The Hughes riskApps™ system is comprised of four components:
 

Database Component

The Hughes riskApps™ database component is a Microsoft SQL Server 2005 database. Depending on the number of patients your clinic(s) will see each week will determine if you can go onto a shared server in your organization or whether you consider deploying a dedicated server. NOTE: some institutions have also used virtualized servers.  If you all will collect histories on more than 150 patients a day please consider a dedicated server.  The server operating system can be Windows 2003 server or greater and the hardware should have 4 GIGs of RAM and dual Xenon processors.  Disk space should be mirrored and approximately 80 GIGs of space to start.  Database files and log files can also be stored on separate volumes if this is your IT departments standard.

SQL 2005 should be setup to accept remote connections (TCP/IP and named pipes). To do this a DBA will use MS SQL Surface Connection Area tool to enable this feature.  If you want to push appointments from an existing scheduling system into the Hughes riskApps™ database, you can do so using standard data exchange functions in SQL - for example: SSIS.  Most clients import a feed once daily, first thing in the AM.  If you decide to go this route, please read this document for extended information on how to format the data, and where to write it in the database.

Microsoft SQL Server 2005 is available in several versions.  The freely available Microsoft SQL Server 2005 Express Edition is sufficient but we recommend the Standard Edition.  For more information about the freely available Microsoft SQL Server 2005 Express Edition.

NOTE: We no longer support Microsoft SQL Server 2000. 

Clinician Application

The Hughes riskApps™ clinician application is comprised of a Microsoft Access 2003 application as well as several .Net 2.0 modules. The clinician application allows clinicians and clinic staff to interact with patient data, run breast and ovarian cancer risk calculations (colorectal calculations are due out in the Summer of 2009), print surveys with graphical pedigrees as well as letters for patients, referring physicians and/or primary care physicians.  Extended risk clinic functionality allows for entering additional information related to genetic testing of patients and family members as well as decision support for future treatment plans of high risk patients.

The machines that will run the clinician application will be used by administrative clinic staff and your clinics clinicians.  They should be on Windows XP (latest service pack) or Windows Vista 32-bit (latest service pack).  The clinician applications requires the use of MS Word 2003, MS Excel 2003, MS Access 2003 and the .Net framework 2.0.  These software components should be install on all desktops that will run the clinician application. 
 

Tablet Application

The Hughes riskApps™ tablet application is a Microsoft Access 2003 application that connects to the database component and allows patients to navigate a questionnaire and provide answers to both family history and life style questions. Tablet computers must have .Net framework 2.0 and Microsoft Access 2003 installed.  The tablet application is two applications in one: 1) the standard questionnaire and 2)  the risk clinic questionnaire.

The standard questionnaire is a basic set of questions aimed at identify patients who are potentially at high risk.  Patients may then be referred to a high risk clinic program where they can answer the risk clinic questionnaire.  This questionnaire takes approximately 5 - 8 minutes to complete depending on the complexity of a patient's family history.  On subsequent visits, prior survey data is pull foward and patients are allowed to change or add data saving them time; our calculations show patient's spend a average of 3 - 5 minutes on subsequent visits answer the questionnaire. NOTE: Clinicians may also enter this data through the clinician application in a 1-on-1 interview with the patient.

The risk clinic questionnaire collects more detailed information about family members and disease that is used to generate more specific risk calculations.  This questionnaire can take upwards of 15 minutes to answer and is generally done with the supervision of a risk or genetic counselor. NOTE: Clinicians may also enter this data through the clinician application in a 1-on-1 interview with the patient.

If you plan on deploying tablets for patient providedfamily history, you should have a hospital or clinic approved wireless network.  The wireless network your hospital has deployed will be ssecure from outside intrusion.  The tablet machines should have appropriate securities enabled and wireless security commensurate with your organizations standards. Before purchasing a tablet, please check with your IT department to understand their requirements.

We like the Lenovo X200 tablet because it is light weight and generally easy to use. The Lenovo X200 also has a full keyboard that makes setup and installation easier than tablets that have no keyboard.  The weight of the tablet is a critical issue for patients as well; they do not want to hold something heavy.  The tablets should have MS Access 2003 and the .Net 2.0 framework as well. 

NOTE: In June of 2009, the clinician application will become an entirely .Net 2.0 application - e.g. MS Access will no longer be used.
 

Automation Application

The Hughes riskApps™ automation application is a .Net 2.0 c# application that runs on a dedicated desktop machine that is setup to print to a printer or printers in your clinic.  The automation module polls the database on an ongoing basis looking for new patient tablet submissions.  When automation see a newly submitted questionnaire, automation will run risk calculations on the family history and then will also compose and print any documents that have been setup through the automation program.  Automation documents can be as simple as a paper copy of the patient submitted data or as complex as printing a high risk letters for the patient or smoking cessation information if the patient said they smoked.