For most people, the idea of software development is somewhat of a black art.  So consider this: if you’ve ever experienced homeownership, you already have a sense of what it is like to manage software development. 

For starters, you’re familiar with a fixed deadline:

“You really need to get the plumbing sorted out by Sunday night.”

You know about changing requirements:

“I didn’t know it was the wrong color until you finished painting the house”. 

And you know that mistakes are expensive:

Cutting the new bathroom door too small = buying another bathroom door.

Given these challenges are taxing enough in the domestic realm, how does a company like Voalté manage these same challenges in the complex world of software development? And how do our developers keep it all straight when they are delivering code for three endpoints (iPhone, Blackberry, web client), and two servers (voice & data) in a mission critical environment such as a hospital?

The answer is through a process called Scrum. The idea behind Scrum is fairly simple: develop software incrementally in iterations that last two to four weeks.  These iterations, referred to as Sprints, allow the Team to add new features on a frequent basis, with each iteration resulting in a shippable release. Perhaps the greatest advantage of Scrum is to the business itself, through the ability to quickly adapt to changing requirements and customer preferences.

Compare Scrum to the traditional model of software development (Waterfall):

1. Spend six months conducting market research

2. Spend another three months writing the product specifications

3. Hand requirements over to the Engineering Team (with great ceremony)

4. Engineering Team develops the product for a year.

5. Software is passed to the Quality Assurance Team (more ceremony)

6. Then the long slog as the product is debugged, often with limited success.

7. Finally the product is launched (greater ceremony).

Here’s where the real heartbreak is.  By this time the product is launched, the customer’s needs have either changed, or the customer now realizes that with the product in hand, they really wanted something else in the first place (see “wrong color” above).  Compare this to Scrum -- a working product, although not fully featured, is released to the customer far sooner, when changes can be made more easily and less expensively (bathroom door).

There are three main roles in Scrum.  The most central role is held by the development Team (typically seven members).  The Team is self-organizing, meaning that Team members decide how the problem is to be solved, and who is to complete what tasks.  Scrum is a “pull” based process, meaning the Team commits to only as much work as it believes it can complete during the Sprint.

The Team pulls work from a list called the Backlog.  The Backlog is composed of several user stories, which are effectively new features to be added to the product.  An example user story follows:

As a clinician, I want an easy way to send my most commonly used text messages, so that I do not have to retype the same message over and over again.

The backlog is created by the Product Owner, who is responsible for the commercial success of the product.  The Product Owner writes the user stories and prioritizes them by business value.  The Product Owner also has the responsibility of reviewing and accepting work completed by the Team.

The final role in Scrum is the Scrummaster.  The Scrummaster facilitates communication between Scrum participants, removes impediments, shields the Team from interruptions, and ensures the Team is on track to complete the work it has committed to. 

One of the most powerful elements of Scrum is the process of continuous improvement.  At the end of each Sprint, the Team reviews what went well and what didn’t, and then uses this feedback to improve the next Sprint.  This feedback loop is just one of the reasons highly effective Scrum teams see productivity levels at 5 to 10 times the industry average*.

Scrum, born from the shortcomings of the traditional Waterfall process, traces its roots a variety of influences, including lean manufacturing techniques, process engineering, and behavioral science.  Designed to be lightweight, easy and fun, Scrum is realistic enough to be adopted by even the most skeptical engineering team.

Now if I can just convince myself my next home improvement project will be lightweight, easy and fun…

* http://jeffsutherland.com/scrumpapers.pdf

As if I didn’t have enough to do when my CEO walks in and says he wants me to attend a people management course at the Disney Institute. 

I would say that I am a pretty likeable person and I get along with ninety nine per cent of the people I meet, so why do I need people management training?  Well how about saving time, saving money, sustaining good employees and developing a strong corporate culture to name a few.  After all, a few days at Disney can’t be all bad and they do employ a lot of people and they do have a pretty successful track record.  Why not?

After the training, and filled with newfound knowledge, I decided to put my new skills to work at Barcamp Sarasota.   With my Disney training manual close at hand, I proceeded to emulate the giant mouse. Barcamp is a type of 21^st century ”unconference”, a facilitated user-driven unstructured conference usually based on a technological theme. When you arrive you can sign up to give a presentation or just meet other like-minded individuals. 

