Projects

Working on grant-funded research projects or commercial ventures, Estenda focuses on advancing healthcare, medical research and informatics initiatives. Our unwavering focus on exceeding expectations has produced a long list of very innovative and successful projects - all delivered on-time and within budget.

Experienced with the nuances of grant sponsored research projects, we work with both large organizations and individual researchers to help take your innovative projects from concept to reality.

From Concept - The Research...
Estenda’s capabilities go well beyond just software development and quality assurance. We have the expertise to work through all aspects of a research program from pre-proposal to journal publication. Our team routinely contributes to research protocol design, ongoing progress reporting, and study execution. We have significant experience in data de-identification, aggregation, warehousing and analysis. Estenda's team members are often included in our customer's journal publications, posters and conference presentations.

...to Reality - Production / Commercialization
After research has proven a particular solution or intervention improves patient care or savings are realized, Estenda has the practical experience implementing solutions within a medical setting. From technical deployment issues in the cloud or inhouse implementations to training and ongoing support and customizations, Estenda Solutions is positioned to be your long term partner in success.
Flagship Projects
Comprehensive Diabetes Management Program (CDMP)
In the early 2000s, Estenda Solutions began a project for the development of a diabetes disease management application funded by the Department of Defense envisioned by Dr. Sven Bursell, then at the Joslin Diabetes Center and now at the University of Hawaii. This application would facilitate patient care and management based on the Chronic Care Model and create a holistic view of the patient uniquely combining clinical and patient behavioral data.

Designed from the start to be interoperabale with electronic medical record systems available with the Department of Defense, CDMP was successfully built and deployed at multiple institutions where it is successfully used for patient care and research. CDMP's flexible nature combined with its use of open source software evolved into the Estenda Healthcare Informatics Platform (eHIP).

Extensive information about the diabetes solution is available on the CDMP wiki.

Diabetes Eye Care and Treatment (DECAT), formerly known as Joslin Vision Network (JVN)
Estenda Solutions is the primary development partner for a large consortium dedicated to reducing the incidence of preventable blindness among people with diabetes. By utilizing a secure telemedicine model we are able to deploy technician operated retinal imaging equipment in a wide variety of locations and have the images remotely evaluated by highly trained retinal specialists. Estenda supports imaging modalities in over 70 locations from tiny Native American tribal clinics to some of the most well respected and advanced Diabetes specialty practices.

Utilizing the eHIP platform, Estenda was able to build the latest generation DECAT study evaluation and reporting platform in half the time of previous versions while adding significant additional functionality.

CADS - Computer Assisted Decision Support for Diabetes Medication
Working closely with David Rodbard, MD and Robert Vigersky, MD, Estenda Solutions designed and developed a Clinical Decision Support System for Diabetes Medications targetting Primary Care Providers. The concept, medication management algorithms and content were designed by Dr. Rodbard and Dr. Vigersky based on many years of treating patients and conducting extensive research in diabetes patient management. The CDS algorithm evaluates demographic data, current and past medications, labs, diagnoses and the patient's blood glucose profile to make medication recommendations designed to better control their blood glucose. The program provides recommendations to increase or decrease dosages, add or discontinue medications and provide explanations.

Study Manager
Extensive experience participating in clinical research projects and frequently asked to address issues concerning medical informatics, Estenda in cooperation with numerous clinical researchers and medical informatistics created the Study Manager module. Study Manager is a powerful feature incorporated in CDMP/eHIP. It can be deployed as an integrated solution or as a standalone application. Study Manager enables the efficient administration and management of clinical studies from recruitment, through data collection, analysis and finally publishing. Estenda employees are often an integral component of planning research programs and frequently included as author on study publications.
eHIP Jumpstart Projects
Bariatric Surgery Patient Management
Using eHIP Estenda Solutions built a Bariatric Survey Patient Management system for a major Boston-area medical center's bariatric practice called PhoenixCare. PhoenixCare is a suite of patient and practice management applications designed specifically for managing patients pre and post surgery. The application improves both patient outcomes and clinical efficiency by uniquely combining optimized access to traditional health metrics and alerts with patient-reported behavior data.

