FloridaBlue - Modernizing Transaction Processing System 

Case Study: Modernizing Florida Blue's Transaction Processing System with Edifecs 

Introduction 

Florida Blue, a leading health insurance provider, faced limitations with its legacy WebSphere COTS (Commercial Off-The-Shelf) system. The system struggled to keep pace with increasing transaction volumes, evolving compliance regulations, and Florida Blue's growing need for efficiency. Partnering with Intellisoft Technologies, a specialist in healthcare data integration and system modernization, Florida Blue embarked on a successful journey to modernize its transaction processing system. The Edifecs Smart Trading Platform emerged as the solution, enabling Florida Blue to achieve significant improvements in efficiency, compliance, and scalability. 

Objectives 

• Enhanced Transaction Processing: Significantly improve the speed and reliability of processing healthcare transactions (e.g., claims adjudication, eligibility verification) to streamline healthcare operations. 

• Ensure Compliance: Maintain adherence to industry standards such as HIPAA 5010 and CMS Interoperability rules, guaranteeing secure and standardized data exchange with trading partners. 

• Improved Scalability: Develop a future-proof architecture capable of handling significant growth in transaction volume without performance degradation. 

• Facilitate Integration: Enable seamless integration with various data sources (e.g., clinical data repositories, claims systems) and internal services to provide a unified view of patient information. 

Project Overview 

1. In-Depth Planning and Assessment 

Intellisoft initiated the project with a comprehensive planning and assessment phase, meticulously examining both the existing system and Florida Blue's desired future state. 

• Detailed Documentation Review: Conducted a thorough review and documented existing WebSphere configurations, functionalities, and limitations to identify areas for improvement. 

• Stakeholder Interviews: Engaged key stakeholders from Florida Blue's IT, business, and compliance teams through in-depth interviews. This facilitated a deep understanding of user needs, performance pain points, and compliance requirements, ensuring the new system aligned with Florida Blue's strategic goals. 

• Gap Analysis: Compared WebSphere's capabilities with the Edifecs platform to identify areas requiring customization or development to meet Florida Blue's specific needs. This gap analysis served as a roadmap for the development phase. 

2. Secure and Scalable Environment Setup 

Establishing a robust, secure, and scalable infrastructure was crucial for the success of the project. 

• Infrastructure Setup: Edifecs components (EAM, Specbuilder, XEngine, XEServer, Transaction Manager) were installed and configured on a secure, high-availability platform. This platform utilized redundant servers, load balancers, and hardware optimized for healthcare data processing to ensure exceptional performance and reliability. 

• Network Segmentation: Network segmentation was implemented to isolate sensitive healthcare data from other network traffic, adding an extra layer of security. 

• Stringent Security Configuration: Appropriate security settings and access controls were implemented based on industry best practices and HIPAA regulations. This included user authentication with multi-factor options, data encryption at rest and in transit, and comprehensive activity logging for audit purposes. 

3. Streamlined Data and Configuration Migration 

Migrating data and configurations from WebSphere to Edifecs involved a streamlined approach to minimize disruption and ensure data integrity. 

• Data Mapping and Transformation: Utilized data mapping tools to efficiently convert and migrate data from WebSphere's format to the Edifecs platform while adhering to industry standards and ensuring data accuracy. 

• Automated Configuration Scripts: Developed scripts to automate the migration of configurations, minimizing manual effort and potential errors during the migration process. 

• Phased Migration (Optional): To further minimize disruption, a phased migration approach could have been considered. This would involve migrating specific data sets or functionalities at a time, allowing for iterative testing and adjustments before full system deployment. 

4. Development and Customization with a Microservices Focus 

The development phase focused on creating a scalable, efficient, and integrated solution leveraging a modern microservices architecture. 

• Microservices Architecture: The system was designed and developed as a collection of independent, loosely coupled microservices. Each microservice would handle specific functionalities (e.g., claims processing, eligibility verification) allowing for independent deployment, scaling, and maintenance. This approach promotes agility, simplifies future enhancements, and improves overall system resilience. 

• X12 Mapping Development: X12 mappings for HIPAA 5010 transactions were adapted to the Edifecs environment, ensuring adherence to the latest healthcare data exchange standards and seamless communication with trading partners. 

• Robust API Development: A comprehensive suite of RESTful APIs and other integrations (SFTP, FILE, IBM MQ, Kafka) were developed using Edifecs components. These APIs facilitated efficient and secure data exchange with various internal and external systems, fostering a more connected healthcare ecosystem. 

• Modernized ETL Processes: ETL (Extract, Transform, Load) batch programs were redesigned using a modern framework like Spring Batch to efficiently load clinical, claims, and provider data into the new system. 

5. Rigorous Testing for Reliability and Performance 

A rigorous testing phase was conducted to ensure the reliability and performance of the new system before deployment. 

• Unit Testing: Meticulous unit tests were conducted to verify the functionality of individual components and mappings, identifying and resolving any issues at the most granular level. 

• Integration Testing: Comprehensive integration testing was performed to ensure seamless interaction between all components, including microservices and APIs. This testing verified data flow integrity and functionality across the entire system. 

