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A System For Federal
Dental-Referrals

An enterprise project for managing thousands of NHS patient referrals from the United Kingdom

Technologies
Expertise
Partnership Period
Team Size
Location
Ruby, Ruby on Rails, JavaScript, Go, Ansible, MySQL, AWS
Healthcare
2018 - ongoing
5
The United Kingdom
The Situation
Dental Referrals faced challenges related to the security and performance of their app that prevented the company from efficiently managing thousands of daily patient referrals. Due to the low app performance, our client had huge maintenance bills.
The Requirement
To overhaul the outdated system, enhance its security, improve overall performance, migrate the app to cloud economics, and the cost of infrastructure maintenance.
The Client
The Dental Refferals knew how important the EHR was to the development of modern medicine. Expanding their clinics' network and finding an efficient manner of dealing with digital health commissioning was impossible while relying on the outdated version of the app.
The Challenge
The app's tech debt, prior rush development, and the app's development, and monolithic architecture built on the previous Ruby and Ruby on Rails versions have had us splitting a monolithic app into microservices while improving its security and performance features at the same time.
How We Responded
01
Launched the platform's process of migrating from an on-premises basis to a cloud economy
Researched, analyzed, and implemented the NHS Apps Library Requirements
02
03
Divided the monolithic app into AWS microservices
Updated the existing Ruby/Ruby on Rails codebase to make the new EHR and EMR features possible
04
05
Put the platform's tech debt under progressive maintenance
Boosted the app's testing response practices
06
07
Developed the app's successful third-party testing routine
Refined the code quality and performance by increasing the unit testing percentage from 25% to 75%
08
The Team
Team Lead
Daniel
Software Engineer
Serhiy
Software Engineer
Ivan
QA
Halyna
Describing The Process
The Dental Referrals platform overhaul followed a customized development process based on the Agile/Scrum project management strategies.
Research
The Dental Refferals Consultants contacted us, asking to look into the project, evaluate, and research the ways of fixing the issues. The NHS regulations and the NHS App Library requirements, in particular, have been analyzed.

The process of fixing a bug always starts with defining the cause of the problem. This is why we have thoroughly researched the previous version of the code, which enabled us to develop the project's documentation, define the team and the stack.

As one of the tasks was cutting infrastructure costs, we suggested migrating the platform to a cloud provider.
01
Cloud economics
Business Value
Cloud Financial Management
Cost savings
Staff Productivity
Operational Resilience
Business Agility
Typical focus
Most compelling cloud benefits
Tell us about your project, and we will send you an estimate within 48 hours
Olha
Engagement Manager
Architecture
02
New AWS Architecture Prototype
Development & DevOps
03
To handle the architecture and engineering for the enterprise project, Ralabs team of Ruby on Rails developers established six core processes:
The app is being turned into a full-scale platform, reliable for preserving and managing the patients’ sensitive data.

The app’s efficiency is being gradually improved simultaneously with the AWS migration process.

The NHS general and the NHS Apps Library standards have been adhered to.

The platform’s third-party penetration testing practices, which is one of the core NHS requirements for telehealth software, have been improved.

While the AWS migration of the platform is still going on, the app is being kept operative.

The app’s new architecture has been devised and is being gradually implemented.

Considering the need for a continuous delivery of the product, the DevOps stage has been launched as soon as the first deliverables arrived.
Testing
Our first step was increasing the percentage of unit testing from 25% to 75% as we had to define the bugs in the code. Since we are now trying to raise the bar to 100%, we are boosting the refactoring percentage, while simultaneously adding the integration testing framework to the app.

One of the critical requirements by the NHS Apps Library is the app’s ability to pass third-party testing and security audits that envision an alleged intruder breaking into the system and trying to steal patients’ sensitive data. We help FDS to pass security audits on a regular basis and we have established a process of detecting, fixing, and preventing the issues that may cause a security breach.
04
Security Audit Companies We Are Working With
The Outcome
01
Cost Saving (Total Cost Ownership)

Improved financial forecasting; decreased maintenance costs
Personnel Productivity

Unnecessary tasks elimination; less time spent fixing bugs and maintenance issues; more focus on business needs and features development
02
03
Operational Resilience

More uptime/less downtime; decreased risk of patients’ sensitive data loss; faster data recovery; failover and load balancing; improved backup features
Business Agility

Faster responses; the ability to implement new features quickly; efficient and less time-consuming delivery
04
Let's See What We Can Do for You
Tell us about your project, and we will send you an estimate within 48 hours.
Olha
Engagement Manager