Using SCRUM for Agile Development of Complex Apps

Here at Appdragon we believe in close Client engagement in our software development projects. A recent example is where one of our current client, social media firm Rottweiler Productions, are working closely with our SCRUM Product Owner and the SCRUM development team to evolve their latest offering, MatchDayMe (MDM).

MDM is complex in that it's a new concept and the requirements were difficult to pin down at the start of the project and they are evolving at a rapid rate as the project progresses.  Competitor activity, new library code, user expectations and desires all affect the way the client wants their iPhone and Android phone apps to look and feel and the functionality they need to deliver.

We could follow the traditional 'waterfall' model and spend endless meetings trying to pin the client down to a specific, well defined set of requirements.  It would cost him a fortune in expensive consultant and facilitator time and the minute the requirement specification was signed off, I guarantee it will require changing.

We can quickly get barriers removed by continuous sprint reviews, pulling in the Product Owner (and the client if the two aren't the same person) and scoping out individual features as we develop.

Most importantly, we can get feedback from the client on whether the function we've just "Sprinted" (if that's a correct SCRUM term) is actually what they wanted, or whether what they wanted is actually slightly different now they've seen how it works.

With SCRUM we evolve towards a quality end product which not only meets all of the Client's expectations, but goes beyond that. It meets the expectations the client didn't even have at the start of the project.

At Appdragon we're working towards having a team of fully trained and, where appropriate, accredited SCRUM professionals. We see that as being the best way to deliver the best possible solutions to our clients so that they can envisage their goals and objectives and please their own customers.

If you're interested in joining the Appdragon development team and learning how to develop in an agile way, contact us via our web site or email your CV to us.  We're currently recruiting in our Dhaka office, looking for especially talented developers with 2 years plus experience on iOS, Android and Python.  Don't worry - the SCRUM way of life is something easily learnt on the job and you'll love the way we work.

Telehealth in the Middle East

Appdragon's business development director, Saadi Hussain, has been flying in and out of the middle east region on a regular basis and has developed a good understanding of the Telehealth opportunity there.  

With a penchant for running marathons in the Sahara Desert, he understands the challenges and ideologies of the region and the benefits that Telehealth could bring if implemented well.

It's by far from a complete view as the cultural, political, geographical and socioeconomic mix is broad and varied, but its conclusion is fairly similar to that reached in other geographies - Telehealth is going to be major.

If you look at Bahrain for example, the population is relatively small at 1.3m people (smaller than Greater Manchester) and close to 89% live in urban areas.  Kuwait has a population of 3.2m and 98% of those live in urban areas.  Oman however, has a less urban society with just 73% living in urban areas.  The geography and social history of the region explains why there's a penchant for urban living, but what affect might this have on health provision and in particular Telehealth services.

Well one of the usually cited USPs of Telehealth is somewhat negated by such a large urbanite population - that Telehealth brings quality healthcare to the remote, generally poorer rural communities.  If most people live in the cities, where hospitals and clinics also tend to be located, then the inconvenience of travelling to a healthcare provider is less prevalent. 

Kuwait has some state of the art health facilities but faces challenges like anywhere else

However, city living also has its health related drawbacks. Both the ability to afford and the availability of rich, luxury foods makes diet a big concern and the high, growing occurrences of diabetes and obesity as well as the knock-on heart conditions, are testament to this.  Also, more of the population undertake "city" jobs, often based in offices   or factories, with less fresh air and exercise that their rural counterparts.

Let's consider obesity and males in particular.  In the UAE 30% are considered obese. In Saudi Arabia it's just shy of 29%. Over 31% in Qatar are considered obese and almost 38% in Kuwait. Bahrain and Oman have the lowest rates at 24% and 19% respectively.

So we've established that city living could cause more health problems, but how can Telehealth help in the urban setting?  Well, getting around in the city isn't as easy as you might think because of traffic and transport issues. Busy, hectic lifestyles leave little time to visit clinics for checkups and the high pace of life has a telling effect on blood pressure - especially for those individuals with poor diet and exercise regimes.

Telehealth allows the busy city slicker to keep tabs on their health and vital signs at a time that's convenient for them, without having to take time out of their day.  Spotting symptoms early can enable more effective intervention and potentially improved health outcomes as a consequence.

Telehealth also, importantly, provides healthcare providers, governments and employers with a wealth of important health trend data that can be used to spot and deal with trouble spots or high risk jobs or areas.

