NextGen21: Genomic Health Networking for Patients and Core Organizations. Artie Nolasco (MHI563)

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NextGen21: Genomic Health Networking for Patients and Core Organizations. Artie Nolasco (MHI563) by Mind Map: NextGen21: Genomic Health Networking for Patients and Core Organizations. Artie Nolasco (MHI563)

1. Outcomes

1.1. Team Goals

1.1.1. Qualitative

1.1.1.1. Politeness on every interaction. This includes saying "please" and "thank you" when requesting information from a patient, hospital or third-party organization.

1.1.1.2. Keeping a positive tone. Avoid the usage of negative connotations or phrases.

1.1.1.3. Setting proper expectations at the beginning of each interaction. False expectations might become a ticking bomb down the line.

1.1.1.4. Tone and inflection. Expressing passion towards a particular matter on either a call, chat, interaction, or app flow. Even when interacting co-workers, this proves created a harmonious atmosphere.

1.1.1.5. Building rapport with prospective investors and stakeholders on the line to increase satisfaction and trust throughout business relations

1.1.2. Quantitative

1.1.2.1. CSAT (customer satisfaction surveys) scores must be above 92% in a monthly basis.

1.1.2.2. Adherence is measured on how closely the genomic panel application follows compliance and reliability. Overall, compliance must be above 77%.

1.1.2.3. API (Average Patient Interaction) measures the average time patient or healthcare provider spends in the program. This metric indicates whether the application is using time productively to assist the patient with their medical needs. Too small of an API might indicate a correlation with low CSAT scores. Likewise, high API might correlate to low application monitoring, or information relay (variety of external factors may play a role in this) and this may lead to further coaching from a manager down the line.

1.1.2.4. Issue resolution measures how efficient the application is at fixing the patient's inquiry When a patron/patient gets a survey, they are asked whether the problem they called for was resolved on the first call. This stat needs to be above 82%.

1.1.3. Baseline Data

1.1.3.1. In 2015-2016 only X% of the IT programers conducted research activities related to patient doctor and usage on the genomic panel testing. There were only X number of usage related activities that triggered patient feedback. This data will be used to foster better ways offering feedback within the genomic application. Surveys will be emailed randomly at the end of each interaction, whether it's a simple consultation, a chat/call for IT support within the app from hospitals, doctors or patients.

1.2. Leader Expectations

1.2.1. Keeping track of agent progress.

1.2.2. Keeping an open door policy to ensure trust.

1.2.3. Being an advocate for the team and work with hand in hand with other managers.

1.2.4. Accept vulnerability and feedback from agents.

1.2.5. Differentiating those in the team who add value and those who devalue our goals in conjunction to our Promoter Outomes.

1.3. Accepting Internal Feedback

1.3.1. Being transparent and accepting feedback from different channels.

1.3.2. Accepting feedback from peer managers.

1.3.3. Accepting feedback from my subordinates.

1.3.4. Accepting feedback from my peers and subordinates to ensure progress towards success. Welcoming transparency.

1.4. Tools for Measuring Success (CSAT Survey Example)

1.4.1. CSAT Survey Example

1.4.1.1. CSAT Expectations and Practices

1.4.1.1.1. Our primal focus would be to increase Promoters, while decreasing Detractors.

1.4.1.1.2. Building an engaging, fun, and positive "Wow" experience for all parties involved.

1.4.1.1.3. Adapting to different learning styles from our patients, business partners, while marketing innovative, life-changing products.

1.4.1.1.4. Making our products and support available worldwide and maintaining a stable cohesiveness of customer care. We must stand out as the most prevailing technological company worldwide.

1.4.1.1.5. Gaining agreement on every issue and ensuring a proper resolution path. More choices for every doctor/patient interaction.

1.4.2. Weekly Meeting Agenda Items

1.4.2.1. Is there a Here to Help attitude with every interaction? If not what training needs to be implemented.

1.4.2.2. Is the application productive enough to save time and money? Which other ways does the application help in preventive services data.

1.4.2.3. What are some of the best practices shared by team members involved in genetic consultations?

1.4.2.4. What have we gathered from the CSAT surveys? How can this data be migrated into a graph friendly environment?

1.4.3. Mock Scenarios/Simulations

1.4.3.1. Produce weekly simuations

1.4.3.2. In weekly meetings go over mock scenarios

1.4.3.3. Return to Learning Module completion. Each team member needs to review procedural content every 60 days for up to date practices.

1.4.3.4. Mock scenario feedback can be given during weekly meetings

1.5. Timeline

1.5.1. Phase I

1.5.1.1. IT Security and Prototype Development

1.5.1.1.1. Future Identity Management advances should provide for end-to-end full life-cycle capabilities, including change management, that will not only provide a single point of user authentication/authorization but a single site for user control and access to their related PII (personally identifiable information). Apple In partnerships will help with this. (May-July 2015)

1.5.1.1.2. Future Identity Management advances should provide for end-to-end full life-cycle capabilities, including change management, that will not only provide a single point of user authentication/authorization but a single site for user control and access to their related PII (personally identifiable information). Apple In partnerships will help with this. (May-July 2015)

1.5.1.1.3. An initial Phase I critical component would be to meet HIPAA compliance is the process of correctly identifying and authenticating users along with a comprehensive authorized privilege and role-based access control. (May 2015-Continuously)

