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From a Microsoft Case Study:
Client: The Menninger Clinic
CIS developed by Insource

This low cost solution, a Clinical Information System (CIS), Increases User Productivity, Simplifies Their Access to Patient Information and People, and Enables a More Effective and Efficient Workforce.

Background
The Menninger Clinic is a specialty hospital offering in-patient psychiatric services and treatment programs for adults and adolescents, as well as Professional Assessments and Adolescent Inpatient Evaluations. Menninger offers specialty diagnostic and treatment programs for a wide range of symptoms and disorders, including mood disorders such as depression and bipolar disorders, obsessive-compulsive disorders, eating disorders and substance abuse. Menninger is affiliated with Baylor College of Medicine and The Methodist Hospital System.

The Menninger Clinic requires a method to record patient documentation to support the requirements of Admissions, Clinical and Marketing staff. Menninger currently utilizes the Insource custom developed, Menninger Clinical Information System (MCIS), an in-house multi-user Web-based application to capture patient data and document each patient’s treatment from Pre-Admission through Post-Discharge.

Solution Summary
For many healthcare organizations, large amounts of critical information, such as clinical records, is contained in unstructured textural documents. In creating a typical application a fully normalized relational database used to represent the data can grow to enormous size. This can lead to a substantial cost for developing, maintaining and extending the application. By taking advantage of the XML capabilities of InfoPath and the document management and search capabilities of SharePoint the Insource solution implements a "document-centric" architecture that represents all application data as XML form documents stored within SharePoint document libraries. Reference tables and lookup data are represented as structured XML documents stored within a Reference Data Document Library.

MCIS is patient-centric and built to take care of the patient throughout their stay whether inpatient or outpatient. Thus, all the users of the system are constantly focused on their patients and information about their patients rather than other issues of the hospital. The MCIS solution is based on MOSS 2007 which is an ideal collaborative platform by its nature. The Insource solution focuses that collaboration around each individual patient entering and being treated. It streamlines the way users enter, access, and share patient data. Using familiar Office technologies, MCIS helps to better leverage existing technology investments and facilitates the integration of data across the organization.

Usage Scenarios
The following table describes a few of the key usage scenarios for the solution.

Key Event	Objective	Key Activities / Results
User browses or connects to application site or folder	Show user-appropriate content	If user logs in on a shared workstation, a login ID and password is required for system access Site content and documents are displayed only if user has proper access permissions
New patient is created	Initialize required patient data	Ensure existence of required patient metadata Generate new patient ID Create document library folders for patient as necessary Create overview page for patient using the Patient Overview template
Patient is admitted to unit	Establish patient episode, perform room/bed and staff assignments	Increment current patient episode number Ensure proper assignment of room and bed Ensure proper assignment of treatment team Reload selected details from forms for prior episode (Readmission of recently discharged patients only)
Patient is discharged from unit	Perform proper episode closeout activities	Ensure completion of all required discharge activities and forms Notify HIMS Initiate lockdown and archival of patient data with HIMS approval
User creates a new form	Ensure that form is initialized with appropriate patient identifiers and default data	Create a new patient record (selected Admissions forms only) Prompt for patient selection if the current patient context has not been established Load default data and dropdown list values from the appropriate lists and forms
User submits a form	Ensure proper document identification and versioning based on established rules	Ensure that all required data has been entered Ensure that all entered data meets validation rules Send notifications if necessary Retain multiple document versions as necessary Update audit trail
User requests access to protected content or documents	Ensure proper user authorization	Request is sent to MCIS Administrator Approval is granted by user and IT management MCIS Administrator grants access and notifies user

The MCIS approach leads to several benefits:

Reduced complexity simplifying solution maintenance
Improved flexibility leads to substantial reduction of the costs of enhancements
Reuse of built-in features means that many requirements do not need customization
Reduction of user effort to create and manage patient records by eliminating redundant data entry into multiple systems.
Improved system reliability achieved through reduction of code complexity and support for built-in change control.
Reduced IT support costs through elimination of legacy systems and reduced developer effort to create and maintain medical forms.
Greatly improved ability to quickly respond to new and changing business requirements through improved development tools and extensible system architecture.
Tighter internal controls and improved compliance with HIPAA privacy rules enabled by improved document management, integrated security, and auditing capabilities.
Improved data design and architecture facilitate integration with other systems.