The healthcare industry is in a mad rush to get up to digital speeds and to become relevant in the new world of ObamaCare. The impetuousness came with ARRA (American Recovery and Reinvestment Act of 2009), when the federal government offered to pay medical practices and hospitals the money to upgrade their Health information technology (health IT) if they qualify under Meaningful Use (MU). It is an investment our government is making that should also provide a healthy return.
The United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008 and in December 2011, the outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% to 30% of health care spending is waste. This waste comes in the form of over-treatment, failure to coordinate care, administrative complexity, burdensome rules and fraud. So with the government making such an admission, it means they are desperate to see a more efficient system, where tax dollars are no longer lost in the shuffle.
The waste they hope to dispel comes in the form of proactive efficiencies that will help providers reap benefits beyond getting money for an upgrade; reducing errors, increasing the availability of records and data, providing reminders and alerts (making healthcare more proactive), providing clinical decision support, and by automating the process for prescription medication. As redundancies are reduced, costly errors decrease.
What is great about this is that while the Federal government is bankrolling this process, they are not micro managing. This allows the free market inventors to solve the problems in a way that streamlines the process and really works for medical professionals who will be shopping around for the best solution.
To give you some idea of the math involved: ARRA authorizes a net $27 billion in spending to support EHR (electronic health records) adoption through 2017. In perspective, it’s a shadow of what is spent annually on healthcare by the US Government. Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) – together accounted for 21 percent of the budget in 2011, or $769 billion. Nearly two-thirds of this amount, or $486 billion, went to Medicare, which provides health coverage to around 48 million people who are over the age of 65 or have disabilities. The remainder of this category funds Medicaid and CHIP, which in a typical month in 2011 provided health care or long-term care to about 60 million low-income children, parents, elderly people, and people with disabilities. Both Medicaid and CHIP require matching payments from the states that will also benefit from the stimulus.
If the $27 billion spent on EHR eliminates only 5% of the waste, a conservative amount for the sake of argument, the US Government will save $38.45 billion annually.
Is there a downside? As this data becomes more digitized, privacy advocates are rightly paying attention. But MU requires that the facility “conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of this analysis.” In other words – they must be compliant with HIPPAA, a topic for another future post
There are always risks with such an overhaul – but the math involved makes an extremely compelling argument in favor of Meaningful Use dollars.
Whiteboard-IT creates custom software for many industries, including the healthcare industry.
Last week I wrote about PhoneGap in the context of how I believe it could make mobile development more available to small business. This week I am writing of another equalizer which can work cooperatively with PhoneGap, and allows mobile friendly sites to be developed without the need for a native mobile application. This provides developers with a write less – do more environment and can buy time for small businesses, hesitant to take the plunge.
Though we are seeing small businesses loosening their development dollars, the mindset of austerity from a down economy is still ever-present. So as the number of electronic touch-points increases exponentially, the money allocated to keep pace is still being doled thoughtfully and efficiently.
I give you JQuery Mobile(JQM); a turbo boost for your development dollars that gets you to the mobile environment while developing for the web. Because mobile is quickly becoming the first-screen customers see, businesses can no longer ignore applying effort in this area.
Also notable is the fact that mobile and small screen size are no longer one and the same. With giant phones like the Galaxy S3 and small tablets like the ipad Mini, net tops, desktop replacement laptops etc, it’s really important to utilize screen real estate, or lack thereof properly, and custom targeting will never get it right.
What happens when you custom target a desktop, then minimize the screen and drag it into the corner? Unless your site is reactive then it will not produce a good experience. Prioritizing columns and replacing icons can provide a great experience without having to custom target screen resolutions.
Still, it’s one thing to develop a mobile app and another to be mindful of the mobile environment. While many business owners are deciding if an app is the way to go, they can now buy time to ponder the question. One way to do this is to bring your website to its lowest common and most efficient denominator, something JQM is helpful to do.
