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Although ASPs roughly configure the application to your requirements when they install it in the data center, if you require customization, the ASP makes the actual code changes at this stage.

As mentioned earlier, customization ranges widely in the extent of its complexity. For instance, you might want your legacy applications integrated with the hosted application. Obviously, this cannot be done from the data center, and it requires expertise in additional applications. Also, you might not want your mission-critical applications inextricably tied to a hosted application that you may discontinue using in the future. It's up to the ASP to gauge the type of APIs and tightness of integration to your level of commitment to the solution. Depending on whether the ASP offers integration as a value-added service, and often even if it does, these charges are additional to the leasing fee. Some ASPs will bundle integration into the fee, but this is likely only if the required time and materials are easy to determine.

Typically during this phase, you experience for the first time the ASP's value-added services like outsourced IT personnel and accelerated application deployment. So customization is a key indicator of the quality of the ASP's future customer service.


IBM Global Services
Customer: CareTouch, Inc.
Key elements of the solution: Accelerated deployment, extensive application development and integration, one-stop shopping for the complete solution

An estimated 52 million people in the United States today have taken on the responsibilities of life care: that is, caring for sick loved ones with a continuing health condition who cannot live fully independent lives. Often these caregivers have no prior experience. Yet, the current healthcare system, its resources strained to the limit, provides little support in this vital area. This leaves an even bigger burden directly on individuals and families and indirectly on their employers. For example, lost productivity from employees caring for elderly relatives and friends cost American business between $11 and $29 billion yearly.

CareTouch, Inc. offers a powerful remedy to reach and support this often-isolated group of caregivers. The company was conceived in January 2000 by the world's largest not-for-profit healthcare delivery organization, Kaiser Permanente. Moving at Internet speed, CareTouch launched its call centers and the most robust, comprehensive e-commerce site of its kind http://www.carepanion.com six months later. In fact, it built its Web e-commerce solution in just 85 days with the help of IBM and the use of leading IBM WebSphere platform technologies such as WebSphere Application Server, WebSphere Commerce Suite, and VisualAge for Java.

"We saw a huge, unmet need in the healthcare marketplace and we're using the Internet and IBM e-business technologies to meet this need—there are a number of Web companies out there trying to do a part of what we're doing, but not with the same speed or scale," explains Dr. Peter Juhn, MD, president and chief executive officer. Prior to founding CareTouch, Dr. Juhn was the founding executive director of the Care Management Institute, Kaiser Permanente's national disease management, outcomes measurement, and clinical policy entity.

A Robust, Scalable e-Business Solution

Speed-to-market is essential for any new company. Still, CareTouch had to make sure it built a robust e-commerce foundation that could handle future growth. Through its parent company, Kaiser Permanente, it would have instant access to more than 8.5 million potential customers. Down the road, it could potentially reach a worldwide audience on the Net.

To get it right, the CareTouch executive team decided to work with a technology partner to launch the Carepanion e-Commerce System. After a spirited competition among several leading firms, it chose IBM and its WebSphere platform solution. Scalability and robustness were the decisive factors. As Juhn says, "We are planning for success—we fully anticipate we'll have millions of customers using our site on a daily basis."

In fact, IBM Rochester benchmarked the system prior to its launch, showing it could readily support up to 2,500 concurrent users with its current architecture. And, it can scale up easily to support double that number.

"With the architecture IBM developed, we simply add more servers to support more users," adds Dr. Prasuna Dornadula, vice president, Web development, and acting chief technology officer. "With WebSphere Application Server and Commerce Suite," he continues, "we have a proven solution that has been used to build a number of major e-commerce

sites—we consider it to be more robust and easily scalable than any other alternative we considered."

A Proven Technology Partner

Beyond the technology, CareTouch also had high confidence in IBM as a partner. IBM had already proven its mettle in helping Kaiser Permanente implement a Clinical Information System. According to Dr. Eric Aguiar, MD, executive vice president and chief business officer, "It was an 'A' team and that's what we needed to jump start our project—time is serious money in the dot-com world."

Not only thatthe Kaiser brand name has been carefully protected over the years and represents a huge corporate asset. The company wanted to ensure that its e-commerce solution would continue to maintain the value of that brand. CareTouch was counting on IBM's expertise to ensure they got it right from the word go.

"IBM has repeatedly demonstrated it has the ability to ramp up not just the development effort, but to scale a solution to support hundreds of thousands and potentially millions of users," says Aguiar.

