Quebec's Health Insurance Board Implements Web Services to Facilitate Information Exchanges

Client Challenges

Since its inception more than 30 years ago, Quebec’s health insurance board, or RAMQ, has worked toward both sustaining and improving the health and well-being of Quebec’s 7.5 million or so residents. It has been instrumental in the healthcare sector, collaborating with the province’s health and social services department, the local health and social services network development agencies and healthcare facilities.

Healthcare professionals, such as doctors, dentists and optometrists, use billing agencies’ services to charge customers. To deliver billing services, agencies need specialized software to exchange information—as flat files—with the RAMQ. Some private clinics, however, are bypassing billing agencies altogether and using billing applications themselves.

The RAMQ has been relying on mainframe-based telecommunications software since the mid-1980s to support information exchanges with billing agencies. However, the software is fraught with the following problems:

• Uses old-generation modems with a maximum throughput of 19,000 bpi
• Rests on a proprietary Datapac telecommunications network
• Can't be upgraded
• No longer supported by the vendor
• An impediment to upgrading the mainframe operating system

Furthermore, billing agencies and private clinics are forced to maintain a Windows 3.1 workstation to run the client component of the telecommunications software, which enables exchanges with the RAMQ mainframe.

The sluggish exchange throughput (some take more than 20 minutes) causes delays at month-end, when everyone is jostling to submit their payment requests.

Implemented Web Services

The RAMQ decided to implement web services to bolster information exchanges with billing agencies, as well as a website to help monitor and manage especially the following exchanges:

• Billing files in XML
• Mainframe processing results, including error and account statement files
• Billing files manually for those that aren’t equipped with automated file transfer functions. (This solution is aimed at customers with low billing volumes).

Web features include a:

• Registration function allows billing agencies to log on and get authenticated
• Website for agencies to monitor exchanges and consult file (error and account statements) processing results
• Website for RAMQ agents to assist agencies
• Website for system managers to administer the application

The solution runs on a .NET architecture, with BizTalk 2004 as a broking server and WebSphere MQ to convey messages to the mainframe.

Benefits

• Better management and control of exchanges that boost both operational effi ciency and customer service. What’s more, the quality of information is improved with user-friendly functions that support agencies across all operating phases, from the initial registration to daily transmissions
• More secure exchange mechanisms:
  
  • Authentication of users based on requisite trust levels
  • Confi dentiality and integrity of communications (128-bit encryption)
  • Logging of information so transactions are irrevocable
• More productive, robust and predictable service levels without restricting the number and volume of transmissions and based on predetermined service ranges. As a result:
  
  • Transfer times decrease due to faster throughput Internet links and greater processing capacity by implementing expandable infrastructures
  • Capacity monitoring improves because of monitoring tools
  • Outage is detected

Other benefits include:

• Implementing an infrastructure to support all new RAMQ online services
• Cutting external vendor software costs by implementing expandable solutions based on online services so the RAMQ can dispense with Windows 3.1 workstations
• Minimizing operational and fi nancial impacts on billing agencies

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