The world now thinks of a website as more than a virtual directory. And with Google’s emphasis on recency and relevancy of content, websites have much more information from which to cull, which is not always practical for smaller screens. To help solve this, JQM provides responsive tables that allows developers to prioritize columns and use abbreviated headers on the page so that only crucial information is displayed. This releases the pressure on the decision to go mobile and allows you to concentrate on when to go full throttle with a mobile app.
When do you do this? When you are ready. It takes a plan that weighs cost vs. profit, and has a good marketing strategy, a good design, good content, and a desire to invest your brainpower – your most important asset.
Among the radical changes in the recent world is the impact of mobile devices on modern society. Quickly becoming the first screen of information for everyone, mobile apps are even being used by the electronically resistant senior population who has found convenient use of large-print apps and the ability to maintain closer contact with grandchildren. We have seen such a great shift in the past five years so that even the shortest elevator ride has people pulling out their phones to manage their lives. This poses opportunity, as well as, challenges for businesses trying to stay ahead of the pack.
Big business has been the first mover with custom mobile apps that segment services to their simplest form. With a few clicks on an iPhone, anyone can re-order medication, purchase movie tickets, or find their way using GPS technology. To the small businessman, mobile apps are still something to put-off developing because it adds to the development budget, and they resort to mobile friendly sites that only require one build. This means developing web apps with a width of less than 960 px and reducing the number of pages that display on mobile devices. A true mobile app requires additional development dollars, but is native to the mobile device, even using geo location sensors and maps.
There are also more challenges involved with mobile apps because, just as web applications must function in multiple browsers, mobile apps must also function in multiple mobile frameworks (iPhone, Android, etc.), adding to the burden and cost of development. For all the trouble, most small businesses throw in the towel applying their efforts in things they understand.
Developers should be paying attention because they can use their existing development team without the need to find or create mobile specialists. It also allows the ability to incorporate sensors, like geo location and cameras, which are native to the mobile environment.
Small business will love this because it simplifies their development strategy and gives them wider access to their customers. It makes mobile development affordable for everyone and could very well equalize the playing field between big and small business. For this reason, we are paying close attention to PhoneGap and hope to add it to our list of services very soon.
When calculating the value of a project, consider the lifetime value of a client
Early in my career as a freelancer, I would look back on projects that went way over budget on time, and when eating a large portion of my time I would tell myself “I’m never doing that again”. However, on the very next project I would fall back into my old habits of trying to make sure that the customer got what they wanted for their budget.
Many times looking back, I considered this a business error. After all, how can I make any money if I flush it down the drain by going over budget and eating a large amount of my time on every startup project? Time and time again on new projects, I would add unnecessary features early in the project, and then late in the project regret it because of the non-billed time I spent in order to close the project out to the client’s satisfaction.
Lately however, I’ve looked back upon my career and a successful application lives on, grows and needs to be nurtured and enhanced. Some of my biggest failures on the initial project have virtually made my business. Without giving any numbers in particular, I’ve had several projects that, over the lifetime of the project, have provided revenues of over 70 times the initial project costs. Now with this comes a great deal of service, but after all, that’s what we sell right? And unlike the initial project, where there is usually some risk with the client, add-ons after the project is a success are typically a no-brainer. Adding a report here or a time-saving action there provides immediate quantifiable value, and is usually an easy target for us to stay on budget.
It’s so important to make sure you get to the finish line with relationships intact, even though at the end of it you may be so tired of the project that you want to rip all of your hair out and go be a greeter at Wal-Mart. I think this is where a lot of freelancers and businesses fail. At the end, they are so frustrated with the project and client relationship that they are ready to move on to something and someone else, where they swear they will not make the same mistakes.
With a focus on the life of the relationship, it has taken the pressure to avoid eating the cost of some overtime on the initial project off of our chest, and allowed us to focus on the long term goals of the client as if they are our own. After all, their success is our success and embracing that has made all the difference.
Read more about how we invest in the initial project for the sake of the lifetime value of the client with Test Driven Development.
A Programmer’s Haiku
For on-time launches
We admire to dispel
A programmer’s optimism
— Marshall Malone
Experience teaches a developer that the qualities that make great programmers can also break them.
