SECA 6: Innovation @SharedHealth

Shared Health was the product of an innovative idea to create web-based solutions to securely share and connect medical information across a patient's network of clinicians. In fact in 2006 The Chattanooga Area Chamber of Commerce named Shared Health as the Kruesi Award winner for innovation. I will outline a few of the recent events which reflect the company's commitment to implementing new ideas at work.

Innovative Approach

Building and maintaining a data center is resource intensive, precisely why most companies prefer to lease servers from IBM or CSC. Roughly 30% of annual IT infrastructure budgets are spent on data center operations. Another major chunk of the fixed costs goes software licensing. Most software vendors have CPU based licensing and these costs affect scalability of servers. So in order to bring down these annual costs our company started exploiting the option of virtualizing our data center using VMWare. Although the new data center is still being built, the project has already gained popularity because of its huge cost savings. Apart from increasing the efficiency of our data center space and resources, server virtualization has also helped us save energy for cooling.

Innovative Ideas

Most of our data comes from claims processed by insurance companies. State funded Medicaid and Medicare are our biggest clients but expanding beyond this clientele was a challenge. Insurance companies are reluctant to share their data; for example Cigna would not want to be associated with a clinical exchange which also sources data from Aetna. This severly impacts our clinical outreach. So our sales team started looking at other options to work around this hurdle. We started partnering with IPAs (Independent Practice Association) which consists of network of physicians in a region or community. These IPAs handle claims processing on behalf of physicians and send us a copy of the claims before being processed by insurance providers. This is a big win for us in our quest for scalable data receipt. We hope that in the long run as more and more physicians adopt our EHR system the insurance providers would succumb to the market pressure and participate in our health information exchange.

Innovative Processes

Shared Health has several wellness initiatives to encourage employees to maintain a healthy and active lifestyle. Until recently the company used to reimburse monthly membership fees to fitness centers but with time it became evident that a membership does not motivate employees to spend atleast an hour in fitness activities. After many successful pilots the company has now launched a new program called Actiped where a small pedometer tracks the miles covered and hours spent in cardio intensive workouts. Now each employee can earn a dollar for every 5000 steps; guess what 28 billion steps recorded in 3 months!!!

I am sure there are many other innovative ideas floating in the organization; some of them in very advanced stages while others still being brainstormed on the whiteboard. It seems evolution is a continuous process and I am excited to be a part of it.

SECA 5: Production - SCRUM an Agile Methodology

My company is currently developing a newer version of our core product and we have adopted the agile development methodology called SCRUM. Wikipedia defines Scrum "as an iterative, incremental methodology for project management often seen in agile software development, a type of software engineering". Scrum is unique because it introduces the idea of "empirical process control", that is Scrum uses the real-world progress of a project (not best guess) to plan and schedule releases.

In Scrum, projects are divided into sprints, which are typically one to three weeks in duration. At the end of each sprint, stakeholders and team members meet to assess the progress of a project and plan its next steps. This allows a project’s direction to be adjusted or reoriented based on completed work. The scrum process makes a lot of things visible that were not visible before. It records a fine-grained list of tasks that the team is doing on a daily basis in the sprint backlog. During a sprint, no one is allowed to change the sprint backlog, which means that the requirements are frozen for that sprint. Development is timeboxed and the sprint must end on time. If requirements are not completed for any reason, they are left out and returned to the product backlog. A sprint burn down chart is used to display the remaining work in the sprint backlog and is updated every day to give a simple view of the sprint progress. After a sprint is completed, the team demonstrates how to use the software.

Scrum has three fundamental roles: Product Owner, Scrum Master, and Team Member. The Product Owner is responsible for communicating the vision of the product to the development team. The Scrum Master acts as a liaison between the Product Owner and the team. The ScrumMaster does not manage the team. Instead, he or she works to remove any impediments that are obstructing the team from achieving its sprint goals while making sure its successes are visible to the Product Owner. The ScrumMaster also works to advise the Product Owner about how to maximize ROI for the team.
For software projects, a typical team includes a mix of software engineers, architects, programmers, analysts, QA experts, testers, and UI designers. For each sprint, the team is responsible for determining how it will accomplish the work to be completed. This grants teams a great deal of autonomy, but that freedom is accompanied by a responsibility to meet the goals of the sprint.

Some of the salient features are iterative development, high level accountability, small teams, regular builds, configuration management and frequent monitoring. However like any other system it has its own drawbacks; decision-making is entirely in the hands of the teams and there has to be constant, hands-on management.