phenomenal,” says Suitor. “A single server on
the new architecture can easily handle the
load of our entire 11-server Web farm in the
old architecture.”
The new architecture also has significant new
safeguards in protecting availability. For
example, M.D. Anderson has used Operations
Manager 2005 to integrate a custom
monitoring solution into ClinicStation, which
helps the IT department see developing
problems and resolve them before they affect
users. “In medicine,” says Vogel, “you must
have systems that do not fail. Because if they
do fail, there are consequences, which
ultimately end up on the shoulders of the
patient. We take that extraordinarily
seriously.”
Methodology for Continued Growth
“The institution continues to expand
dramatically,” says Suitor. “In every
measure—number of patients seen, clinic
visits, surgeries, and revenue—it grows every
year. While I don’t think we can claim
ClinicStation is the only cause of that growth,
it’s certainly a significant contributor.”
The reason is not just the system’s flexibility
and scalability, but the IT organization that M.
D. Anderson has developed to support it. “Our
department underwent significant growth,”
says Suitor, “with the development
organization increasing from 3 people to
more than 40, and we did so with real
success.”
Thanks to technologies such as Visual Studio
Team System and the methodology Avanade
helped put in place, M. D. Anderson has
large-scale development capabilities for new
projects. “With our release management,
version control, code libraries, and other
capabilities, we have built a software
development factory that frankly I would
stack up against any commercial software
company, bar none,” says Vogel. “And it’s all
built around Microsoft product offerings.”
Increased Productivity
The result is a dramatic increase in
productivity for the institution’s most
expensive resources. “Historically,” Suitor
says, “if one physician wanted to consult
another, they’d have to go to the same
physical location so they could look at the
same images and data. Now they can talk on
the phone and be looking at separate
computers, but be looking at exactly the
same thing.”
Because the system can also provide links for
appropriate resources outside the facility, it’s
not just M. D. Anderson medical staff who
gain. Referring physicians, consulting
physicians, and even patients have their own
portals to relevant data. Vogel recalls one
situation where an M. D. Anderson patient
was hospitalized in London, and the
physicians were able to share electronic
images as part of a joint consultation. “In this
example, it turned out there was no serious
complication,” Vogel says, “so the patient
was able to be discharged, rather than having
to be operated on due to a lack of
information.”
“We knew the institution would be counting
on the features of ClinicStation, so
performance and functionality were key areas
of emphasis,” says Suitor. “The new version
has exceeded our expectations.”
Furthermore, M. D. Anderson has used the
system’s flexibility to improve its workflow.
“For instance,” Suitor says, “if a drug
utilization needs to be reviewed by a
pharmacist before a patient can continue
with care in the clinic, we don’t need to have
a pharmacist standing right there to do it. The
pharmacist can take care of it from wherever
he or she needs to be operationally. This
means we can keep the hospital and all of
the clinics flowing much faster.”
Reduced Costs
The improved productivity has led to
significant decreases in costs, though Vogel
is reluctant to attach specific numbers to
them. “We’ve had faculty here point out that
if every physician who uses ClinicStation
saves a half-hour a day (which is certainly
reasonable), that has saved the center—
depending on assumptions and calculations—
$8–10 million a year. But the problem is, that
$10 million doesn’t accrue to the
organization’s bottom line.”
For More Information
For more information about Microsoft
products and services, call the Microsoft
Sales Information Center at (800) 4269400. In Canada, call the Microsoft
Canada Information Centre at (877) 5682495. Customers who are deaf or hard-ofhearing can reach Microsoft text telephone
(TTY/TDD) services at (800) 892-5234 in
the United States or (905) 568-9641 in
Canada. Outside the 50 United States and
Canada, please contact your local
Microsoft subsidiary. To access information
using the World Wide Web, go to:
www.microsoft.com
For more information about Avanade
products and services, call (206) 2395600 or visit the Web site at:
www.avanade.com
Microsoft Server Product Portfolio
It’s a problem, however, only from an
accounting standpoint, in terms of
quantifying benefits. The benefits do exist—
for patients. “What’s it worth to a patient to
have his or her physician at the other end of
the phone with instantaneous access to the
CT scan that was completed this morning?”
Vogel asks rhetorically.
For more information about the Microsoft
server product portfolio, go to:
www.microsoft.com/servers
He continues, “We have extraordinary
statements from physicians saying they could
not do what they do today in the absence of
ClinicStation. It’s like those famous television
commercials: the technology costs a few
bucks and the staff time costs a few bucks,
but when a physician stands up and says he
couldn’t practice without this—that’s
priceless.”
For more information about University of
Texas M. D. Anderson Cancer Center
products and services, call (713) 7926161 or visit the Web site at:
www.mdanderson.org
Software and Services
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Microsoft Server Product Portfolio
− Windows Server 2003
− Microsoft BizTalk Server 2004
− Microsoft Operations Manager 2005
− Microsoft SQL Server 2005
Microsoft Office
− Microsoft Office SharePoint Portal
Server 2003
Microsoft Visual Studio
− Microsoft Visual Studio 2005 Team
Foundation Server
Windows Vista
Windows XP
Avanade ACA.NET
Avanade Connected Methods
 Avanade ACA Lifecycle
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Hardware
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Document published October 2007
HP ProLiant server computers
Partners
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This case study is for informational purposes only. MICROSOFT
MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS
SUMMARY.
Technologies
− Internet Information Services 6.0
− Microsoft .NET Framework
− Web Services Enhancements 3.0 for
Microsoft .NET
Avanade