Programmers are artists. Programming is a synthetic art. Programmers create something from nothing. Therefore, it is not a stretch to say that a programmer, by nature, is an optimist.
The difficulty, however, is that a programmer’s belief in himself, or a project’s outcome, does not always allow him to factor sound logic in his construction of a timeline. When this happens, his optimism has failed him and the client. Most programmers will admit that they consistently underestimate how long it will take them to accomplish a task.
I’m inspired by the book; The Mythical Man-Month, by Frederick Brooks, Jr.; a well-known IBM developer. At the book’s core, he dispels the notion that adding man-hours to a project will speed the pace of that project. In fact, he affirms “adding manpower to a late project makes it later.” In describing this assertion, he uses the analogy that 9 women cannot work together to produce a baby in one month.
The Man-Month, in a timeline, suggests that X number of men can accomplish Y many tasks in Z many months and that the men and months are interchangeable. (more men = fewer months, more months = fewer men, etc…) As eager as programmers and patrons are to see a project to conclusion, many employ this myth into their logic. This brings a slow and painful death to their client’s satisfaction.
Brooks says, “Men and months are interchangeable commodities only when a task can be partitioned among many workers with no communication among them.” In other words; when tasks require heavy communication, the project doesn’t speed up with more effort. In fact, adding man-hours can slow a project down.
I remember a client’s story; how 2/3 of their team was replaced with “better developers” in the middle of the project. Though the developer believed and even insisted they would be on time, his reasoning was based on a false and optimistic notion; the mythical man-month. As the client feared, they launched almost 6-months later than intended, and by the end of the 6th month, everyone was seeing blood.
At the root of this is the understanding that programmers don’t just slip into a project. They require training by those people who are experienced in the project. For example; adding 2 men will require at least 3 man-months to get them up to speed; time, which is most likely, not budgeted in the original estimate. This also means the tasks are redistributed 5-ways so that by the end of the 3rd month, 7 more months of effort remain. With 5-trained people standing; only 1-month remains in the budget and the product is now late, as if no one had been added.
To hope to get done in 4-months, considering only training time and not repartitioning and extra systems test, would require adding 4 men, not 2, at the end of the 2nd month. Now, one has at least a 7-man team, not a 3-man [team]…”
And the client suffers as their expectations far exceed the reality. There are two prices that every client pays when a project falls behind.
- The financial and psychological costs to both developer and patron because of added man-hours.
- The impact of late software on a business, which depends on the project to support the business efforts.
As costly as this is, it is a failure by most developers to deploy sound planning principles. Instead of calculating myths, the average project should look like this, according to Brooks:
1/4 component test and early system test
1/4 system test, all components in hand
- The number of months of a project depends on its sequential restraints.
- The maximum number of men depends on the independent number of subtasks.
From these two quantities one can derive schedules using fewer men and more months. One cannot get a workable schedule using more men and fewer months.
Until estimating is on a sounder basis, individual managers will need to stiffen their backbones and defend their estimates with the assurance that their poor hunches are better than wish-derived estimates.
I think of our company as one that provides reliable service, but I have been recently affirmed in this notion when I began reaching out through social media. The results blew me away.
This summer we launched a new initiative to reach out to our personal connections and see whom we know. It wasn’t a difficult exercise, but required that we take a bit of time each day to engage ourselves on LinkedIn. When we began, our combined list of contacts was small, more indicative of our social networking inactivity than the reality of connections.
As we reached out, we did not merely send out invitations to connect and move on, but we relied on thoughtful engagement, going for as much quality as quantity. Our hope was to connect in a more tangible way; making referrals, endorsements, writing recommendations, and providing readable and relevant content on our website. It was important to us that this experience was less about intrusion for numbers sake and more about benefitting those with whom we connected. In other words; if they benefitted – it would be returned to us.