Also, with some many people in one small space, waiting rooms and hospital wards become overcrowded.  This is especially the case in countries like Kuwait where a large part of the healthcare provision is funded by the state, so budget is limited.  Telehealth can help manage this by reducing the need for in- and out-patient appointments for checkups and also to reduce the number of interventions requiring clinic or hospital attendance.

Setting up a patient to use SmartMed to monitor their own health in the home

Telehealth also allows those undergoing treatment to be discharged sooner, in the knowledge that they can monitor their recovery from the comfort of their own home using Telehealth services such as SmartMed's HomeCare solution.

This is just a snippet of the opportunities for improved healthcare that Telehealth can bring in the Middle East.  For further information and to find out more about SmartMed speak to our agents in the region Harrington Consultants.

Saadi Hussain
Business Development Director
SmartMed mHealthcare Solutions

A Day In The Life of...

 Simon Eyre Co Founder & Director - Appdragon and SmartMed.

Blogging in my garden office - Appdragon's Suffolk Satellite Office

As in any technology start up, every day working at Appdragon brings its challenges, its downs (thankfully just a few), its highs (gratefully many) and, of course, every day is unique.  

A typical day for me, as for the other directors, starts at around 6.30am with a quick check of the email in box on my iPhone and setting my Skype status to "online". A bit early I know, but when you work so closely with the middle east and Asia, you want to maximise the parallel working time. For me, night time is family time, so my Skype status switches to "Away" after 8pm.  Everyone in the team knows how to get hold of me if there's an emergency (or preferably they try our CTO Neil first instead!), so being online 24x7 isn't a necessity - just yet.

After breakfast with the kids, and if it's a day of working from home, I struggle through the rush hour (usually a few birds pecking on the grass) with just a short trek across the garden to set the heating to 'high' or, if it's a warm sunny day, to open the doors and windows.  If it's a day of meetings, then generally I'll be on the 7.30am train into Ipswich for a quick change onto the mainline into London followed by 80 minutes of quality working time on the train, and then a 15 minute stroll through the City, down Petticoat Lane and into Whitechapel where the current headquarters are based.

Back to working from home.  I feel lucky to have a job where I can work from home so often. In this, the age of the Internet, working in an office isn't necessary most of the time.  The Appdragon team is dispersed around the globe but fast broadband, collaboration tools and of course, audio and video conferencing make communications easy.  I've worked from home for over 10 years now, first of all as a Product Director in BT's mobile services organisation - where most of the team were also home workers, based in locations as far apart as Singapore and the west coast of the USA.  At least with Appdragon we have the luxury of a central London HQ where we can all meet up or arrange face to face meetings with clients and suppliers.

If I'm working from home, the first thing I'll do is plan my day, taking into account any overnight emergencies that have dropped into my inbox.  I like to give myself at least 3 major, pressing tasks to complete that day, with at least one of them being something important but not urgent.  Otherwise it's all too easy to focus on the emergencies and forget the less pressing tasks that are just as important.

I'll then fill up the list with smaller but just as important tasks, dropping the ones that I consider urgent but not important - why would you waste your time on something that isn't important and won't therefore move you closer to your ultimate goals and ambitions, just because someone else thinks it's important?

It's then back to the email. I like to have a clear inbox as much as possible, so the first 30-60 minutes of each day is filled with clearing the inbox, noting the important actions on my to do list for today or another day.

Once I have a map of what needs doing, I'm then less stressed as things unfold over the day.  It's easier to slot in ad hoc phone calls or mini-crisis if you know what's key and what can be delayed until later or tomorrow.  

Anyway, next is a series of catch ups with colleagues, especially if it's the start of a new week. Most days there'll be a Skype chat or call with the development team leaders on the various projects, and then a catchup with the CTO Neil.  At this point, with rarely a fail, a call will come in from the Business Development team, unable to keep the excitement of yet another client lead to themselves! Interruptions with the promise of new business is always welcome though.

Once we've all caught up with each other it's into the individual tasks on my to do list for the day.  Quite often this will mean designing a feature, data model or UI screens for the latest app we're working on, or briefing the designers if it's a major piece of work.  At the moment Neil and I are spending a lot of time on Quality documentation as we prepare for our ISO 9001 accreditation.  

