Case Study: HAMB Systems
Internet-based Patient Eligibility System
HAMB Systems is a software development company wholly owned by 28 small to medium health funds. These health funds are in the unique position in the provision of health care in the Sydney, Australia private health market. They account for more than 60% of all health funds in Sydney, Australia.
Government pressure to provide patients with informed financial consent has driven private funds to provide significant information, which has previously been unavailable. This information was being provided by manual methods, both calculation and reporting.
Clearly, provision of this information to the 1300 hospitals across Sydney, Australia was beyond the financial capacities of even the largest health funds. Transactional volumes are substantial. Most large hospitals perform in excess of 150 eligibility checks per day each.
Emerging Systems provided HAMB with an Internet-based patient eligibility system for each of the funds. The system allows each hospital (or healthcare provider) to securely enter data for a patient and their episode of care. All transactions adhere to best practice transaction control - even across the Internet. Based on this information a patient's health fund status and individual exclusions or co-payments are calculated.
The system provides a range of reports from financial summaries through to audit details. It provides adherence to all current privacy legislation and reporting. It also provides for a number of additional security measures and auditing facilities that offer significant improvements over the traditional models for Internet security.
The system is closely integrated with the internal thick client system (of several versions) that each of the funds use internally for the management of their business. The transactions are replicated in real time to a Delphi-based system across an encrypted link. Data is kept synchronised with a Unix-based system via a number of parallel interfaces.
Products & Services Used
The system relies on Unix, Microsoft SQL Server, MS Queuing, Microsoft IIS and several Microsoft development tools.