It didn’t take long to see an impact on our bottom line. New connections led to new conversations, which led to new projects. In short order, we nearly doubled the number of people in our network, and the connections we made gave us a great deal of positive feedback. Here’s one such example:
Whiteboard-IT is extremely knowledgeable, providing innovative IT solutions to help resolve my needs in a timely and cost effective manner. They are available at a moment’s notice and are highly responsive to issues that need to be resolved quickly. Bottom line…they do what they say they will do. I have recommended Whiteboard to other colleagues in a variety of businesses and will continue to do so. I cannot say enough good things about their customer service, technical expertise, and business personality.
Jessica Boroff, RN, BSN The Compliance Store
Of course she would not have said these things if we weren’t good at what we do. Her recommendation is now posted on our site, which others will also see. But the renewed activity, including these testimonials, has been a priceless part in priming our sales pipeline. And future clients are more confident when they you have mutual connections.
But it goes to show; If you do a quality work at your trade it’s unlikely that everything has completely dried up, fiscal cliff or not. You may find, as we did, that reaching out out to your connections may be of great benefit. It may also generate a nice return.
CFO’s and business owners want feedback from their programmers, which is tough when often times the better programmers have spent their lives incubating skills that borrow from their ability to return phone calls. And costs for a web site are all over the place; from several hundred dollars for a simple revision to a hundreds of thousands of dollars for a site with vast databases, and volumes of functionality. So – when a project depends on a high level of accountability and communication, and all of them do, clients just want to know what is really happening behind the veil of code.
All consultants’ fees are based on a daily billing rate, which reflects the value they place on one day’s labor plus expected overhead expenses. These rates appear in fixed fees, monthly retainers, hourly billing or even by measuring a company’s performance. Either way, those fees must be justified with the quality of their work combined with effective communication and reporting.
The savior of the coding hero is to maintain good internal systems and to enjoy the ability to recognize weakness and to compensate for it by surrounding one’s self with colleagues of varying skills and personalities. This wisdom steers a client away from hiring one-man shops where “man-down” doesn’t mean the death of a project. Consistency comes when redundancies are as present as the front-line programmer.
At Whiteboard, we make a habit of communicating internally through continual education, participation in the open source community and a diligent internal peer review process. In doing so we encourage our staff to pay attention to the details. It also keeps us talking, keeping all parties informed. Upon request, our clients receive online access to reports that monitor the progress of each project, including time sheets.
We have cleaned up many messes created by one-man shops or companies who care little for the details. And while we are grateful for the opportunity to do so, we feel your pain and look forward to providing relief.
You are probably using several software applications that talk to each other. Whether you have a custom web application or prepackaged financial solution, getting applications and services to communicate requires a skill, technique, and knowledge to protect your information. So, what happens when your web service is not secure? What information could you be leaking and how could you be vulnerable?
- Privacy refers to ensuring that messages are not visible to anyone except the web service and the web service consumer. Traffic should be encrypted so that machines in the middle cannot read the messages.
- Message integrity provides a guarantee that the message received has not been tampered with during transmission.
- Authentication provides assurances that the message originates from where it claims it did. Both a legal term as well as a technical term, non-repudiation refers to the concern of not only authenticating a message, but proving the origin of that message to other parties.
- Authorization refers to ensuring that only consumers who should have access to a resource of your web service actually have access to that resource. Authorization requires authentication because without authentication an attacker could pretend to be a highly privileged user.
Building a web service or API (application programming interface) requires a methodology for exchanging secure information, and there are two popular solutions: SOAP and REST.
Simple Object Access Protocol (SOAP) is a popular protocol specification. It is a complicated specification and some developers, though well-meaning, leave security vulnerabilities. An example of a vulnerability is SOAP injection. What is SOAP injection? It occurs when the server attempts to parse the XML message from a client. If the XML message is malformed, meaning that it does not follow the rules that the server expects it to follow, the server may return an error message that actually shows code and gives insight into the underlying system. Developers may turn off this behavior. However, this is often forgotten before a deployment.
REST (Representational State Transfer) is an architectural style for distributed systems. The World Wide Web is one such distributed system. REST has become a popular architectural choice for designing web services. Such web services are referred to as RESTful web services. An advantage of using REST is that the security vulnerabilities are well known as they are the same vulnerabilities that impact web sites. This means that developers who are familiar with website security will be able to leverage their knowledge to secure RESTful web services.