1.5.1.1.4. Understanding the value proposition for cloud. (July-September 2015)

1.5.1.1.5. • Exploring cloud workloads and deployment models. (September 2015-January 2016)

1.5.1.1.6. Developing a cloud solution based on the value proposition, workload and deployment model. (January-May 2016)

1.5.1.1.7. An initial Phase I critical component would be to meet HIPAA compliance is the process of correctly identifying and authenticating users along with a comprehensive authorized privilege and role-based access control. (May 2015-Continuously)

1.5.1.1.8. Understanding the value proposition for cloud. (July-September 2015)

1.5.1.1.9. • Exploring cloud workloads and deployment models. (September 2015-January 2016)

1.5.2. Phase I

1.5.2.1. IT Security and Prototype Development

1.5.2.1.1. Future Identity Management advances should provide for end-to-end full life-cycle capabilities, including change management, that will not only provide a single point of user authentication/authorization but a single site for user control and access to their related PII (personally identifiable information). Apple In partnerships will help with this. (May-July 2015)

1.5.2.1.2. An initial Phase I critical component would be to meet HIPAA compliance is the process of correctly identifying and authenticating users along with a comprehensive authorized privilege and role-based access control. (May 2015-Continuously)

1.5.2.1.3. Understanding the value proposition for cloud. (July-September 2015)

1.5.2.1.4. • Exploring cloud workloads and deployment models. (September 2015-January 2016)

1.5.2.1.5. Developing a cloud solution based on the value proposition, workload and deployment model. (January-May 2016)

1.5.3. Phase II

1.5.3.1. Healthcare Partner Strategy

1.5.3.1.1. Systems must be adaptable to various departmental needs and organizational sizes. (July 2016)

1.5.3.1.2. Architectures must encourage a more open sharing of information and data sources. (August 2016)

1.5.3.1.3. Technology refreshes cannot overburden the already brittle budgetary environments. (September 2016)

1.5.3.1.4. Scalability is a must as more patients enter the system and more data becomes digitized. (October 2016)

1.5.3.1.5. Portability is needed as doctors and patients would benefit from the ability to remotely access systems and data. (November 2016)

1.5.3.1.6. Security and data protection are paramount. (December-January 2016-2017)

1.5.4. Phase III

1.5.4.1. Uptime and other appropriate service levels should be reviewed and included as part of the initial service level agreement and Phase III. (Continuous Review)

1.5.4.1.1. For example, many rural healthcare facilities still use modems to connect to the Internet. Upgrades should be available to these community infrastructures.

1.5.4.1.2. The healthcare industry’s dependence on the availability and reliability of information can be a matter of life and death. Performance is another factor that is slowing the pace at which cloud computing is adopted by healthcare organizations. Globally, hospitals, physicians and patients have different types of Internet connections that can impact performance of a healthcare system.

1.5.5. Phase II

1.5.5.1. Healthcare Partner Strategy

1.5.5.1.1. Systems must be adaptable to various departmental needs and organizational sizes. (July 2016)

1.5.5.1.2. Systems must be adaptable to various departmental needs and organizational sizes. (July 2016)

1.5.5.1.3. Architectures must encourage a more open sharing of information and data sources. (August 2016)

1.5.5.1.4. Technology refreshes cannot overburden the already brittle budgetary environments. (September 2016)

1.5.5.1.5. Scalability is a must as more patients enter the system and more data becomes digitized. (October 2016)

1.5.5.1.6. Portability is needed as doctors and patients would benefit from the ability to remotely access systems and data. (November 2016)

1.5.5.1.7. Security and data protection are paramount. (December-January 2016-2017)

1.5.5.1.8. Architectures must encourage a more open sharing of information and data sources. (August 2016)

1.5.5.1.9. Technology refreshes cannot overburden the already brittle budgetary environments. (September 2016)

1.5.5.1.10. Scalability is a must as more patients enter the system and more data becomes digitized. (October 2016)

1.5.5.1.11. Portability is needed as doctors and patients would benefit from the ability to remotely access systems and data. (November 2016)

1.5.5.1.12. Security and data protection are paramount. (December-January 2016-2017)

1.5.6. Phase III

1.5.6.1. Uptime and other appropriate service levels should be reviewed and included as part of the initial service level agreement and Phase III. (Continuous Review)

1.5.6.1.1. For example, many rural healthcare facilities still use modems to connect to the Internet. Upgrades should be available to these community infrastructures.

1.5.6.1.2. For example, many rural healthcare facilities still use modems to connect to the Internet. Upgrades should be available to these community infrastructures.

1.5.6.1.3. The healthcare industry’s dependence on the availability and reliability of information can be a matter of life and death. Performance is another factor that is slowing the pace at which cloud computing is adopted by healthcare organizations. Globally, hospitals, physicians and patients have different types of Internet connections that can impact performance of a healthcare system.

1.5.6.1.4. The healthcare industry’s dependence on the availability and reliability of information can be a matter of life and death. Performance is another factor that is slowing the pace at which cloud computing is adopted by healthcare organizations. Globally, hospitals, physicians and patients have different types of Internet connections that can impact performance of a healthcare system.