 The Disney approach to people management focuses on four main themes -recruitment, training, communication and care.  Now this is where Disney weaves it’s magic.  Their attack strategy (so to speak) is to create an overall mood by way of incorporating beautiful visuals and audio into their training and literally everything else they do. They attack your senses and arouse your emotions.  You are rendered helpless.   They create a magical formula that leaves an everlasting impression on anyone who enters their domain.  This was now going to be my new approach to organizing Barcamps, hiring employees and helping to develop an enviable corporate culture.

My first plan of action was to create a buzz, not just interest, but hype and buzz and excitement that Voalté, a prominent, young, local start up, was an organizing sponsor of Barcamp Sarasota.  The word started to spread that we were coming and also seeking to recruit a couple of summer interns for software testing. 

At Barcamp Sarasota I gave a presentation about Voalté, who we are, what we do and what our goals are.  Borrowing on Disney’s captivating audio and visual approach I included pictures, videos, and music to enhance my presentation and motivate my audience.  Before the presentation began I put up an image of the four co-founders of Voalte wearing our signature black and pink scrubs.  In the background the Pink Panther theme was playing. The mood was set.

After my presentation I was approached by many young hopefuls who all wanted to intern at Voalté .  Because of the overwhelming response, I now had to set up a round of interviews.  Once again, I had the opportunity to focus on my new people management skills.

The first item on my agenda was to prepare a plan of action prior to the interviews.

The plan included having the interns being interviewed individually by the four co-founders whose photos they had already seen at Barcamp.  Next, I prepared the conference room where the interviews were going to take place.  I wanted their first impression of Voalté to be stellar.  The conference room also included images of our advertising campaigns and trade shows.  A little attention to detail helps set the mood.

Fortunately we were able to select two interns from our pool of applicants. 

Voalté is a mobile development shop where we create iPhone and BlackBerry applications.   Now our two interns had to be trained on how to use our computer systems, how to use our development tools and how to build our software.  Training and communication was key.

Everyday became a new learning experience for our interns.  Daily they met with me for 30 minutes to review work they had completed and to receive their marching orders for the day.  They were also included in the daily developer briefings (scrum) and by the second day they were giving the other team members an update on their progress.  By the end of their first week not only did they manage to find a couple of bugs but they also completed their first test report and summary.  Everyone was very impressed.  As a reward for their hard work and efforts I took them out for lunch at the end of their first week.  Even Disney agrees that by celebrating success you create an environment of success.

When you break down and analyze the Disney “dynamic” it literally all boils down to common sense and simplicity. Disney did an amazing job of articulating and presenting their blueprint to us. It consistently works for Disney and many Fortune 500 companies. It’s really very simple if you follow the blueprint and implement the concepts.  You’ll be amazed.

As the Vice President of Innovation at Voalté, it is my responsibility to understand smartphones and work with caregivers to figure out ways to help incorporate these devices into their lives at the point of care.  In fact, our company focus is entirely on providing hospitals the best communication solution for clinical communication on the latest cutting edge mobile platform.

I have used multiple BlackBerry devices throughout my career and have also used an iPhone the last few years. I can easily claim to be a smartphone “fanatic” and it is probably the one device I would not be able to give up in my professional life (seeing the value of smartphones in my personal and business life was a deciding factor in why I started Voalté to help bring about smartphones at the point of care).

Last month I decided it was time to see what all the fuss was about regarding the Android operating system.  On April 20, 2010, at approximately 4:15PM- I pulled the SIM card out of my iPhone 3G and switched over to a Google Nexus One (both use AT&T and I wanted to make sure the carrier was not a deciding factor in the experiment).

This wasn’t just a one or two day test of the Android- this is full fledged, 100% business operations, mail, app’s, and all - switch from the Apple iPhone OS to the Google Android OS. Below are a list of my thoughts after more than a month of Android vs iPhone use:

1. Multi-tasking and widgets

The first things I noticed about the Android was the concept of widgets vs just being able to run applications. The widgets enable you to peak into an application and see small amounts of information right on your desktop. For example, my mail widget shows me the latest email that has just come in, my calendar widget shows the time and attendees of my next appointment, and my Facebook widget shows the last status update in my newsfeed.