Developers working with either of these technologies must be concerned with the four security points. No methodology or architectural choice ensures that your information is well-protected. It is important that your consultants explain the architecture they plan to use and how their implementation plan accounts for security concerns. If your developer does not have a detailed answer, it is a red flag.
I remember hearing it on the radio; another major retail store was targeted by hackers, a store I had shopped not two weeks prior. That sinking feeling struck, the one that calls me to drop everything in order to familiarize myself with my credit card company’s phone bank to cancel my cards.
New brawny standards protect us against such events and the incentive for a company to comply is tremendous, but tough standards are not great if they are tough to reach. So we ask; is the arsenal guarding us from online theft too hard to grasp for the average online business?
So to answer our initial question; PCI Compliance is too costly for the average businessman to comply, but we are fortunate to live in a free market that sees bureaucracy as an opportunity. Companies like Braintree may have been created with profit in mind, but they are offering a service that gives us carrots and saves us from the stick.
Businessmen want to know how much effort to invest in pursuing “Likes.” The popular feature seems to many as a cheap form of validation, equivalent to the old Stuart Smalley bit, “I’m good enough, smart enough and doggone it, people like me.” Those who never wanted to become experts in social media are asking “why is it important?” and “will this bring me money?”
Likes Bring Measurable Results
To say a “Like” is an end is short-sided, like saying that motion stops when a pebble hits the water. To do so would ignore the ripples that act like homing beacons to viewers and search engines.
A Like does many things behind the scenes, providing measurable objectives, reports, and now impacting search queries. Bing’s new features make it easier to see what your Facebook friends Like, incorporating your community in your search results. This begins a more conversational aspect to your searches. Decisions can now be made by a committee of your choosing on news stories, bands, celebrities, movies, or brands.
A Like is a validation that someone is interested in you, your product or your service. And in social media, we collect validation like currency.
Still, there are many benefits to a Like. When someone “Likes” your page it appears on news feeds, meaning their recommendation will be broadcasting to their 300 closest friends; a ripple effect that allows compounding affirmation. This is validation supreme.
Those Likes that you click will also help Facebook configure what advertisements go to you, so for those Facebook advertisers who choose to focus on one or another interest, this is big.
Likes Bring Conversation
That Like also gives you permission to talk to your clients who have, in essence, voted for you. When you update your status, there is now a measurable audience waiting to see what you have to say. And if your content is share-worthy, you have the potential to go viral. This, of course, increases the need for your content to be impactful and relevant.
For Search Engine Optimization (SEO), the Like acts as a beacon for Google’s eager robots seeking content with recency and relevancy. And while Google algorithms cannot see what is happening inside Facebook, they can certainly see what relevant activity is occurring on your site. And a Like button embedded on your site is highly relevant, especially if it is clicked often.
Of course, frequency is as important as reach; it’s important to get in front of your people repeatedly and often. And that endorsement from a friend is much more powerful than an paid ad, creating greater loyalty. It’s a handy medium to remind people that they have a friend when they need it, and the transparency personalizes and localizes in a format that allows the occasional shameless plug.
Can you monetize this? Sure – like this article, which says:
- On average, fans spend an extra $71.84 they would not otherwise spend on products they describe themselves as fans of, compared to those who are not fans.
- Fans are 28 percent more likely than non-fans to continue using a specific brand.
- Fans are 41 percent more likely than non-fans to recommend a product they are a fan of to their friends.
And this one which gives conflicting information:
Depending on who you ask and the metrics you use, a Facebook follower could be worth nothing at all, as little as $3.60, as much as $22.93, exactly $136.38 more than a non-follower, or a whopping $214.81 for a nonprofit organization.
Still, for those who grew up in traditional media, the Like button is Nirvana. Where we once were dependent on expensive statistics dependent on research diaries filled with vague groups and guesses, we can now track individual motivations and interests with laser-LIKE focus. Its value is measurable beyond compare.