Over the past few months as part of our #HealthIT100in100 initiative, I’ve had the opportunity to speak with many companies. It was clear right from the start that COVID-19 was having a significant impact on development processes, product roadmaps and staffing at these companies. For some, the changes wrought by the pandemic are temporary, but for a few, the pandemic has shown them a better way of doing things.
When the world changed
“It was apparent very early in the pandemic that we were going to have to do things differently,” said Kim Franks, VP and GM of Consumer Health at Allscripts. What Franks and the team experienced was a sudden influx of enhancement requests. These requests poured in directly to Franks, to Paul Black (Allscript’s CEO), to account managers and via their support channels. The requests were almost entirely for enhanced telehealth capabilities.
For TigerConnect, there were two signals that the world had changed. First was the sudden cancellation of HIMSS20. “We were heads down getting ready for the conference,” recalled Phil Leung, VP of Product at TigerConnect. “But we quickly had to switch to Plan B when it was cancelled.” For many in Health IT the cancellation of HIMSS was a watershed moment and was a clear indication of the seriousness of the spread of COVID-19.
The other signal was the increase in the volume of messages flowing through the TigerConnect system. “We have a dashboard at the company that we keep an eye on everyday,” explained Leung. “I remember seeing the numbers keep building up and taking off like a rocket. We had recently celebrated reaching 5 million messages sent through our system. It took us about 160 days to go from 4 million to 5 million which was a record for the company. But because of the COVID-19 crisis, it went from 5 million to 6 million in just 10 days.”
Impact on Development Processes
Most companies follow the same basic product development process. It all starts with gathering requirements from customers, creating design specifications based on those requirements, scoping the effort to build the new features, developing the functionality, testing the new product version, and finally releasing the new version to customers. The time and effort spent at each step varies by product and from company to company.
I was concerned that companies would reduce the time for testing in their rush to get products out faster during the pandemic, but thankfully that turned out not to be the case.
“We have some stringent processes when it comes to product releases,” explained Franks from Allscripts. “Normally we wouldn’t include any new feature set as part of a CU [Cumulative Update] release, but we’ve had to backtrack on that in order to deliver the functionality that our customers need.”
At the time of our conversation, the Allscripts team had completed seven CU releases in just six weeks – an unprecedented pace of product enhancement. According to Franks, the team had to “fast track development, requirements gathering, and QA” to get new features into the hands of their customers as quickly as possible.
The TigerConnect team changed their development approach by zeroing in on the minimum viable product (MVP) that their customers needed. “We really focused on what front-line customers needed in order to get through the crisis,” said Leung. “This meant stripping out features that could be delivered later. For example, when we normally roll out a product, we have both mobile and web versions. To speed things up we decided to deliver our mobile version first and then the web version later. Similarly we decided to take care of direct one-to-one conversations first and then add the more complex group conversations at a later time.”
Leung and his team also eliminate unnecessary steps from their standard process: “This was a chance to rethink our preconceived ideas on what needed to be done and the dependencies we had in our process. Normally, for example, we would take product specifications and create estimates as well as a project plan to deliver them. But when you compress the delivery timeline to just a week or two, what’s the point of a project plan?”
Impact on product roadmaps
While companies like Allscripts and TigerConnect were inundated with requests, other companies had client bases that went quiet for a time. That’s what ibi (Information Builders) experienced. Dennis McLaughlin, VP Omni Operations and Product Management at ibi shared with me that client requests slowed to a trickle in the early weeks of the pandemic as hospitals and health systems were consumed with preparing for COVID-19. This didn’t concern McLaughlin and the team at ibi, because they understood that eventually their clients would need the data analytics capabilities of their platform to help battle the pandemic.
The ibi team used that quieter time to focus on projects that hadn’t been a priority before the pandemic but that would be needed soon. For example, they did a “mini push” to ensure their platform could easily track important COVID-19 metrics like facility utilization, capacity, and bed availability. McLaughlin believes this change in their product roadmap has helped position the company well for the increased demand for analytics that is happening now.
TigerConnect, in contrast, adjusted their product roadmaps significantly. Leung recalled sitting down with CTO Tim Goodwin and CEO Brad Brooks to figure out how to best help their customers get through the pandemic. “We ultimately made the choice to pause every other major initiative on the roadmap in order to focus on the Telehealth product line (TigerTouch),“ said Leung.
