The rapid rise of cloud computing, and mobility of the workforce navigating data sovereignty, particularly geographically disparate teams, are common challenges in healthcare technology projects. We’ll share findings and learnings from the North Dakota Health Information Network (NDHIN) implementation of Orion Health Amadeus on Amazon Web Services (AWS). NDHIN were looking to enhance their Health Information Exchange (HIE) platform by improving the exchange of critical clinical data, while leveraging the power of the cloud.

Understanding the bigger picture

The entire project team must recognise the big picture and values of the project. Understanding the purpose helps reduce noise and extra work that can creep up throughout the project. The purpose of the NDHIN project was to upgrade their system to enable them to easily add new capabilities to their platform. To achieve this, we migrated all historical data and upgraded integration across the network of participants and partners.

Key project deliverables with technology components had to be supported by solution architecture including technical design and decisions across the project team, internal, and external stakeholders.

Tackling data constraints

Data sovereignty requirements meant tasks must be labelled either onshore or offshore depending on whether access to personally identifiable information (PII) or personal health information (PHI) was necessary to complete a task. Anonymised data was provided where possible and to further mitigate these constraints, we performed data analysis including HL7 messages and code sets, and produced an aggregate report without PHI. This played a pivotal part in the velocity of the team and lifting stakeholders’ confidence in the solution.

Simple information like finding 11% of HL7 messages did not provide VersionID in the MSH (message header) segment, or that 89% of PID (patient identification) segment does not provide a religion field, can identify external dependencies and tasks early to mitigate delays in delivery.

Task specification was another key success factor for the project, and it ensured that team members had tasks well articulated, with acceptance criteria, and linked to a project deliverable that demonstrated value. This vastly improved team members’ ability to understand and complete tasks efficiently without requiring frequent clarification.

Learning from each other

The project team followed Kanban agile methodology, commonly used by software development teams. This had an enormously positive impact on learning for the project team picking up varied project tasks, and increased flexibility for change throughout the project by use of a prioritised backlog for the team. With a number of other agile ceremonies combined with Kanban, the team focused efforts on customer value and feedback. Use of common tooling brought in software development processes such as release notes and known issues with automation.

When the rubber hits the road

Like any other project implementation, an inevitable curve ball was thrown in the middle adding an unplanned scope of work. By utilising the techniques above, the project team were able to define and refine tasks, making sure the project stayed on track.

The ability to respond quickly to changes, together with continuous delivery practices allowed the team to manage and deliver changes successfully. Continuous delivery tooling and AWS enabled each team member to deploy a production-like solution from version control in a click of a button. This was crucial in avoiding common pitfalls of issues when “the rubber hits the road”.

Successful delivery starts with disciplined people and understanding the value and purpose of the project. Health IT projects today are laying a foundation of digital transformation for future healthcare delivery. By embracing tools and processes that support changes in technology and people sets us apart to tackle new challenges with discipline.

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