2. Evidence

2.1. Evidence Lead Project Focus

2.1.1. Integration of healthcare

2.1.1.1. Cloud social/genomic health networking allows for companies to make sound investments.

2.1.1.2. All parties such as patients, doctors, nurses, administrators, and even third-party payers can be involved.

2.1.1.3. This is a global app not only restricted to the US.

2.1.1.4. Unnecessary filing and paperwork are a activities of the past.

2.1.1.4.1. Time compression in the works.

2.1.1.5. An evolving application that grows with addition and input of users.

2.1.2. Health networking (Trakadis, Y.J. 2012)

2.1.2.1. Healthcare needs a gathering post for the exchange and filtering ideas.

2.1.2.2. Doctor/patient support, teamwork within other sectors in health organizations.

2.1.2.3. Creation of a communication tool that allows organizations to work in the backend to improve the patient experience.

2.1.3. Prospects of Healthcare

2.1.3.1. Patients are intimidated by the amount of paperwork or cost of healthcare access. Genomic databases store information much more efficiently

2.1.3.2. Establish Issue Resolution Procedure. Avoiding costs of repeat care.

2.1.3.3. Review Project Control Procedures

2.1.4. Long-term healthcare education (Lupton, D. 2006).)

2.1.4.1. Free access to patient educational programs.

2.1.4.2. Access to a variety of databases when it comes preventive care and best practices.

2.1.4.3. Doctors, and nurses also encouraged to embrace EBP (evidence-based practice). Databases allows for easier patient-specific/project research.

2.1.4.4. Hospital libraries are available online and in the cloud. Patients are allowed to download as much information as they need regarding their health.

2.1.4.5. Wikis will also be available and encouraged.

2.1.5. Disease prevention and a proactive approach to personalized healthcare (Lupton, D. 2006).

2.1.5.1. Screening can be done real-time

2.1.5.2. No more doctor visits or trips to the clinic (except for certain interventions).

2.1.5.3. 24-hour patient monitoring by healthcare professionals (depending on the disease or ailment).

2.1.5.4. At home care telemedicine between doctors and patients.

2.1.6. Database gatherings (Hayes, D.F., Markus, H.S., Leslie, R.D., & Topol, E.J. 2014))

2.1.6.1. Inaccurate gathering of data when electronic data is bypassed.

2.1.6.2. High number of hospital malpractice.

2.1.6.3. Patient-driven health care is imperative. Patients only go to the hospital when it's too late or when they need to.

2.1.6.4. Preventive care is the key.

2.1.6.5. Map the Project Organization Chart

2.1.6.6. Review Project Organization

2.1.7. Cost Containment (Garber, S., Gates, S.M., Keeler, E.B., Vaiana, M.E., Mulcahy, A.W., Lau, C., & Kellerman, A.L. 2014)

2.1.7.1. Saves time and money to all parties involved.

2.1.7.2. Quick access to a variety of free services (database library, nurse chats, community forums, social networking blogging)

2.1.7.3. Patient privacy when it comes to the way they want care delivered.

2.1.7.4. Patient loyalty and better billing processes

3. References

4. Finance

4.1. Financial Impact

4.2. Financial Planning

4.3. Marketing & Pricing

4.3.1. Application Pricing Rationale

4.3.1.1. Competitive analysis

4.3.1.1.1. Comparison to other genomic cloud apps out there.

4.3.1.1.2. There's little to no market out there for genomic apps, therefore the pricing is higher due to demand.

4.3.1.2. Setting user expectations in comparison to other apps or the lack of existence of such apps in the current market.

4.3.1.3. Experimenting with customers via a prototype.

4.3.1.3.1. While I was volunteering for St. Luke's Hospital a random survey was given out to ask patients how much they would pay for an app like NextGen21. The example survey is attached.

4.3.1.4. Commissions and refunds

4.3.1.4.1. App Stores like the iOS App Store take 30% of commission usage for every app that is launched.

4.3.1.5. Functionality and User Review/Perspective

4.4. ROI

4.4.1. Investment Example

4.5. Financial Targets: Patient Scenario

4.6. Value Measures

4.6.1. Increased Productivity

4.6.1.1. Employee satisfaction through stock investments gained from shares and growth in the product.

4.6.1.2. Meeting and exceeding KPI (key point indicators) across support call centers, sales team, IT support portals, compliance reporting and company sectors.

4.6.1.3. Establish enterprise standards and regulations across the board to ensure fluidity, consistency and drive across all employees.

4.6.2. Increased Profitability

4.6.2.1. Stable investor relations. Global expansions through regional app stores. Partnership with mega-companies such as Apple to officially implement the app into select mobile device iOS updates.

4.6.2.2. High ROI (Return on Investment) values. ROI for this product would be 40%

4.6.2.3. Forecasting yearly budget plans and making comparisons between actual and projected plans through investment relations.

4.6.3. Increased Value for Consumer Audience

4.6.3.1. Magnitude of long-term benefits offered to customers. Easy to use work flows that are secure, government compliant and efficient providing care.

4.6.3.2. 24-hour customer support portals

4.6.3.3. Wide range of purchase options, payment plans, enterprise marketing.

4.6.3.4. Beta developer programs as well as the opportunity to contribute towards the virtual healthcare library in the cloud.