TigerConnect had already been working on TigerTouch – their telehealth solution prior to the pandemic, but it was originally scheduled for a mid-2020 release date. To get something to market quickly, they released TigerTouch in two phases. “In the first phase we launched the texting and asynchronous part of the part of the solution,” explained Leung. “We then launched the voice and video part of the solution soon after.” The shift in focus and the pivoting of their product roadmap, allowed them to compress the delivery timeframe.
Impact on Developers
Not only has COVID-19 impacted the product plans and process at Health IT companies, it has also had a profound effect on developers themselves – how they work, where they work and how they interact with each other. Product development has long been a team sport. Even though each developer writes code on their own, there is a high degree of coordination and collaboration needed in order to ensure teams are working on the right things.
As offices closed and people began working from home, companies and individuals had to adapt to new ways of staying connected and working together.
McLaughlin’s team at ibi was particularly challenged because most of their developers were located in New York City, the initial hotspot for COVID-19. Because of this, they made the decision early to send people home to work. Initially McLaughlin was worried about how people would adjust to not being able to run into a meeting room with a whiteboard to collaborate. The team hardly skipped a beat.
“One of the things that was most surprising to me was how easily our team moved to online operations,” McLaughlin said. “We shifted right away to web meetings and used our other online collaboration tools in earnest. There was no drop in productivity. The infrastructure team did a great job getting people equipped to work at home, especially for people who don’t travel and therefore didn’t have a laptop that could easily be transported. They also had to procure things like printers and desks for people.”
Similarly, TigerConnect was one of the first companies in Los Angeles to transition entirely to working at home. Leung referred to the change as “jolting,”: “We scrambled to figure out a new way of managing work and life at home, as so many have. But everyone was all-in from day one.”
“The shift to working at home has reinvigorated some of Allscript’s development teams,” Franks noted. “They feel that they’re doing something very worthwhile and helping people – both clients and patients. They are giving their all to get the tools our clients need out to them.”
Some changes will be permanent.
Many of the Health IT leaders I spoke with over these past few months openly wondered if the temporary measures they put in place will become permanent. A few who wished to remain anonymous, told me that this pandemic has shown senior executives that a large office building might not be necessary going forward – and that they were now looking into the feasibility of downsizing their space and potentially keeping a portion of the team at home. While it may be a bit premature to say that work-from-home will become the norm for corporations, the success these companies have enjoyed has opened the eyes of leaders who had previously resisted it.
This change in attitude about work-from-home is not restricted to just executives. McLaughlin at ibi has seen a similar shift in staff as well. “People are understandably concerned about commuting into the office who never gave it a second thought prior to COVID-19. Being New York based, many take public transportation to get to the office. Given the choice, I think many would prefer not to take that risk.”
McLaughlin also suggested that there may be another shift in store for ibi because of COVID-19. Hiring tech talent in New York City has been extremely challenging with so many other tech companies based in the area. The pandemic, however, has shown that the entire team does not have be based in the city. Four months of working remotely has shown them that they can have teammates located outside the city and even beyond New York state. This greatly increases the potential talent pool for the company.
In addition to the workforce, there are other changes that may become permanent. Allscripts, for example, does not foresee returning to their pre-COVID product roadmap. To put it simply, the world has changed too much and Franks said that “It’s going to take a lot of time sitting down with clients and asking them how this pandemic has changed them operationally…” and then adjusting their roadmap to match it.
Advice for the Health IT Community
As a final thought, the company and development leaders I spoke with offered the following tips and advice:
- Make sure your team knows the role they play in the big picture. The pandemic has given IT teams a unique opportunity to see the value they give to the whole healthcare community – not just their direct customers. Use this opportunity to show them the impact they have.
- Although things may seem bleak at times, there is also reason for hope. This pandemic has proven that healthcare organizations can be nimble and agile. They have embraced (and procured) telehealth technologies with head-spinning speed, showing all of us that when the need is acute, they can react quickly.
- Be flexible and open-minded. Now is not the time to stick to standard operating procedures. With the situation changing daily, you need to be flexible and adaptable. What worked today may not work tomorrow.
- Don’t shy away from tough decisions. It will benefit you in the long run. As Leung noted, “When every hour counts, take a hard look at what truly is necessary in your development cycle.”
- Let people surprise you. In a crisis, people want leadership…but they also want an opportunity to shine. Don’t try to micromanage. Instead, set clear goals and guidelines then step back and let your people surprise you with their work and dedication.
This article is part of the #HealthIT100in100