High Availability Access to Care: Community Care Referral and Authorization

Case Story


Program Overview

The Department of Veterans Affairs (VA) is a leader in healthcare modernization, leveraging best practices in organizational change, information technology, and consumer engagement to revolutionize the healthcare experience for our Nation’s Veterans. One of its many successes is the Community Care Referrals and Authorizations program, which supports VA‚Äôs mission to honor Veterans through the provision of healthcare.

CCRA provides eligible Veterans with the care they need at the right time, from the right provider, in the right place, which may be from a community-based provider. CCRA uses a web-based portal to automatically generate referrals and authorizations for Veterans receiving care in the community.

The solution is hosted in the AWS Federal Risk and Authorization Management Program (FedRAMP) High Government Cloud with middleware systems hosted at VA Regional Datacenters.

More about CCRA: CCRA is an enterprise-wide system used by community care staff to generate referrals and authorizations for Veterans receiving care in the community. Clinical and Department of Veterans Affairs (VA) community care staff located at VA medical centers (VAMCs), outpatient clinics, community-based outpatient clinics (CBOCs), and Veterans Integrated Service Network (VISN) offices use this solution to enhance Veterans access to care.

Customer Challenge

Provide a Secure, Highly Available Cloud Solution

To provide timely referrals and authorizations, the VA customer needed a solution that maintained high availability, defined as 99.99% uptime, while preserving data integrity, solution state, and user session state in the event of a disruption.

Partner Solution

To fulfill those requirements, Cognosante hosts the system in the FedRAMP High Government Cloud, which has been architected for at least 99.9% uptime. The AWS environment utilizes elastic load balancing (ELB) with AWS application load balancers (ALBs) to distribute incoming application traffic across multiple availability zones. The load balancers and multiple availability zones are integral architecture components that support high availability to application end users.

CCRA has measured uptime as the ability of end users to access and use the user interface. This metric is measured by monitoring the response times of the Apache web servers through ELB. The CCRA Operations team monitors the Apache response times. If at least one website of each of the secure sign-on internal and secure sign-on external is reporting acceptable response times (i.e., less than 5 seconds) as determined by the ELB, then the system is considered to be available to end users of the application. If significant spikes in response time for one or both websites are observed from the ELB, then the system is considered to be unavailable to end users of the application.

Results and Benefits

Ensuring the platform is highly available has enabled the CCRA program to process over 24 million referrals for 4.5 million Veterans. CCRA has reduced turnaround times for appointments from over 30 days to under one week ‚Äď a 75% reduction ‚Äď while streamlining care coordination and providing a better customer experience for Veterans nationwide.

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