4.7. Financial/Marketing Goals

4.7.1. • Target customers and markets: Hospitals, nurses, doctors and patients. • Principle services delivered by the organization: Cloud services through healthcare and social networking.

4.7.2. • Specify the geographic area: Make the application available worldwide where mobile app-stores are allowed. • Identify the organizations philosophy: Make healthcare access easy to use, relevant, fun, quick and smart.

4.7.3. • Confirm the organization’s self-image: Follow constant patterns of technological evolution for the application’s growth and make services more reliable worldwide. • Express the organization’s desired public image: Be leading cloud health networking firm worldwide. (Nowicki, 2011, p. 267).

4.8. Impact Across Healthcare

4.8.1. Social Impact (Rossolatos, D. & Aitchison, K., 2014)

4.8.1.1. Social impact: 95% of patients in this research sample said they would prefer unrestricted access to their incidental findings regardless of how applicable it was to their own known clinical condition. Interestingly, surveyed clinicians were more cautious in their recommendations for return of data.

4.8.2. Possible Economic Impact

4.8.2.1. Creation of healthcare jobs and savings on unnecessary expenses (Tripp, S., Grueber, M. & Cummings, D., 2011)

4.8.2.1.1. Creation of more than 116k jobs in the US alone

4.8.2.1.2. Nearly $6 billion in personal income for workers

4.8.2.1.3. Providing a definitive, accurate diagnosis of a disease or disorder, thereby helping to avoid misdiagnoses and the associated stress on patients and healthcare spending on unnecessary or ineffective treatments.

4.8.2.1.4. Detecting a disease or disorder at an early stage, thereby saving healthcare costs and increasing labor force productivity.

4.8.2.2. Pharmacogenomics ((Tripp, S., Grueber, M. & Cummings, D., 2011)

4.8.2.2.1. The use of genetic and genomic testing to identify biomarkers that can warn against adverse reactions and drug ineffectiveness, and thus has the potential to significantly improve health care.

4.8.2.2.2. Overdosing and misdosing of medications cost more than $100 billion dollars annually, and can be considered a leading cause of death in America.

5. Technology/Communication

5.1. IT Governance Model

5.1.1. Allocate proper funding for the cloud program

5.1.1.1. Investors are queued in regarding the massive growth and implementation of the application.

5.1.2. Support and execute integrative initiatives

5.1.2.1. Work in hand with other IT developers to increase availability and integration

5.1.3. Minimum standards for outcome delivery

5.1.3.1. Set a variety of guidelines entailing the variations and limits within the services provided in the cloud app.

5.1.4. Sufficient evidence for the foundation of 21st century social healthcare cloud computing

5.1.4.1. Provide proper relevant data to backup our vision of social cloud computing in healthcare

5.1.5. Embrace innovation and relentless improvements on patient service levels

5.1.5.1. Being mindful of new emerging technologies. Establishing business contracts with other companies and partnering.

5.1.6. Proper function assurance

5.1.6.1. Leadership teams and investors gather to discuss proper expectations from the social networking cloud service.

5.1.6.1.1. Business leadership council

5.1.6.1.2. IT leadership council

5.1.6.1.3. IT architecture council

5.1.6.1.4. Business IT relationship managers

5.1.6.1.5. Internal investors

5.1.6.1.6. External investors

5.1.6.2. Proper Expectations and their Definition

5.1.6.2.1. Project Completion Ahead

5.1.7. The Four Are's of the Governance Model

5.1.7.1. Are we doing the right things as a team?

5.1.7.2. Are we doing them the right way?

5.1.7.3. Are we getting it done well?

5.1.7.4. Are we getting the desired benefits?

5.1.8. Collaborative Leadership

5.1.8.1. Expected Innovative Behavior

5.1.8.1.1. Accepting change

5.1.8.1.2. Accepting vulnerability

5.1.8.1.3. Being collaborative

5.1.8.1.4. Engaging communication and transparency

5.1.8.2. Gathering with Senior IT colleagues to create an environment that fosters creativity and thinking outside the box