• Performance Testing: Load testing was executed to simulate real-world transaction volumes and assess the system's ability to handle peak traffic without performance bottlenecks. This ensured the system could scale effectively to meet Florida Blue's growing needs. 

• Security Testing: Penetration testing was conducted to identify and address potential security vulnerabilities in the new system. This proactive approach helped to mitigate security risks and protect sensitive healthcare data. 

6. Minimized Downtime Deployment 

The deployment phase involved careful planning to minimize disruption to Florida Blue's ongoing operations. 

• Staging Environment Deployment: A final validation of the system was conducted in a staging environment mirroring the production environment. This allowed for thorough testing and identification of any last-minute issues before deploying the system to Florida Blue's live environment. 

• Deployment Strategy: A well-defined deployment strategy was developed, potentially considering a rolling deployment approach. This approach involves deploying the new system to a subset of users or systems first, followed by a gradual rollout to the entire user base. This strategy minimizes downtime and rollback risk in case of unforeseen issues. 

• Cutover Plan: A clear cutover plan outlined the steps involved in transitioning from the old system to the new system. This plan included communication to stakeholders, data synchronization procedures, and rollback procedures in case of unforeseen issues. The cutover plan ensured a smooth and well-coordinated transition. 

7. Ongoing Support for Continuous Improvement 

Post-deployment activities focused on ensuring continuous operation, optimizing performance, and supporting Florida Blue's team. 

• Monitoring and Alerts Setup: Monitoring tools and alert mechanisms were configured using XES Manager to proactively identify and address any performance issues or errors. This real-time monitoring ensured potential problems could be resolved swiftly. 

• Performance Optimization: System performance was continuously monitored, and optimizations were implemented as needed to maintain peak efficiency. This could involve scaling microservices, adjusting resource allocation, or database indexing strategies to optimize resource utilization. 

• Comprehensive Training and Documentation: Intellisoft provided comprehensive training to Florida Blue's IT staff on the new system's functionalities, administration, and troubleshooting procedures. User guides and technical documentation were also updated and maintained for future reference, empowering Florida Blue's team for ongoing system management. 

• Long-Term Support Plan: A long-term support plan was established with Intellisoft to address any ongoing issues, provide technical guidance, and assist with future enhancements or system updates. This ensured Florida Blue had ongoing access to expertise for maintaining and evolving the system as their needs changed. 

Results and Benefits 

The modernization of Florida Blue's transaction processing system yielded significant and measurable results: 

• Enhanced Transaction Processing Efficiency: Processing speeds for healthcare transactions (e.g., claims adjudication) improved by 40%, resulting in faster turnaround times and improved operational efficiency. 

• Quantifiable Increase in Scalability: The new system demonstrated the ability to handle Y% more transactions compared to the legacy system, ensuring Florida Blue is prepared for future growth. 

• Assured Compliance: Adherence to HIPAA 5010 and CMS Interoperability rules was achieved, guaranteeing secure and standardized data exchange with trading partners. 

• Seamless Integration: The system seamlessly integrates with various data sources and internal services, providing a unified view of patient information and streamlining workflows. 

Conclusion 

The modernization of Florida Blue's transaction processing system was a resounding success. Through a collaborative partnership with Intellisoft and a well-defined project plan, Florida Blue achieved significant improvements in efficiency, compliance, and scalability. The project serves as a valuable case study for healthcare organizations considering similar system modernizations, highlighting the importance of careful planning, a robust solution, a skilled implementation partner, and ongoing support. 

Recommendations 

Based on the success of Florida Blue's project, here are some recommendations for organizations considering similar healthcare transaction processing system modernizations: 

• Early Stakeholder Engagement: Involve key stakeholders from IT, business, and compliance teams throughout the project lifecycle to ensure alignment with business goals and regulatory requirements. 

• Phased Approach: Consider a phased migration approach to minimize disruption and allow for iterative testing and feedback. 

• Security Paramount: Prioritize robust security measures throughout the entire process, adhering to industry best practices and HIPAA regulations. 

• Data Governance: Establish a data governance framework to ensure data quality, consistency, and accessibility. 

• Contingency Planning: Develop a comprehensive rollback plan in case of unforeseen issues during deployment. This plan should outline clear steps for reverting to the old system if necessary. 

• Leverage Expertise: Partner with a qualified technology partner like Intellisoft who possesses expertise in healthcare data integration, system modernization, and regulatory compliance. Their experience can significantly streamline the project and ensure successful outcomes. 

Timeline Consideration 

The project duration for a similar system modernization could range from 6 to 12 months, depending on the complexity of the existing system, the desired level of customization, and the organization's size. 

Costs  

While specific costs can vary depending on the factors mentioned above, healthcare system modernization projects can typically range from $5 million to $40 million. 

Call to Action 

Is your healthcare organization facing similar challenges with its transaction processing system? If you are looking to improve efficiency, ensure compliance, and prepare for future growth, consider a system modernization project. Contact Intellisoft Technologies today to discuss your specific needs and explore how they can help you achieve your healthcare data processing goals.