My imagination goes into overdrive regarding the potential of Android Widgets in point of care communication- but that is the topic for another blog post.

Multi-tasking was OK (iPhone 4.0 levels the playing field)- but it really was the capability to use widgets that really impressed me.

2. Applications

The applications for Android are not up to par with Apple. It’s not even close. The look, the feel, the quality- it’s day and night. I would imagine this is due to a couple reasons. First of all- Apple has a head start in the world of App development. There are more developers working on iPhone app’s; Apple claims more than 200,000.  And while a majority are not worth downloading, there are a few gems that really raise the bar for other applications.   Second, developing software using Apple’s iPhone Software Developer Kit provides more guidance and better tools for development, compared to Android’s Java based SDK. You give developers better tools and they will build you better app’s.

There’s an App for that- and chances are- it runs much better on the iPhone.

3. Performance and Battery Life

I get pretty good battery and performance out of my iPhone (especially considering how much I use it in a single day), but the performance of the Nexus One Android running 2.1 was much better than my iPhone 3G running iPhone OS 3.X. I will admit that I was using an older generation of the iPhone, but the performance on the Android device was noticeably better. I usually get a good 12 hours out of my iPhone, but the Android was easily pushing 18-20 hours.

Performance and battery were an easy win for the Android.

4. It’s the little things

Moving from an iPhone to an Android, you quickly begin to appreciate Apple’s meticulous attention to detail and creating a compelling user experience. A simple example is the location of the home button on the Android phone- it is located directly under the touch screen and tends to be very sensitive to touch. When the virtual keyboard loads up, it is located right under the Space Bar (one of the most used buttons when constantly typing). The end result is the potential miss type that exits the application and sends you to the home screen- not a pleasant experience when deep in the thought responding to 100’s of emails (which most of us use a smartphone for). The Android is littered with these minor flaws, and while they may seem minuscule, the experience quickly becomes degraded due to these flaws.

Overall – I can’t say that either phone is a clear winner over the other. The quality of the app’s and the attention to detail make the iPhone a great platform for a mobile device, but the concept of widgets and the philosophy of the Android being more of a portal to the web make the Android a really attractive alternative. So here is the big question…

What phone will I be using next month?

Well, to be perfectly honest - a lot of that will be dependent on what we find out from our friend Steve Jobs at Apple’s World Wide Developer Conference…

My name is Caston Thomas and I am the North Central Sales Representative for Voalté; a job that I love. When was the last time you had one of those situations where the reaction you got from someone was mind-blowingly unexpected?  I was telling a friend of mine about what we were doing at Voalté  and about the problems we help solve with caregivers.  She started to sob.

Now, I’ve got a great circle of friends.  They’re a supportive and wonderful group of people.  So, when I’m on a roll, going so far as waving my arms with excitement as I talk about what I do, I don’t expect the reaction to be crying with obvious sadness.  These were not tears of joy.  But when you hear the rest of the story, you’ll understand, just as I did. 

You see, my friend is a respiratory therapist.  She works hard at her jobs.  She floats between two hospitals and works long hours but enjoys what she does so much that I don’t think I’ve heard her complain about her work even once.  She entered into the profession to touch peoples’ lives - to really make a difference.  It doesn’t take long when you meet her to know that she loves what she does.

That evening, “Ann” told me a story - the reason my excitement brought back a painful memory – the event that almost caused her to leave the profession and the one that caused her to struggle with “burn out” for a couple of years.  As best I can retell her story, “Ann” was in the ER one evening.  She had been called down to help an elderly gentleman that had been brought in by ambulance.  He was having serious problems breathing – complications from pneumonia, if I recall correctly.  It was late at night and his family had yet to arrive.  Well, the man entered a state of serious respiratory distress.  He was drowning on the bed and there was little she could do.

“Ann” told me there was one chance in a hundred that he would be alive if she left the room to find the people and equipment she needed to save the man’s life.  In one short moment that seems like a lifetime, “Ann” had to make a single, gut-wrenching decision.  “Do I leave this man alone, almost certain that he will be dead before I’m able to find what I need to save his life?  Or do I stay with him so he doesn’t die alone?”

“Ann” told me, just as I’m sure she’s told a hundred other people, about looking into this gentleman’s eyes as he died – the panic, the confusion, the desperation.  I don’t know this, but as she told me her story, I was imaging that the pain I saw in her eyes was a replay of what she saw that evening.