5.1.8.3. Advancing the Innovation Program

5.1.8.3.1. Organizing meetings

5.1.8.3.2. Exchanging every idea out there with IT leaders within the organization

5.1.8.3.3. Accepting vulnerability

5.1.8.3.4. Accepting transparency within the organization

5.1.8.4. Encouraging mentoring groups

5.1.8.4.1. Seeking help from outside forces such as other IT neighbors or developers

5.1.8.4.2. Maintaining quality over quantity

5.1.8.4.3. Seeking the weakest spots or rough patches in the organization to make it grow

5.1.8.5. System Thinking Measures

5.1.8.5.1. Considering government and local systems of healthcare

5.1.8.5.2. Measuring the viability of the application within a local environment

5.1.8.5.3. Facilitating telemedicine across hospital clients and patient populations

5.2. IT Assets

5.2.1. Application Support

5.2.1.1. Photo/data uploading portals

5.2.1.2. Personalized Patient profiles and portals

5.2.1.3. Knowledge Database libraries

5.2.1.4. Facetime portals: Doctor/patient interactive menus.

5.2.1.5. Genetic and counseling advice given over chat

5.2.1.6. Corporate and patient level scheduling segments done through hospitals

5.2.1.7. Health Professional /Patient Engagement

5.2.1.7.1. Nurse David Chapley input

5.2.1.7.2. Partner and Pharmacist Justin Vines input

5.2.1.7.3. Nurse Travis Platero input

5.2.1.7.4. State licensure is specific and different for every state (Kocher, R. 2014).

5.2.2. Secure Data Management (Privacy Post, 2014)

5.2.2.1. Encryption and key management

5.2.2.2. HIPAA Management

5.2.2.3. Strong passwords

5.2.2.4. Strong Access control methods from IT professionals

5.2.2.5. Constant employee training and awareness on security policy and procedures

5.2.3. IT Staff

5.2.3.1. Patient security teams

5.2.3.2. Third-party payer liaisons

5.2.3.3. Cloud support services staff

5.2.3.4. Healthcare professional support IT services

5.2.3.5. IT Billing services

5.2.3.6. Integrity teams

5.2.4. Technology Architecture

5.2.4.1. Compatible mobile profiles: Android, Windows based devices, iOS devices

5.2.4.2. High end integration with popular social sites such as Facebook, Twitter, LinkedIN, Instagram, etc.

5.2.4.3. Types of social cloud servicing levels

5.2.4.3.1. Public patient facing cloud access

5.2.4.3.2. Corporate level cloud access

5.2.4.3.3. Private physician portals

6. Leadership Structure

6.1. Ethical Leadership Principles

6.1.1. Candor

6.1.1.1. Authenticity

6.1.1.2. Self-Awareness

6.1.1.3. Self-Mastery

6.1.1.4. Humility

6.1.2. Noble Purpose

6.1.2.1. Setting an initial purpose or focus on a project.

6.1.2.2. As a leader I will lead use ongoing testing procedures and prototypes to increase the productivity of the application

6.1.2.3. As a Noble Purpose leader I believe in the notion of "One size fits all." This application should first be launched here in the US and later expand. Legislation will have to create further flexibility for Doctor and nurse licensure.

6.1.3. Ceaseless Ambition

6.1.3.1. I plan on working harder on a goal and visualizing results from the Triple Aim perspective.

6.1.3.2. Taking on a challenge (short term and long term goals). Short term goals may consiste of rapidly launch the application this year and expect Beta results, while long term goals focus on the expansion of the organization as the app grows with popularity.

6.1.4. Passion

6.1.4.1. Having a heartfelt devotion to the work ethic

6.1.4.2. Drive of a leader

6.2. Leadership is when "persons with certain motives and purposes mobilize resources so as to arouse and satisfy the motives of followers."

6.2.1. Transactional Leadership

6.2.1.1. Extrinsic and basic motivation

6.2.1.2. Motivated by self-interest

6.2.1.3. Chooses to maximize personal gains over the greater good

6.2.1.4. Personal needs are more important than the group norm

6.2.1.5. Goals are short term

6.2.2. Transformational Leadership

6.2.2.1. Intrinsically and morally motivated

6.2.2.2. Considers followers needs as important

6.2.2.3. Will sacrifice self-interest to advance the common good

6.2.2.4. Views group norms as more important than personal needs

6.2.2.5. Aims at higher level goals

6.2.2.6. Creates purpose empowerment, power to accomplish, quality control, outrage and moral action

6.2.3. As the Senior IT leader, CIO, and CEO, I will practice Transformational leadership

6.2.3.1. Allows me to work hand in hand with my advising leaders

6.2.3.2. Maintain an open mind of future partnerships with investors such as Apple

6.2.3.3. Personal needs will be set aside and focus both on my IT group and also on clients such as hospitals and the uses (patient base)

6.3. Major Stakeholder Groups

6.3.1. External Stakeholders

6.3.1.1. Customers/Clients

6.3.1.1.1. Patients are the first in line to test and experience genomic cloud networking capabilities from our beta application through the sharing of their own genetic information. It is obvious that initial testing will be done internally at Cupertino Apple headquarters to test the safety, compliance and effectiveness of the application

6.3.1.1.2. Clients, such as hospitals and clinicians may tailor their own goals and methods of gathering data for diagnostic purposes.

6.3.1.2. Investors

6.3.1.2.1. Investors have the capability to interact with the CEO (myself) and discuss matters as financial ventures, or expanding the project. They may also provide insight as to the future of the project and possible stoppage if the initial outcomes are not being met.

6.3.1.3. Society

6.3.1.3.1. Here, the media and the public eye may either scrutinize or praise the product at hand. This group has a highly unpredictable influence on the matter since they're very opinionative and subjective. The marketing and strategic group can work together with the media as well as the press to filter any misconceptions or rumors spread by the public about our product. Hopefully, in the future, these cases can be handled through the procedural literature we compose within the company.

6.3.1.4. Government

6.3.1.4.1. The government can turn our switch on and off. This will be highly monitored to ensure our organization is compliant with policies and local/state health procedures. Periodic mock audits may help my group prepare for any future prying from the government to ensure everything is up to par with any regulation out there.

6.3.2. Internal Stakeholders

6.3.2.1. Employees

6.3.2.1.1. We are the body of the organization and help it grow by exercising innovative qualities. This group is comprised of a variety of teams focused on different tasks (marketing, IT, engineering, hospital consultants, accountants, researchers, strategists, leadership team).

