The Gunner Team breaks down the project
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What was the problem to be solved?
MD Anderson wants a partner to provide a HIPAA-Secure solution that will enhance a patient’s discharge transition to home, providing notification of clinical or service alerts to the proper MD Anderson staff, while reducing readmissions in a manner greatly acceptable to the patient.
This automated call solution should be easy and efficient for all MD Anderson staff.
What was the proposed solution?
Gunner Technology proposes a five-step solution to solve MD Anderson's problem.
Obtain patient data from the EPIC software API and minimize or negate any requirement of additional patient input.
This exchange should be a real-time or near real-time feed.
Automated call with default language but optional “plug and play” Algorithms can be patient specific inserted, based upon factors such as diagnosis, age, and severity.
The automated call Algorithms can be edited and personalized, if deemed appropriate by MD Anderson management staff.
IVR solution must be robust and capable of thousands of simultaneous calls.
Patients should have an option to either proactively call in for the automated call, respond to a text, or receive the automated phone call.
Calls should be as brief and efficient as possible.
The automated calls will begin within 24 hours of discharge.
Multiple attempts to connect will be made at an agreed-upon time of day and documented.
More than 50 lifelike voices across many 15 different languages are available.
Current call responses can readily be seen in a color coded, green-yellow-orange-red format
Various customizable reports will be available for analysis including:
What challenges arose during the project?
MD Anderson proposed a tight timeline for project completion.
The client wants the platform implemented within approximately 20 days after kickoff, fully tested within 30 days of kickoff and launched within 120 days of kickoff.
While that is an aggressive deadline, it's certainly doable.
In fact, the only difficult aspect to this timeline is the Epic integration.
In Gunner's experience, the firm has found that epic integration can vary from client to client and Gunner is forced to assume certain things about MD Anderson's usage of the Epic platform.
To minimize this risk, Gunner will immediately tackle this part of the project upon contract award.
What was the technical approach to the project?
Gunner Technology sees this project as three separate projects to be build as Microservices.
Microservice #1: Epic Integration
This microservice will be responsible for integrating with the Epic API.
The first Lambda function will get triggered every minute by an Amazon CloudWatch event trigger and pull the most recent patient data from Epic, extract the relevant data, buttress the data with supplemental information such as next call time, last call time, default preferences and more and insert it into HIPAA-compliant, encrypted Amazon DynamoDB tables.
Microservice #2: Progressive Web App Dashboard
Gunner will use the React Framework to build a PWA for dashboard and reporting functionality.
This will ensure sub-second load times.
To be clear, this is an automated solution and does not require admins to view or edit the data as the app is procuring defaults from Epic.
However, this portion of the dashboard will allow admins to override the defaults on a case-by-case basis.
Microservice #3: Interactive Voice Response
This is the service that will call, text or handle incoming calls from patients.
Twilio will be the crux of this service.
The default functionality will be for Twilio to call a patient.
Using Amazon Polly, the call can be made using more than 50 different voices across more than 15 different languages, including English and Spanish.
If a response requires escalation, this service will use Twilio to forward the call to an appropriate call center, use Amazon SES to email the call center a link to the patient who is calling and update the patient record to denote such a call is made.
That way, whoever answers the call in the call center can easily use Microservice #2 to quickly bring up the patient in the UI and see patient data and responses.
The actions taken by the call center can then be noted in the Dashboard and recorded for reporting and analytical purposes.
Similarly, if MD Anderson admins update a patient's contact method to "Text" or "Call-in", Twilio will behave the same way but either via text or in response to a patient dialing a specified number.
What was the project management approach to the project?
Over the years, Gunner has refined the process to suit may different situations and the firm is continuously refining and tweaking it on a per client and per project basis to best suit the needs of the situation and project.
However, Gunner generally approaches each project, initially, with the same methodology.
Eliminate the Unknowns
Nearly every project starts with unclear requirements and unknowns.
More so than anything, these can derail a project, so the team's first priority is to get rid of both, using Research Sprints.
Find our Velocity
Gunner's project manager estimates how long a project will take based on the summation of all Effort Points at the beginning of the project.
For example, after creating the user stories, a project may have a total of 5,000 Effort Points.
Using simple math, the PM can estimate that will take the team 100 iterations (usually weeks) to complete based on a 50-point Velocity..
However, each project is different so the team of two with an average Velocity of 50 might trend higher or lower on a given project.
Augment if needed
Because Gunner meticulously tracks and refines Velocity, the team's project manager will know immediately if the project is off track.
The project manager can also use this score and method to alert the project stakeholder if a new feature they want is going to jeopardize the timeline and/or budget of the project.
Each project generally has three environments set up fo it.
Production for the live site.
Staging for the stable test site.
QA where the latest features are tested by humans.
Each step of the way includes automated testing upon each deployment, which occurs at the end of each iteration, prior to the planning meeting.
What’s on QA gets deployed to Staging.
What’s on Staging gets deployed to Production.
Each user story gets its own Git branch where it is developed and tested.
Upon acceptance, that branch is merged into the master branch and deployed live.
What platform was built for this project?
That said, given the nature of the data, Security is of the utmost priority for this platform.
Gunner's solutions architect works with the developers on the team to implement a Continuous Development, Git-based, DevOps framework leveraging technologies such as AWS CodeCommit, AWS CodeDeploy, AWS CodePipeline and AWS CodeBuild.
How did this project benefit the client?
By using Gunner's solution, MD Anderson will decrease the unplanned readmission rate and increase patient satisfaction scores.
The IVR solution will reach to 100% of MD Anderson's discharged patients, inquiring about specific matters for every discharged patients within 24 hours of discharge to ensure that the patients have transitioned home safely.
This automation will satisfy one of MD Anderson's Operational Priorities and provide patients with a better experience without consuming an excessive amount of MD Anderson Resources.
Why was Gunner selected for this project?
Gunner Technology has the technological skills to complete this project better than any other firm at a cost that can't be matched.
This solution is not an off-the-shelf solution.
It is built to suit MD Anderson's goals and visions specifically.
Gunner has built many custom solutions for the healthcare industry and plans to add even more value through subcontracting with AZ Tech on this project.
AZ Tech brings a healthcare technical team with experience in building technology solutions and Algorithms for reducing hospital readmissions using IVR technology, which included a $100,000 Duke Endowment Grant.
AZ Tech closely followed the 2008 Iowa Chronic Care Consortium study using IVR technology to reduce heart failure readmissions, and the 2011 Geisinger Monitoring Program using IVRs.
The team is familiar with the Park Nicollet, Billings Clinic and UMMC’s Diabetic Telehealth programs, which also used IVRs for remote patient monitoring.
AZ Tech firmly believes that IVR technology can affordably and efficiently be utilized to make significant improvements on patient care and reductions in avoidable readmissions.
The combined team of Gunner and AZ Tech would be honored to work with MD Anderson on this after discharge communication program.
What tools, techniques and methodologies were used on this project?