I may spend time on Skype and email with the developers, working out some detail on GUI design, trying to fathom a client requirement or helping fix a bug that just won't go away despite all logic suggesting it shouldn't even be there.  My background in programming as a teenager comes in handy in these situations and Neil or the dev team are always on hand for the stuff that's too technical.

It's then catching up with the finance and billing teams.  Checking that all due payments have been made or received, signing off purchase orders, preparing invoices and checking and reconciling the accounts and forecasting cash flows.  Online banking means this is a much easier task than it used to be, as you have the current financial transactions at your finger tips.

After a quick bite to eat, on the patio if it's a nice day, or at my desk if it isn't, and a quick stroll clear my head, it's into the afternoon.  Being a morning person, my most productive time is before 2pm.  So I like to get all the creative stuff or things I need to be alert for or concentrate on out of the way early in the day.  For a few hours in the afternoon I let the work carry me along.  I try to schedule phone calls and conferences for the afternoon as the adrenaline of working closely with others keeps me going, or I might let some of the 'urgent' actions dropping into my inbox take some of my time. 

I tend to get a second wind at around 4pm so I try to get back to the to do list later on in the day as the creative juices begin to flow again.   I break off to greet the kids home from school when I can, perhaps helping with homework or catching up on their days over a cuppa - this is the real advantage of working from home.  At this point I often migrate back into the house and respond to emails or messages that have come in throughout the day.  Until about 9pm I'll be dipping in and out of my emails, perhaps working on a blog entry or posting on our social media sites, but evening time is generally family time, even if that means watching TV with the kids whilst keeping an eye on my laptop.  It's great that modern technology allows me to work this way, ably mixing a home life with work.  The line of distinction between the two is blurring all the time - which I think is a good thing - although my wife might claim the scales aren't exactly as balanced as they should be!

Family gets priority at the weekend. Mobile apps and broadband helps me stay in touch with work.

It's not all work. When I'm not working I like to relax with a game of tennis and I like to get involved with my son's football team whenever I can.  Football is my obsession, especially Sheffield United and I like to listen to radio commentary over the internet whenever they're playing, and try to get to the odd away game as I no longer live near Sheffield. In the warmer months I try to get out on my bike around the narrow, quiet country lanes in Suffolk or, when it's colder or time's constrained (which is all too often), I'll squeeze in a swift walk across the fields and woods nearby.

So that's as typical as a day gets for me. But, to be completely honest, it's difficult to define a "typical" day in reality. It's a bit of a cliche, but in my case it really is true - every day is different and for that I feel truly fortunate.

Simon Eyre
Director & Co-Founder

www.iappdragon.com

Telehealth Can Make a Difference in Bangladesh

Appdragon is about to launch its SmartMed HomeCare telehealth service into Bangladesh after several month's of successful piloting.  Telehealth services can make a real difference in developing countries like Bangladesh, where mobile networks are typically much better than fixed telephony networks, with greater reach and data rates.  This is generally because of foreign and local government investment in what is regarded as one of the key infrastructure components, but also because there are relatively fewer and smaller copper wire networks to maintain, so funding can be directed straight at the newest mobile technologies.  Also, mobile network infrastructure is less costly and quicker to deploy, requiring less below ground work and cable laying.

The availability of mobile technology isn't the only factor that makes Bangladesh the perfect place to deploy telehealth solutions though.  You only need to look at the demographics of the country to realise that the provision of suitable healthcare, to all, is problematic.  There is a total population of 156.6m with an annual growth rate of over 6%.  However, life expectancy isn't on a par with other developing nations at 69 years for females and 71 for males.  This means a larger middle and old-aged population, a group of society who are traditionally heavy users of health care services.

Then consider the geography.  There are several major cities, with Dhaka the largest of the all counting for about 7m people, with a total of 29% living in urban areas. This is low compared to the region where the average is 34% and globally the average if 54%. This all means a large majority of the population are spread out across the rural lands, with relatively poor transport connections and challenging terrain including mountains, rivers and jungle.  Getting to and from hospitals which are entered around the big four cities is therefore challenging, time consuming and expensive.

If we look at the availability of health care professionals in Bangladesh, again the stats suggests a very strained infrastructure with only 3.6 physicians per 10,000 people (the regional average is 5.9 per 10,000).  Nurses and midwives are even more scarce at 2.2 per 10,000 (15.3 regional average).