6.3.2.2. Managers

6.3.2.2.1. The leadership team oversees operations in the development of every product.

6.3.2.3. HR

6.3.2.3.1. HR maintains the balance in employee equality, satisfaction and job security. Programs that put our employees on the frontline of success will be constructed, thereby allowing a "free-thinking" environment where no idea goes to waste.

6.3.2.4. CEO/Owners

6.3.2.4.1. This group is responsible for the initial root of developing and assembling the cloud genomic project. As being closely involved in this category, I would need to apply my VAT/DiSC styles more closely towards my colleagues and co-workers to establish a positive legacy. As the leader in this category, others striving to grow in the company would need to follow the same principles complexity leadership.

6.4. Leadership acceptance

6.5. Systemness across technology

6.5.1. Craftsmanship

6.5.1.1. Test driven development

6.5.1.1.1. The leader encourages those involved in the development to utilize the right amount of level testing, ensuring that the application is well designed, of high quality, minimizing defects and increasing courage to modify flaws that may affect app performance in the future.

6.5.1.2. Unit tests

6.5.1.2.1. The leader utilizes the right amount of unit testing to ensure the application's components are working as desired.

6.5.1.3. Integration tests

6.5.1.3.1. The leader ensures that the proper utilization of automated integration tests are assessed.

6.5.1.4. Refactoring

6.5.1.4.1. The leader ensures that the app's code is readable and understandable so it's easier to maintain and modify.

6.5.1.5. Continuous integration

6.5.1.5.1. The leader ensures that the app is working at its optimum. From feedback reports, project leaders will be able to see if patients using the app are using the latest version. This facilitates the success of integration for future builds.

6.5.1.6. Simple/emergent design

6.5.1.6.1. The leaders uses innovative thinking to get the simplest possible design for an acquired feature within the app.

6.5.2. Team Norm

6.5.2.1. Definition of done

6.5.2.1.1. Leaders establishes a well known and evolving definition of done that ensures quality, function and completeness which all work is held and is enforced by the team.

6.5.2.2. Peer reviews

6.5.2.2.1. The leader is empowered and utilizes lean peer review practices, including small reviews, walkthroughs and verifying defects are fixed, effectively to ensure the application is well designed, of high quality, minimizes defects, meets team standards, and satisfies the definition of done.

6.5.2.3. Pair programming

6.5.2.3.1. Leader ensures that pair programming is utilized. This consists of including 2 team members at one single terminal, while they collaborate with a project, rotating roles. This increases high quality, minimizes defects, meets team standards and satisfies the definition of done.

6.5.2.4. Collective ownership

6.5.2.4.1. Leader encourages the ownership and sharing of work, roles and responsibilities to ensure high productivity and sees individual problems as the team's problems.

6.5.2.5. Focus

6.5.2.5.1. The leader has a strong understanding of each iteration goal and their work consistently revolves around that goal.

6.5.2.6. Creative solutions

6.5.2.6.1. The leader encourages innovative thinking to foster creative solutions in the project and in every process at work.

6.6. User Experience: Ownership and Input

6.6.1. The current problem

6.6.1.1. Organizational needs

6.6.1.1.1. Hospitals need a more streamlined process of communication among staff members.

6.6.1.1.2. Hospitals may experience high error margin, loss of data, increased liabilities, and poor management when dealing with treatment of patients with chronic illness.

6.6.1.1.3. Unnecessary paperwork and bureaucracy in hospitals.

6.6.1.1.4. Too much autonomy among doctors and nurses. Less teamwork, teamwork, or accountability.

6.6.1.2. Patient experience

6.6.1.2.1. Patients are not taking enough ownership of their healthcare needs.

6.6.1.2.2. Those who live in rural areas, are elderly, disabled, and live on their own require a more seamless POC (point of care) access from the comfort of their own home.

6.6.1.2.3. Young population need more choices to seek care outside the typical norm of going to a clinic or hospital for non-emergency consultations.

6.6.1.3. Costs/expenses

6.6.1.3.1. Increased healthcare costs over the next 10 years require some alleviation.

6.6.1.3.2. With ACO's taking charge and increasing the burden on hospitals as well as physicians to be more accountable, rise in staffing is needed as well as more capital expenditures within health organizations.

6.6.1.3.3. Accounts receivable are not getting properly handled. Billing statements are not accurate enough or provide patients with enough options to make timely payments on given services.

6.6.2. The proposed solution

6.6.2.1. Complex service oriented architecture (SOA)

6.6.2.2. Development of personal care profiles for patients worldwide

6.6.2.3. Easy to use portals for hospital administrators, doctors and nurses

6.6.2.4. Chatting portals for patients

6.6.2.5. Journal Databases/EBP research portals, and consultation workflows for patients and professionals alike

6.6.2.6. Social networking links to educate communities of patients suffering from the same chronic illness. Establishment of support groups and solidarity.

6.6.2.7. Quick payment options with services such as ApplePay, Bill-me-Later, or regular CC (credit-card) transactions for non-emergency consultations. These options are geared towards the younger population (18-late 20's)

6.6.2.8. Boundless healthcare access and redefining the healthcare identity of the 21st century

6.7. Leadership Management Strategy

6.7.1. NextGen21 may call for unexpected shifts for change due to business needs in the healthcare arena (health care reform, policy change, patient demand, economic growth, company growth, investments).