“Ann” said she still wakes up from time to time, this man’s eyes haunting her in a nightmare.  I must confess that I can’t even pretend to understand what she’s gone through.  That event happened many years ago and it still affects her tremendously.  I have never brought it up again.

As much as I don’t want to believe this, I’m afraid that just about every nurse that has been in the profession for a while has a similar story.  I admire every single person that has dedicated himself or herself to the nursing profession. 

Working at Voalte gives me the opportunity to impact people’s lives.  I know that I am improving the lives of the caregivers I serve.  Indirectly, I know that I’m helping to create an environment where every patient and every family member has a better experience, even if it is under very difficult circumstances.  Thank you.  It is a privilege to serve you.

“An upgrade in our XYZ system broke the integration to ABC.”

“We will need to do assignments in two places if we want that functionality.”

“Our nurses carry two pagers and a phone because the systems don’t integrate easily.”

Do any of the above sound familiar?  If so, you probably are one of the many hospitals going through the alarm management middleware selection process.

As Vice President of Innovation at Voalté, I spend a great deal of time traveling around the country talking to CIO’s, CTO’s, and Chief Nursing Officers about communication in hospitals and their alarm management strategy.  One point of constant frustration seems to keep appearing in the realm of middleware alarm notification.  This frustration was building when I first started Voalté about a year and a half ago, but recently it seems that it is starting to reach a tipping point.

The world of alarm management middleware in hospitals seemed to really take off due to Emergin and the concept of an Enterprise Service Bus leveraging a Service Oriented Architecture for alerts and notifications.  The concept of a single source to receive alarms from a number of systems, prioritize them, and dispatch them to “the right person, at the right place, at the right time” really hit home with CIO’s and others looking to integrate disparate systems into a unified alarming system

Since the acquisition of Emergin by Philips, it seems that the market has opened up to a number of companies. The three frontrunners in the market currently appear to be:

Emergin (A Philips Company)
Globestar (ConnexAll)
Comm-tech (An Amcom company)

New players, such as Intelligent Insites and Imatis, have entered the arena .  In addition to the true “middleware” companies, a great deal of the previously integrated systems are building their own point-to-point connectors with other vendors.  There are VoIP phone vendors that are creating proprietary direct connections to input systems, input systems companies building direct connections to phone vendors, and everything in between.  The end result is a group of disparate systems and integrations with no global strategy for alarms and notification.  With no open standards that have been widely adopted by input, middleware, and output companies, the confusion (and point-to-point integrations) seems to be growing.

As a service that needs to leverage these systems (its the AL in Voalté!) I am hoping things work themselves out in the next few years.  The market has been created and seems to be maturing now, so it will be interesting to see where the incumbents move things and where the new players will try to drive innovation.  Whether good or bad, it will at least be interesting to see where this world of alarm management middleware plays out in the next few years.

Last week I attended the second annual Erlang Factory 2010 conference in San Francisco.  Erlang, is a programming language and runtime environment (which means it has it's own virtual machine, unlike most languages).  For example you would develop your application using the Erlang programming language and then run it in an Erlang virtual machine on top of your operating system.  This added level of abstraction allows your Erlang application to run on any system that can support the Erlang virtual machine.  During that conference I delivered a 10-minute presentation on Erlang in Healthcare, how the Voalté server is powered by this new technology and what it can offer other developers in the healthcare community.

Who is using Erlang in Healthcare? As far as I know, Voalté is the only company using Erlang in production software within the healthcare market.  Please comment if you know of any other companies.  We would love the opportunity to share best practices and discuss how to better evangelize Erlang in the healthcare space.

Why are we using Erlang? Ericsson, the European telecommunication supplier, developed Erlang in their research labs during the mid-1980's for the following reasons:

Concurrency - Erlang's main strength lies within its support for multi-core CPU's.  Erlang is designed around the idea of extremely lightweight "processes" that communicate via asynchronous message passing,,  thus avoiding the complexity and performance impact of threads and memory locks.

Distribution - Erlang was designed to be run in a distributed environment with each Erlang virtual machine referred to as a node.  A network of these nodes on different machines can communicate as if they were all on the same computer.  This built-in distribution makes it very easy to create a cluster of computers running your application.