Chronic Kidney Disease, Congestive Heart Failure & Liver Disease Management
Building on eHIP and the successful Diabetes Management application in partnership with clinical experts, Estenda adapted the functionality of CDMP to address the unique aspects of managing patients with chronic kidney disease, congestive heart failure and liver disease. Adapting the CDMP for these chronic conditions helped each practice develop a customized solution to target their population's unique needs in mere months. This accelerated development saved millions of dollars and was successful in less time than it takes to implement most commercial systems because it was expressly tailored to their needs.

Chronic Kidney Disease Statewide Data Repository & Reporting
Still in its early stages Estenda Solutions using the eHIP architecture has partnered with the National Kidney Foundation of Hawaii for the creation of a state-wide Chronic Kidney Disease Repository. Presently lab data from multiple labs in Hawaii are flowing daily into the repository allowing researchers to access the data cleansed of any patient identifying information. With the ability to create custom reports using eHIP's reporting capabilities, researchers can query the data to answer pertinent questions in a timely fashion without having to involve technology resources.

Hepatitis B & C Screening and Immunizations
Estenda Solutions in cooperation with The Hawaii Medical Center East Liver Center and the University of Hawaii Telehealth Research Institute (Liver Alliance) with funding from the HMSA Foundation are in the process of developing a state wide clinical information system to support the individuals and institutions that screen for, treat, and manage patients with Hepatitis B and C. The first stage, currently in production, is managing the screening process for Hepatitis B and C. Higher than normal rates of infection drive the need for aggressive screening programs and often the same people are screened multiple times resulting in duplicate lab testing and financial strain on the screening programs. Through integration with the screening laboratories and incorporating historical data, screeners can quickly determine if a person has already been screened and how best to direct them for treatment if necessary. Successful immunizations and follow-up for individuals testing positive are tracked through the system to close the loop saving valuable resources in terms of time and dollars.

Electronic Nursing Documentation System (ENDS) for Latent Tuberculosis Infection
The ENDS application allows nurses to easily document activities related to providing care for patients with Latent Tuberculosis Infection (LTBI) in an outpatient setting at Tripler Army Medical Center in Hawaii and Fort Bliss in Texas. Key technical requirements for successfully accomplishing this project were meeting a compressed development schedule and utilizing an architecture compatible for inclusion in AHLTA. eHIP easily met these requirements and was used to deliver the project on-time and budget.

Medical Home Model - Remote Patient Monitoring
Through a partnership with iMetrikus, Estenda enhanced CDMP/eHIP to incorporate remote patient monitoring data (blood glucose, blood pressure, heart beat, and weight) with the clinical and behavioral information already available within the system to complete the holistic view of the patient between medical appointments. Previously patients could upload this data automatically through our available patient portal, but iMetrikus allows patients to upload this information using the telephone without need for an internet connection or computer.
Next Generation Personal Health Record
Robert Wood Johnson Project HealthDesign
The Robert Wood Johnson Project HealthDesign was envisioned to encourage and support technology pioneers to design the next generation of personal health record systems in ways that empower patients to better manage their health and health care.

Estenda Solutions in cooperation with T.R.U.E. Research Foundation— working at Walter Reed Army Medical Center and the University of Hawaii envisioned a prototype personal health application to improve the lives of people managing diabetes and reduce their risks for further illness. The prototype PHR application is designed to capture information about daily living that is important for diabetes management and gives action-oriented advice for self-care. The team’s application is not a standalone device; rather, it is a set of rules, algorithms and data structures with user interfaces that consumers can access on the Web via a computer or Internet-enabled mobile device.

The PHR application will analyze, summarize and display data, advising users on nutrition, daily physical activity, blood glucose, emotional state, and the interaction of all these factors. It will also enable consumers to conduct “what if ” analyses that can predict the health results of choices they might be considering, such as the effects of a particular meal on blood glucose levels.
Interoperability
Estenda has integration experience with multiple EMRs and private laboratory system utilzing eHIP. We have successfully integrated with the following EMRs using HL7 using Mirth and/or properietary mechanisms using web services and direct database access.
  • Nextgen
  • GE Centricity
  • Department of Defense/Military Healthcare CHCS/AHLTA
  • VA Vista
  • Indian Health Services RPMS
  • PECS
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