Building, scaling and managing leading edge innovation in healthcare technology

The staggering cost of healthcare in America is well known.

Technology holds promise to dynamically reduce the problem, but it requires healthcare organizations to adopt a different approach and mindset. New technological forces are redefining the rules that had traditionally governed competition. Economies of scale are now a hindrance to competition, not an enabler to it. Innovation requires a new formula.

Healthcare’s Innovation Problem

Healthcare faces multiple technological, organizational and procedural barriers to innovation that are critical to understand and address throughout project lifecycles.

Infrequent Delivery of Value/Long Delivery Cycles -- traditional healthcare organizations use the waterfall method of development, completing one or two major releases each year.

Inflexible Application Architecture -- huge code bases and monolithic applications (example: ERP) within healthcare organizations can be difficult to change, test, deploy and scale. This creates a barrier to adopt new technologies as architectures can be difficult to evolve.

Rigid Analytics -- traditional data warehouses and reporting tools found in healthcare organizations are ideal for batch reporting and business intelligence (BI) but not best for machine learning (ML) and predictive analytics. Today’s market competition demands ML and predictive analytics, too.

Outdated Infrastructure -- healthcare organizations still operate on-premises data centers versus within cloud computing infrastructure. This delays the ability to put innovative ideas into practice quickly and efficiently and significantly increases the upfront cost required to test these innovative ideas.

Organizational Architecture -- healthcare organizations are designed using a horizontal, hierarchical model. Horizontally aligned delivery teams limit speed of change. Autonomy of teams enables more efficient capacity for adoption.

By recognizing and embracing these challenges at the forefront of technology efforts, organizations increase their ability to solve issues today as well as prepare for those that may arise in the future.

A Framework Solution

The approach to healthcare innovation needs to be centered on agility and speed. Organizations need to be able to create new markets and respond to changing dynamics within existing markets. This is how leading and startup technology companies operate. Their practices can be implemented by any company in any industry through innovation labs and incubators, or by building a world class in-house engineering team. Regardless of engineering resource, a framework that addresses the issues outlined above is needed, unique to each organization and built intuitively for present and future scale.

Infrastructure: Moving to cloud computing is optimal. A Hybrid approach is a good way to start and might be an idea permanent solution for some organizations.

Barriers to innovation are reduced in a cloud environment, as large capital expenditure is not required as new services are created within your organization. Previously, cost associated with such a task would include capital expenditure for infrastructure, labor and research time plus additional resources to install and maintain. In hybrid cloud, concepts can be tested without capital expenditure, prototyped in a cloud environment then rapidly deployed and measured for success.

Benefits:

o Enables agility - traditional on-premise infrastructure can be a barrier to speed. Cloud allows for speed and fosters experimentation.
o Reduces upfront cost and lead time - cloud environments eliminate large, up-front investments and enable on-demand, pay-as-you-go and pay-for-what-you-use models that can reduce costs. As an added benefit, and as the cost paradigm shifts from CAPEX to OPEX, cash reserves can be used for more critical business initiatives and investments.
o Increased elasticity - scale on-demand empowers organizations to quickly increase or reduce infrastructure environments to meet need.

Software: Moving towards microservices

Microservices architectural style is an approach to developing a single software application as a suite of small services, each running in its own process and communicating with lightweight mechanisms, often an HTTP resource API. These services are built around business capabilities and are independently deployable by fully automated deployment machinery.

Benefits:

o Increased Agility - elevates development and deployment to achieve operational agility. Agility affords companies the ability to tweak and adapt business models more efficiently and effectively, plus drives greater capacity for experimentation.
o Faster speed - allows you to respond to customer and market demands quickly as well as make changes as needed from data, analysis, etc. You’ll increase your ability to experiment here as well.
o Resiliency - releases are isolated and localized to individual services therefore eliminating risk. It also allows for quicker recovery from issues and errors once applications are deployed. The less time you spend fighting fires, the more time you have to innovate.

Analytics: Adopt Data Lakes

A “data lake” is a storage repository that holds a vast amount of raw data in its native format, including a range of data types and formats. data. The data structure and requirements are not defined until the data is needed. This gives data scientists and developers the ability to easily configure and reconfigure their models, queries, and apps on-the-fly.

Benefits:

o Increased agility - data lakes enable faster experimentation with different analytical models. Key business questions can’t wait.
o Greater insight - unlock more insight by applying machine learning and predictive analytics to more data in less time to make better decisions.
o Prevent “information decay” - information and data are time-dependent. Quick, efficient use enables organizations to move better.
o Cloud-based analytics - as data volume grows, it becomes heavier for server architectures, creating “data gravity.” Analytics tools in the cloud enable closer touch to data versus in-house tools, resulting in quicker, more effective exploitation of data’s value for competitive advantage.

Organization: Vertical Teams for Each Service

Each team is responsible for one service, which it builds and runs. The team is solely responsible for that service. The team owns the API, business logic, and the data layers. The teams are no longer dependent on any other team.

Benefits:

o Increased agility - autonomous teams focused around microservices enables your organizational structure to better align with your software structure. The result eliminates inefficiency and other issues for optimal performance and results.
o More with less - multiple small teams, each responsible for a small part of the system, own the complete lifecycle of the services they create to enable greater degree of autonomy. This replaces hindrances of larger teams which cannot operate with maximum efficiency.

Delivery: Continuous Delivery

Continuous Delivery is a development discipline where you build software in such a way that the software can be released to production at any time. A key requirement for achieving Continuous Delivery is extensive automation of all possible parts of the delivery process (or, “deployment pipelines”).

Benefits:

o Increased agility - release software deployments and updates more often to enable faster iterations and more experimentation.
o Improved processes - apply techniques such as agile, development operations and continuous delivery to develop, build and deploy software faster and more efficiently than before (and the competition).

About Scale and Management

Most traditional large healthcare organizations are struggling to deliver applications and value fast enough to respond to changes in the marketplace. Hard-to-change and tightly-coupled systems make frequent delivery of technological advancements very difficult. Scaling innovation requires the commitment of the full executive team to effectuate the cultural and organizational changes required to support the framework described above and orchestrate and integrate change across the organization.

The Value of Embracing Innovation

Disruption and change is no longer avoidable in healthcare. But with the right approach and framework to innovation, legacy healthcare companies, big technology organizations, new startups -- and most of all, patients -- can benefit.

By Ahmad Jubran, VP of Engineering, ConsejoSano

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