High blood pressure affects 27% of those aged 25 and over, higher than the 25% regional average.  9.9% of females (9.8% of males) have diabetes, again higher than the regional average. In real terms, that means that over 42m people have blood pressure issues and around 30m have diabetes related health issues.  Obesity, though relatively low compared to the West (just 1% of the population are affected) is growing at an alarming rate and 1% still means 1.6m are overweight to an extent where it can affect their health (source: WHO website).

So we have the factors that lay the foundations for the need for telehealth: 1) good technological infrastructure, 2) poor transport infrastructure, 3) a large, dispersed rural population and 4) significant health problems and 5) very low availability of health services and qualified clinical personnel.

SmartMed HomeCare will start to address this by enabling patients, initially in the suburbs of the major cities, to monitor their own conditions from home whilst SmartMed's qualified physicians monitor the patient's progress remotely from the Dhaka based SmartMed Telehealth Centre.

This not only means the patient doesn't need to struggle across the busy, traffic choked city to attend a clinic thereby improving their quality of life and reducing the strain on busy clinics and hospitals, but it also means more regular checks and timelier interventions.  Ultimately this will result in fewer escalations and complications of the illness, requiring less in- or out-patient attendances.  

In Bangladesh we have teamed up with local, well-respected doctors who were trained in the NHS in the UK but have practiced in Dhaka and Bangladesh for many years.  Our intention is to use local knowledge and expertise to deliver services usually reserved for the wealthier end of Western society to as many people as possible across Bangladesh.

Our next launch will be the HealthWorker proposition, which addresses the needs of the 300,000 or so community based healthcare workers across the country.  Providing them with SmartMed's Android based apps and Bluetooth medical peripherals will allow them to see more patients in a shorter space of time, have qualified, experienced clinicians analyse the results and advise them on any interventions and it will enable them to deliver a broader level of services, addressing a greater number of illnesses and conditions.

It's clear that telehealth isn't the ultimate solution to healthcare problems in the developing world but in Bangladesh, we sincerely believe that telehealth and SmartMed in particular will make a big difference to the quality of care many thousands (and hopefully millions) of people can receive. Wherever they are...

For more information on our Bangladesh offerings, please visit our localised web-site at www.smartmedbd.com or check out or video of how SmartMed HomeCare works in the UK market .

Healthcare providers. Do you want to reduce your waiting lists?

Dumb question. Of course you do. Healthcare providers everywhere face the enormous challenge of providing quality health outcomes for the millions of patients suffering with chronic illnesses.  Escalating pressure on medical resources mean hospitals, clinics and GPs are looking to alternative ways of dealing with the problem, without the need for significant capital investment.

Achieving better healthcare for everyone. Everywhere.

The answer could be tele-health, such as Appdragon's SmartMed (TM) offering.  Tele health is the provision of health care away from the hospital, clinic or surgery.  This could be in the patient's own home, at their place of work or, virtually, anywhere. With modern lifestyles, it's frustrating and stressful for patients to be tied to clinic appointments for routine testing, and it's also expensive for health care providers to provide frequent assessments.

Is Tele Health the Answer?

Tele health, if correctly implemented, can address this conundrum by using mobile broadband, smart phones and app technology to empower and enable the patient to take control of their own condition.  This can lead to better engagement of the patient in managing their own progression of their pathway.  Patients may become much more aware of the symptoms and ways of minimising the affects of their condition.  For example, studies show that patients regularly testing vital signs relevant to a chronic illness, are more likely to stick to diets, prescriptions and exercise regimes.  Of course, it's not the ultimate solution and it won't work in every instance, but for those patients and health care providers that do buy into this new approach, the potential gains are clear.  Reduced health care costs due to fewer in- or out-patient admissions, sooner discharge after minor operations or procedures and fewer re-admissions to hospital. For the health care provider then, a reduction in costs and the ability to divert scarce resources to primary care and emergency treatments (or even research and development) are the main benefits.  For the patient and society at large, an empowered patient could mean less stress and better motivation to take control and manage their condition. This could mean slower progression of chronic conditions and fewer episodes requiring treatment or time off work or absence from loved ones.

SmartMed's Article in Global Health Opportunities 2015

In a future blog I'll talk a little more about what tele health actually is and how it could work in certain scenarios, but for now, take a look at our web site for more information, or read our article on page 101 (or our ad on page 60) of the latest edition of Global Opportunity Healthcare Journal 2015.