NYCHSRO - MedReview, one of the oldest peer review organizations in the US, asked SDS to develop a solution that would streamline and simplify their current process, support their first-class analysis, and fuel the future growth of the business.

SDS's Solution

SDS began with a full analysis of MedReviews business processes, their methodology for collecting information and their procedure for compiling reports. This information was then reviewed and analyzed in light of MedReviews business goals and objectives, and the resulting effort was the development of the URMS (Utilization Review Management System) Application.

URMS streamlines the complex, resource-intensive and information-intensive utilization management process. The URMS Application tightly integrates all modules of the review process, providing a single soup-to-nuts software system for utilization management. Each of the Systems key features supports the delivery of MedReviews first class analysis and offers fuel for future business growth.

URMS is powered entirely by a purpose built, J2EE compliant, Enterprise Java Bean 2.x engine. Java technology makes URMS easily portable between
Environments, including Intel/Windows, Sparc/Solaris, Linux, and IBM mainframes. The underlying database may be Oracle, Sybase, ASE, Microsoft SQL Server, Interbase or IBM DB2. The containing application server may be any J2EE, EJB 2.x compliant container.

The internal architecture of the application is an open 'bus' with functionality and interface modules plugged in. This architecture makes it possible to easily extend the functionality without disrupting existing functionality. It also simplifies pushing and pulling data with external systems and data feeds.

Lastly, URMS is designed for fault tolerance and scalability. Installations may be as simple as a single server box or as complex as a distributed set of application servers and database servers with automatic fault detection, failover, and intelligent load balancing at all levels.

URMS Application Features:

1. Provides a tight integration of all utilization management procedures: URMS incorporates all stages of the review process from intake procedures to disease and case management and appeals. No matter how many analysts need to provide input on a specific case, everything can be found by accessing a single application.

2. Facilitation of combining internal data with external data sources: URMS facilitates research and analysis by enabling the user to pull data from disparate external systems into one source. Robust statistical validation ensures the validity of data combination.

3. Provides validation of all information entered by users:

All data entered into the system is checked to make sure that it is correct. Mistakes such as invalid or incomplete CPT codes are virtually eliminated.

4. Provides reliable and comprehensive reporting: Since all of the relevant data resides within the URMS database, analysts are able to produce comprehensive and detailed reports. The softwares validation system works to ensure that the statistical information on the reports is reliable and correct.

5. Provides an extensible front-end: The user interface is designed to be easily and economically extensible to handle additional data elements and business processes that may be particular to an individual client installation.

6. Robust Business Line Coverage: The URMS application is designed for maximum flexibility. Data can be entered for multiple contracts and along multiple product and/or treatment lines