A Comprehensive, End-to-End Solution

The time was early May 2000. The target launch date was late September. After six weeks of intense design meetings, the joint CareTouch and IBM Global Services team went to work. CareTouch developers worked with Jasper Design of New York to create the look and feel of the Web site. IBM, meanwhile, focused on building the e-commerce engine and doing back-end database integration.

CareTouch briefly considered an Oracle database as part of the end-to-end solution, but, says Juhn, "We concluded that for overall robustness and compatibility with other applications, DB2 was our best choice—we couldn't afford to get hung up down the road trying to work out an integration problem."

"Time-to-market was key," reiterates Jeff Lucas, vice president, sales and market development. "One of the reasons we chose IBM was that it gave us one-stop shopping with access to today's leading IBM Web technologies. We could use a DB2 database and the WebSphere platform environment, including VisualAge for Java, and it's all designed and pretested to work together smoothly," he adds. "In addition, IBM could provide the hardware, Web hosting services, and the integration services needed to pull it all together. Frankly, without the IBM total solution, we wouldn't have been able to hit our September 30 launch date."

A Highly Productive Development Environment

The Carepanion e-Commerce System runs on heavy-duty IBM RS/6000 servers located at IBM's server farm in Rochester, New York. Approximately 75% of the application code was based on WebSphere Commerce Suite. IBM Global Services developed the remaining code using VisualAge for Java Enterprise Edition, deployed on WebSphere Application Server.

"WebSphere Commerce Suite gave us the built-in functionality we needed to drive credit card transactions through our e-commerce engine," says Dornadula. "We estimate it saved us anywhere from two to four weeks' worth of development time and reduced the cost of building the solution by approximately $1.4 million," he continues. "All we needed to do was tweak the interface to link it up with the CyberCash system, a leading payment solution," he adds. And, he concludes, "We got additional support for this work from the IBM Toronto Lab team which helped us move forward quickly."

CareTouch used IBM's formal project implementation approach to manage the project. It's an iterative approach with overlapping phases that gives developers the opportunity to respond to changing conditions and scenarios. The phases include:

  1. Requirements definition/macro design
  2. Micro design
  3. Build and test
  4. Production readiness and deployment.

A team of four IBM and four CareTouch developers used VisualAge for Java to develop additional functionality, including a Java-based calendar function, care registry, and address book. Caregivers can use these resources to schedule home care services for their loved ones, share information with family and friends, and also reach out to a wider community of people facing similar challenges.

"We looked at alternative Java developer toolkits," says Dornadula, "but we found VisualAge for Java offered superior debugging capabilities. Sometimes building interfaces can be a challenge," he adds, "but with the integration of VisualAge for Java with WebSphere, it was very easy—we estimate it reduced our development effort by an additional 10%."

In building future applications, Dornadula anticipates his team will be able to reuse at least 50% of the code developed for the Carepanion e-Commerce System. In addition, they are planning to use Enterprise Java Beans to further improve reuse and achieve significant cost savings. For their next project, the CareTouch team is evaluating the feasibility of developing a wireless capability, which will allow caregivers to access Carepanion via palmtops and other portable computing devices.

A High-Revenue e-Business

In its first year of operation, CareTouch anticipates it will generate millions of dollars of revenue through targeting three distinct areas of need. Juhn calls these "our corporate ABCs" and they include:

  1. Advocacy support, giving patients and caregivers a forum to get the advice and assistance they need to make important healthcare decisions—for example, the site provides tools members can use to build a CareCommunity that brings together patients with similar problems.

  2. A brokerage function, which leverages the buying power of large numbers of consumers to help people get healthcare products at special discount prices in a business-to-business environment.

  3. Concierge services, which help caregivers put together all the essential support services they need, including grocery shopping, home cleaning, in-home nursing, and more.

"Caregivers are often thrust into the role without prior experience or an instruction manual," says Juhn. "They must provide care services, seek information, investigate, and shop for and buy medical and health products that are available to solve the needs of the patient," he continues. "The Carepanion e-Commerce System is especially designed to put them in touch with all the resources they need to navigate through what can be a fragmented, confusing world of options and find the most effective, economical answers available to them today," he adds. So, he concludes, "The fact that we have partnered with IBM to build this solution will help us deliver the highest level of service to these people as they face the enormous challenges of caregiving."

Permission courtesy of IBM

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