6.7.1.1. Leadership

6.7.1.1.1. We monitor the progress of change in the company (development of the IT infrastructure)

6.7.1.1.2. Appoint a senior leader who can oversee changes in the management sector

6.7.1.2. Language and Vision

6.7.1.2.1. According to Glaser & Salzberg (2011) "The absence of this vision or failure to communicate the importance of the vision elevates the risk that staff will resist the change"

6.7.1.2.2. A common and existing work language will be established. A community-based environment will be encouraged across workers to increase collaboration

6.7.1.3. Connection and Trust

6.7.1.3.1. We will use forums, meetings, one-on-one conversations to keep the vision flowing across the organization

6.7.1.3.2. A core group of trustworthy leaders will be needed to market the vision of our product

6.7.1.4. Planning, implementing and iterating

6.7.1.4.1. Any upcoming changes in any department must be reported and planned ahead of time.

6.7.1.4.2. A planning leadership team will be established to oversee scheduling and the internal/external impact of change.

6.7.1.5. Incentives

6.7.1.5.1. All staff members will reap the benefits of launching the social networking health application (stocks, investment options, market shares, etc.)

6.7.1.5.2. Loyalty programs

6.7.1.5.3. Cutting edge technology access

6.7.1.5.4. Comprehensive career paths and job fairs for internal employees

7. Innovation Process

7.1. State of DNA Preventive Testing

7.1.1. Current technologies allow NGS (Next Generation Sequencing)

7.1.2. Current processes in NGS will yield a high number of variants. Proper software applications could make an impact to alleviate this method.

7.1.3. Migrating data unto a cloud social/networking platfrom and turning static data into dynamic information yields productive results.

7.1.4. Genomic management of data on the cloud requires overcoming obstacles such as government and local health regulation (i.e. HIPPA).

7.2. Building a Case: Need for Universal Cloud Networking in DNA testing

7.2.1. Reduces the viability of gene variant data misinterpretation for hereditary diagnostics.

7.2.2. Reduces the viability of gene variant data misinterpretation for hereditary diagnostics.

7.2.3. Smaller is better: Reducing or segmenting data for easier analysis by clinicians and patients.

7.2.4. Significant amount of added security for large storage banks of genomic information.

7.2.5. Opening of new job market and research opportunities to encourage further DNA research.

7.2.6. Sequencing for multiple hereditary disorders at once, in a small time frame, increases the diagnostic horizon for doctors allows them to have a better view of the patient's genomic profile.

7.2.7. Smaller is better: Reducing or segmenting data for easier analysis by clinicians and patients.

7.2.8. Significant amount of added security for large storage banks of genomic information.

7.2.9. Opening of new job market and research opportunities to encourage further DNA research.

7.2.10. Sequencing for multiple hereditary disorders at once, in a small time frame, increases the diagnostic horizon for doctors allows them to have a better view of the patient's genomic profile.

7.3. Rapid Prototyping

7.3.1. What was learned?

7.3.1.1. We learned that the application indeed made a significant difference in a nurse’s job aid/facilitator, or a patient’s partner in accessing healthcare data from the comfort of their own home.

7.3.2. How was it constructed?

7.3.2.1. Simple construction paper prototypes resembling the environment seen within the app was used. Patient and nursing portals were used as examples.

7.3.3. What user interaction was used/recorded?

7.3.3.1. I sought the participation of a current nurse and patient to test out the prototype and had them share opinions on the overall usage, value and relevance of the app. I recorded 2 scenarios in which the workflows were presented to the patient and nurse as they followed along finally completing the task or request needed. The nurse was able to access EMR/EMAR data, while the patient had a chat interaction with a doctor and was the first one to test out the ePrescription section as well as having a variety of payment options for copays or medications.

7.3.4. The application of rapid prototyping in the manufacturing industry must be observed by innovative leaders like myself.

7.3.4.1. They provide my group and partners in Cupertino with opportunities to develop the application from basic feedback such as the one seen in the YouTube video

7.3.4.2. As healthcare leaders we should all know that developing an application starts from the primordial materials such as those seen in a drawing board

7.3.4.3. Results from industry models help developers meet the requirements set by the initial standards for a genomic healthcare application that stores important DNA data for further analysis by physicians and genetic counselors.

7.3.5. Structures and Tools in Light of Market Change

7.4. Brainstorming/Ideation

7.4.1. Find patterns of approaching each service within the application itself.

7.4.2. Keeping a notebook with resources and evidence to propel the project.

7.4.3. Sketch various diagrams such as the one presented here. The only difference is the nomenclature for the project, which is NextGen21. What's so useful about this diagram, is that it shows the relationships between each user and portal.

