SpinSys-Diné developed the Referral Management System (RMS) for the U.S. Military Health System (MHS) to allow expedited and reliable referral services between doctors and health insurance providers.

The current referral process depends on phone and fax exchanges and often creates communication breakdowns that can lead to delayed diagnoses, unnecessary testing or poor continuity of care. SpinSys-Diné developed RMS as a service oriented messaging system that handles all Military Treatment Facility (MTF) to Managed Care Support Contractor (MCSC) for Department of Defense (DoD) health insurance provider referrals and Right of First Refusal (ROFR) determinations. Fully integrated with USAF Point of Care (POC) Systems, RMS eliminates the need for manual fax requests from the MTF level. RMS is a “business to business” application that integrates with no less than five (5) large POC systems and processes approximately 1.5M referrals annually.

RMS works in conjunction with the Integrated Clinical Database (ICDB) to provide paperless medical referrals from the MHS sites. COHORT provides the bridge between the all-electronic fax referral from the ICDB sites and the Public Switched Telephone Network (PSTN) through a single fax services provider as well as system to system secure XML services.

Communication between ICDB, COHORT and the fax service providers are accomplished using industry-standard web services over secure connections. In addition to the fax transmission, providers that have the capability will use secure XML transmission. This communication across all interfaces shall use a standard X12 EDI (American National Standards Institute ASC X12N 5010)1-formatted message wrapped in XML, and transmitted securely using SOAP (Simple Object Access Protocol) over HTTPS.

These providers include HealthNet, Humana, United Health Care, and ISOS. The fax service is available to all provided as a backup form of communication, and the referrals are logged in the Referral Database on Oracle 10g using encrypted database connections on port 1521.

Highlights and Benefits of RMS:

  • Manage, track and complete referrals online with minimal infrastructure

  • Identify referral and usage patterns

  • Increase operational efficiency by minimizing lost referrals

  • Improve care outcomes with automated data exchange

SpinSys-Diné successfully migrated the RMS application from a client-server framework, running on USAF infrastructure, to the AWS Cloud platform.

Application migration to the Cloud should be carefully evaluated for its ROI. Cloud computing offers many benefits over traditional on-premise computing solutions including but not limited to:

  • Ability to auto scale up or down to match fluctuating demand for resources

  • Overall lower Total Cost of Ownership (TCO) with no or minimal upfront cost

  • Fully managed infrastructure services with high level of security, reliability and availability

  • Higher team productivity and agility with automated and fast provisioning of infrastructure resources

However, not every application lends itself to a successful Cloud migration and/or will fully recognize the benefits of the Cloud. An upfront analysis of the application and/or application portfolio to identify best candidates for migration is highly suggested. A deep dive into your candidate application(s) to confirm development based on best practices is required. Applications may require updates, including design changes, before migration to the Cloud. These steps should be taken to ensure the highest probability of success and highest ROI.

A DoD mission critical system, with high security protocols including but not limited to Health Insurance Portability and Accountability Act (HIPAA) compliance, RMS was targeted for a proof of concept cloud migration. Amazon AWS GovCloud was selected as the private cloud provider as it met regulatory compliance approval for DoD use.

AWS GovCloud (US) has received an Agency Authorization to Operate (ATO) from the US Department of Health and Human Services (HHS) utilizing a FedRAMP accredited Third Party Assessment Organization (3PAO) for the following services: EC2, S3, EBS, VPC, and IAM.

The modernization solution provided by SpinSys-Diné was delivered in multiple phases. The initial phase allowed for the automation and migration to a SOA based fax delivery system. In subsequent phases, SpinSys-Diné worked closely with different health insurance providers to transition from a fax based system to a pure Service Oriented/messaging based system.

  • AWS allowed for access to durable, available, and US persons only controlled storage that met data security requirements and scaled as the solution grew

  • Due to the elasticity of AWS web application services, we could simply remove resources when the demand subsided, ensuring high asset utilization and cost-efficient web applications

  • AWS GovCloud (US) Region include all categories of Controlled Unclassified Information (CUI), including ITAR, as well as Government oriented publicly available data

  • AWS permits requisition of compute, storage, and other services on demand, gaining access to a suite of secure, scalable, and flexible IT infrastructure services