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Amid the upheavals of the COVID-19 pandemic in 2020, two healthcare firms turned to IT automation tools to weather the crisis.
As with many companies, the pandemic prompted Healthfirst, a not-for-profit insurance provider in New York, and Accuhealth, a telehealth startup in McAllen, Texas, to accommodate a shift to remote work. For these companies, however, that work was different from the average business -- not office employees signing on to a VPN to work from home, but rather patients seeking medical information and physicians treating patients without risking in-person visits.
"The mobile app was the first thing we've developed that went through a DevOps cycle," said Anthony Mongiovi, director of release management at Healthfirst, which has 1.5 million health plan members in the New York City area. "It was in the works, but the pandemic expedited it -- we released in July and it was originally not supposed to be released until the fall."
The mobile app replaced many of the services Healthfirst previously offered in storefront locations.
"We have community-based offices where somebody can walk in off the street, but when the pandemic hit, that all shut down," Mongiovi said.
IT automation adds release management sanity
DevOps at Healthfirst, founded in 1993, is still in progress for most of the insurer's 150 applications. Developers at the company use Agile workflows to write software, but most of the company's apps are monolithic, and deployed manually on a monthly cycle.
However, a release management automation tool from Plutora, which Healthfirst began using in late October 2019, helped the company deliver the initial release of its mobile app more quickly. Mongiovi uses it to supervise automated releases for that app on a three-week cycle while ensuring those updates adhere to the company's governance requirements.
"Before Plutora we had disparate tools, and it was a mess," Mongiovi said. "Before Plutora, I had to guess what was in a release, and a week before the release, [the developer] would think, 'Oh, no, I have to go create a change record in ServiceNow.'... That would be my first indication which applications were being touched."
With Plutora, the mobile app is updated through a DevOps pipeline that includes the CollabNet VersionOne Agile collaboration tool, Jenkins continuous integration software, HP Application Lifecycle Management and ServiceNow's change management system, along with ServiceNow's Ctask, which orchestrates app deployments.
Plutora compares application builds to developers' stories from the Agile planning process and ensures that features match between the two. The tool also updates change management data in ServiceNow, and will soon automate change approvals as its use expands to include pipeline orchestration.
Anthony MongioviDirector of release management, Healthfirst
Plutora, known for value stream management, as well as release management tools, is often brought in to orchestrate existing DevOps workflows, but at Healthfirst, its initial purpose was to organize and automate release management, whether that was done through a DevOps pipeline or not.
"Everybody's using VersionOne, but they're not all using it in the same way," Mongiovi said. "Plutora gives me a single view into, 'what do we have?' I can see out to June and July, and for a few things I can see past that ... which applications are making the most changes, and as things progress, I can tell which are going to be at risk."
This visibility proved crucial to keeping the business running smoothly as the ongoing pandemic coincided with the company's regular open enrollment period in October. One team planned hundreds of changes to an enrollment app for a release scheduled in September, which had the potential to disrupt that application at a crucial time of year.
"I reached out to the IT lead for that application and said, 'What are you guys doing? This is a major risk.'" Mongiovi said. "I was able to ask that question months in advance, and they moved the changes to a release in November."
IT automation stems tide of remote patient data
Accuhealth is at the opposite end of the DevOps curve from Healthfirst, as a startup founded in 2018 to provide technical services to healthcare clients. The company manages a SaaS platform doctors use to make treatment decisions based on data collected from remote patient monitoring devices such as blood pressure monitors, glucometers, pulse oximeters and weight scales. That platform, hosted in the AWS cloud and built on Splunk's log analytics system, is managed by DevOps engineers and integrated with artificial intelligence systems for data analysis.
Still, while remote patient monitoring was growing in popularity before the pandemic, the COVID-19 crisis caused a traffic spike on the company's platform that needed further IT automation to handle.
"We went through a massive surge in demand because of COVID," said Stephen Samson, CEO at Accuhealth. "We were scaling our Splunk instances and having performance issues."
Accuhealth, which has about 10,000 patient customers, collects no more than 5 GB of data daily, but had to accommodate a manifold increase in the number of searches on the company's Splunk log analytics system when COVID-19 struck.
"We were signing up five clinics a day," Samson said. "And then everyone was pressing the 'search' button ... we kept adding [instances], but that wasn't the answer -- there's a point where there's diminishing returns. We had to come up with a better architecture."
In March 2020, Accuhealth's Splunk developers suggested adding the free version of Cribl LogStream, an IT automation tool that enriches logs with metadata and parses them before they're loaded into the Splunk system, to make searches more efficient. Cribl support helped Accuhealth engineers set up and tune the product before they paid a license fee, which impressed Samson. The company now pays about $1,500 a year for a LogStream license.
Stephen SamsonCEO, Accuhealth
"Cribl helped us reduce the load and spend on Amazon EC2 by 30%," Samson said. "Before, we anticipated we'd be able to scale to accommodate about 100,000 patients -- now we estimate we'll be able to scale up to 100 million."
Remote patient monitoring is still a developing industry -- Samson estimated just 4% of that market has been tapped so far. Even when COVID-19 subsides, he expects remote patient monitoring to continue to grow.
"The pandemic was a telehealth catalyst, but eventually that will go down -- doctors still need to see patients in person," he said. "Remote patient monitoring can help people maintain a better connection with their doctor for when they do go in."