7.5. Course Correction

7.5.1. Technology demands

7.5.1.1. Healthcare Changes

7.5.1.1.1. Bedtime stay: Decreasing over 25% on the next decade.

7.5.1.1.2. Healthcare structure will be decentralized. Small units of service will be delivered.

7.5.1.1.3. Practices of different healthcare professions will be altered.

7.5.1.1.4. Users/patients will become more accountable for their own health.

7.5.1.1.5. Connection between providers and patients will be increasingly virtual.

7.6. Change Theory

7.6.1. Change is the only constant .

7.6.1.1. Challenge is necessary for the advancement of any system including mine.

7.6.2. Revolution is hyper evolution

7.6.3. Change is a critical demand for the genomic networking system

7.6.4. Leaders within my company will actively support positive deviance

7.7. Rapid and Accurate Data

7.7.1. Operations/Quality IT team will constantly monitor security and privacy issues within the software launch.

7.7.2. Operations/Quality IT team will constantly monitor security and privacy issues within the software launch.

7.7.3. Server farms will be established to distribute data instead of risking it in single location. Vast encrypted backup data banks will be available in case of imminent threats.

7.7.4. Patient data will be reviewed on an hourly basis for accuracy. Users will receive reminders in case there is conflicting information in a third-party payer, physician, or even administrative level.

7.7.5. Self-corrective algorithms will seen in the collection of patient data by nurses and doctors. These will scan for errors to ensure the most raw and accurate data is presented for better diagnosis and care.

7.7.6. Server farms will be established to distribute data instead of risking it in single location. Vast encrypted backup data banks will be available in case of imminent threats.

7.7.7. Patient data will be reviewed on an hourly basis for accuracy. Users will receive reminders in case there is conflicting information in a third-party payer, physician, or even administrative level.

7.7.8. Self-corrective algorithms will seen in the collection of patient data by nurses and doctors. These will scan for errors to ensure the most raw and accurate data is presented for better diagnosis and care.

8. Health Policy

8.1. Current Policies: What May Not Work (Gold, 2014)

8.1.1. The owner of the data must require the cloud service provider (aka the “business associate”) to contractually agree to maintain all PHI in adherence with HIPAA standards.

8.1.2. ACA reform will have little effect and impedance on the development of the project. On the contrary, it will benefit and the project itself will bring alluring evidence at a local state and governmental level to encourage employers and insurance companies to practice genomic panel testing as part of their preventive routine.

8.1.3. Effect on ACO's

8.1.3.1. ACA implemented ACOs by giving doctors, not only their entitled earnings from fee-based services, but also bonuses if they keep a patient population healthy. Lots of hospitals may not be prepared for such an Cloud Networking exchange and may opt out to leave an ACO program, “because they didn’t save enough money, although, they would participate in a second Medicare ACO model with less risk of losing money” (Gold 2014).

8.2. Policy Change (Bethesda, Md, 2005)

8.2.1. Healthcare organizations (HCOs) are expected to provide new and improved patient care capabilities while simultaneously limiting healthcare cost increases.

8.2.2. Despite the significant advantages for the utilization of cloud computing as part of Healthcare IT (HIT), security and privacy, reliability, integration and data portability are some of the significant challenges and barriers to implementation that are responsible for its slow adoption.

8.2.3. Passing federal legislation prohibiting genetic discrimination is essential to the future development and utility of genomic medicine. Even with such legislation, results from genome sequencing may still affect the ability of individuals to acquire life, long-term care, and disability insurance (Bethesda, Md., 2005)

8.3. New Policies

8.3.1. In the iTriage application example, as seen on the embedded class video titled “The Future of Healthcare Apps,” we see innovation at its finest by allowing patients to choose a provider through their personal preferences in an easy to use “symptom-to-provider pathway” workflow (The future 2013). This project reminds me of my prototype proposition for NextGen21, where the patient takes control of their own health, works closely with a doctor’s schedule and allow for both to cooperate in a productive and efficient clinical intervention. The government could take advantage of specific funding into the IT sector so the developments of such apps are more feasible in the health arena, provide additional incentives to doctors by making them more accountable for the workflows shown in care or through their already existing network as seen in ACO’s.

8.4. Policy Strategy: IT Security for All Parties

8.4.1. Future Identity Management advances should provide for end-to-end full life-cycle capabilities, including change management, that will not only provide a single point of user authentication/authorization but a single site for user control and access to their related PII (personally identifiable information).

8.4.2. Another critical component that is required to meet HIPAA compliance is the process of correctly identifying and authenticating users along with a comprehensive authorized privilege and role-based access control.

8.4.3. Uptime and other appropriate service levels should be reviewed and included as part of the service level agreement.

8.4.3.1. For example, many rural healthcare facilities still use modems to connect to the Internet.

8.4.3.1.1. The healthcare industry’s dependence on the availability and reliability of information can be a matter of life and death. Performance is another factor that is slowing the pace at which cloud computing is adopted by healthcare organizations. Globally, hospitals, physicians and patients have different types of Internet connections that can impact performance of a healthcare system.

8.4.4. Understanding the value proposition for cloud.

8.4.5. • Exploring cloud workloads and deployment models.

8.4.6. Developing a cloud solution based on the value proposition, workload and deployment model.

8.5. Healthcare Organizational Strategy

8.5.1. Systems must be adaptable to various departmental needs and organizational sizes

8.5.2. Architectures must encourage a more open sharing of information and data sources

8.5.3. Technology refreshes cannot overburden the already brittle budgetary environments

8.5.4. Scalability is a must as more patients enter the system and more data becomes digitized

8.5.5. Portability is needed as doctors and patients would benefit from the ability to remotely access systems and data

8.5.6. Security and data protection are paramount