Fault-tolerance - Erlang will continue to operate if a node goes down or becomes unreachable.  Erlang processes can be linked to each other so if one fails the other process is immediately notified and could restart the crashed process.  Therefore crashes in an Erlang application are not the end of the world because they can restart immediately in a manner that is transparent to the end user.

Robustness – Erlang’s error detection can be used to fail-over to other nodes and Erlang's use of pattern matching allows for a "catch all."  This makes designing and prototyping new features easier because you don't have to specify, in advance what types of objects you can receive.  

Soft real-time – Erlang’s response times are in the order of milliseconds, which is excellent for failover support. 

Hot-code swapping – Erlang code can be changed without stopping a system, something no other runtime system has built-in.  This is one of the coolest features, that can permit users to update code without stopping their application and thus enable continuation of an application.

Healthcare, like telecommunications has the same general system requirements, which are distributed high-availability systems.  Point of Care workers need to receive and respond to realtime data from nurse call, patient monitoring and smart medical devices.  Erlang was designed and created from the ground up to make creating these types of distributed high-availability systems practical.  Voalté embraced Erlang's sophisticated functionality, which allowed us to produce a product that was ready to pilot in an impressive time frame of only six months.  In addition, the hot-code swapping aspect has allowed us to update our server while causing minimal system interruption to the end users.

It's an exciting time to be apart of the Erlang community.  Bjarne Däcker, one of the fathers of Erlang, presented the growth curve for Erlang and it’s starting to look like a hockey stick curve (hopefully just like Voalté sales!).  Erlang is being adopted by many leading companies such as Facebook for their chat system, Yahoo, E*trade, and Chrysler, just to name a few.  At the Erlang Factory conference I had the opportunity to meet many people using Erlang in their applications including the founders of the Erlang language.  It was great to get their feedback on Voalté and to hear their stories about creating this great platform that is at the heart of the Voalté Server.

When you have spent as much time in the software industry as I have, you begin to think you’ve seen it all before.  I feel like I am having the same conversations I had in 1983, or as is it simply “deja vu all over again”?

Start with the assumption, that no application can do everything and then you can begin the discussion on where to cut the joints.  Many times it is more important to determine what you are not going to include in your application.  Years ago, when my team was working on PowerPoint, we made the decision not to include charting… you know, line charts, bar charts, pie charts, etc.   What were we thinking?  Businesses needed these charts and how could we possibly do a presentation product that did not include them?  At the time, we knew that other companies that specialized in spreadsheets or business graphics were much better equipped to provide this type of content.

Today, hospital IT is overwhelmed by the rush to install or upgrade EMR (Electronic Medical Records) systems with the Feds committing $19 billion to the effort.  Large EMR providers are licking their chops to get a larger slice of the pie than their competitors.  Most of the providers are trying to create the fully integrated hospital, obviously with their products, like a giant octopus, sitting in the middle with its tentacles spread throughout the hospital.

This strategy assumes that the EMR vendor is able to deliver the best solution in each of the 10 or 20 areas in the hospital…  best of breed everywhere?  I think not.  What the non-healthcare Enterprise market has learned over the last 30 years is that best of breed suppliers need to be easily integrated into an Enterprise solution.  Data needs to be seamlessly interchanged, inter-app communication is clearly defined.  User experiences should reflect the user, and not some systems engineer’s idea of how much information can be shoe-horned onto a single screen.

Less is more.  Keep it simple.  I vividly remember one of the first conversations I had with a nurse.  I had asked her what could we do to create a great solution.  Her answer was simple, “Don’t give me one more thing to do”.

I would like to thank everyone that visited us at HIMSS 2010 in Atlanta this year.  The Voalté team was overwhelmed by your interest and feedback in Voalté One  for the iPhone, and now BlackBerry.  If you were unable to get into our booth, we are truly sorry and I want to make sure you get the personal attention you deserve. We look forward to working with all of you in the coming months.  

For those of you that shared your commitments we’re grateful for your confidence and your business.  And we stand ready to provide a compelling customer experience.

And for those of you,  whom we were unable to provide a personal briefing and demonstration, due to the crowds, please let me know and I will personally arrange a meeting, call or online presentation.

My warmest regards,

Rob Campbell

CEO