Really think big, set a very aspirational end state and work back from there
“I head up global technology, and technology to us means a few different things,” explains Duane Makin, when asked to describe his role at Atlantis Healthcare.
Makin joined the health software company nearly two years ago, after working for eight years at energy company Vector.
Atlantis Healthcare, with headquarters in Auckland, designs, develops and delivers highly efficient, scalable patient support solutions and products to help improve a patient’s quality of life.
The company applies its own health psychology framework and provides patients and healthcare professionals with personalised tools and support, to assist them in managing chronic conditions.
Atlantis Healthcare employs around 180 people across the globe, together with more than 300 nurses, health care practitioners and health psychology specialists.
“While we are not a huge business in terms of employee numbers, we do have reasonable scale in terms of geographical footprint and program deployment,” says Makin.
“We have offices in New Zealand, Australia, UK, United States, Germany and Spain, and have programmes deployed across 28 countries.
We are able to innovate, we are able to develop proof of concepts and we are able to implement trials reflective of our domain rapidly
He says as with the more traditional CIO role, he and his team take care of internal IT systems and services for the enterprise.
“We also leverage technology quite significantly in the delivery of our products and services,” he explains. “So we are also responsible for maintaining, enhancing and improving the technology for these.
He says this responsibility of digital product development, managing both internal and external facing systems, is what interested him when he joined Atlantis Healthcare.
He has team members in each of the company's major markets, but the main team is based in New Zealand taking care of platform and product development, engineering, operations and backend functions.
He also has a team in the UK, which operates as a front-end product and solution focused hub model for the rest of Europe.
“By far and away, the majority of our work is focused on the development, operation and enhancement of our market facing systems and services. It also includes our digital products, as we provide the technology environment that enables and provides services to our customers.
“This is where the lion’s share of my attention sits. Our customers, our services and our products are absolute priority,” he says.
“We have driven simplicity into our operating environment. We intentionally keep our internal services as simple as we can.”
This means using software as a service extensively, he says. Atlantis Healthcare uses Office 365 and Salesforce for its sales CRM.
“Because of our global nature, we have a couple of different payroll systems, all cloud-based.”
He says the company still has some traditional systems, such as the ERP.
A personal experience
Makin explains Atlantis Healthcare’s health psychology framework, software and services help patients with chronic conditions that affect just a few hundred to those that affect millions.
“We have taken best practice and academic research and synthesised that into a framework and methodology to influence behaviour change and self management through interventions,” he states.
These interventions range from text messages, to web content, health coaching and nurse education, journals, applications and beyond.
But an experience involving his family, brought what he says was a more nuanced view on how the company can further improve the framework for condition self-management.
As he found out, it is easy to understand the decisions around chronic disease management, but “it is hard to empathise with users unless you have gone through the experience.”
A few weeks ago, his five-year-old son was diagnosed with type 1 diabetes. As Makin says, while the disease is not life threatening, it means his son will have to manage the condition throughout his life.
After he and his wife spent a few days with their son at the Starship Hospital, Makin came out with a new perspective on the tools, services and products Atlantis Healthcare is providing.
In the context of clinical healthcare, he says generally the systems provided are patient centric, while also considering the needs of healthcare professionals such as clinicians.
“But there is a bigger community, the carers,” he says. “It could be parents, other members of the family or friends, and other workers, such as healthcare aides.
“We also have to provide them the knowledge, the tools and information to assist in the management of the patient."
Dealing with legacy
When Makin joined Atlantis Healthcare in September, 2015, he found the company had a traditional ICT setup.
There were third party data centres in each of the regions and multiple systems across the enterprise.
"The legacy datacentres with traditional infrastructure and application stacks constrained our ability to evolve, shift, move and innovate," he observes.
This complexity, together with the fact that the systems were up for lifecycle service, prompted the company to rethink its IT infrastructure.
“We wanted to move away from siloed applications and programmes tied to specific technology solutions, into a more consistent, cohesive, scalable platform that will lend itself to more contemporary technologies.”
He says the company decided to standardise and deliver its reference architecture, to sit on top of cloud platforms.
We have taken best practice and academic research and synthesised that into a framework and methodology to influence behaviour change and self management through interventions
Atlantis Healthcare has now migrated out of its data centres and onto the AWS platform in the United States and Australia and New Zealand. The shift for the European Union and UK architecture is currently underway.
He says the migration they undertook also allowed them to review and rationalise the company's systems.
As a result, he says, they have started to use some of the more contemporary technologies like serverless architecture, transitioning to Lambda functions where appropriate.
He says the shift has cut their hosting costs by more than half, while reducing the company's server and infrastructure footprint by about the same.
“We are paying based on the volume - variable cost, based on when we use it and how much we use it and that is a much more efficient model for us.”
Atlantis Healthcare worked with The Instillery for assistance with the migration.
“But importantly, we have taken to strengthening our in-house expertise for future evolution, maintenance and support” he says.
“We have some very good capability in the team. That has been hugely valuable through this exercise at the architectural, development and engineering level, and in understanding the capabilities of the public cloud.”
Makin says the internal IT team is also pragmatic, “commercially aware of the cost constraints” around migrating to the cloud.
“With things like cloud, you hear of runaway costs. A few dollars for every service,” he explains. “That doesn't sound like much until you add hourly, daily, weekly, monthly and yearly multipliers , then it adds up pretty quick.”
He says it is important to apply some good cost management tools so the organisation can evaluate the costs of moving to the cloud.
“We still remain in a hybrid [cloud] state,” he says. “While we leverage cloud extensively for our products and services, we do still maintain some on premise capability in technology.”
"The driver behind that is one, the on-premise systems are fit for purpose and two, we do have operational lifecycles that we need to consider."
He says while the organisation has experienced commercial benefits in terms of costs, a benefit that is slightly harder to quantify is the speed and agility the shift to the cloud has provided.
“We are able to innovate, we are able to develop proof of concepts and we are able to implement trials reflective of our domain rapidly,” he says.
A key message he has for other CIOs and CTOs about moving to the cloud is this:
“Despite the industry speaking about full-scale cloud development for years, our experience when we reached out for proven capability in vendors, is that there is only a small handful that have a proven track record beyond test and development environments and product development use cases.
“In terms of full scale workload, only a handful of people seemed to have that capability locally. We also found some limitations in the management tooling available at the time though this is continually evolving and tools like Cloudability and Clearstate provide good oversight.”
He says the cloud services space also moves rapidly and that “it is almost impossible to keep up".
“Part of it is to continue to understand what is changing and really be aspirational,” he states.
“Really think big, set a very aspirational end state and work back from there.”
"While already being impacted by the growing DevOps movement, traditional outsourced infrastructure and service management models need to be rethought.
"Conventional operating models based on typical support transactions are too rigid."
“By taking away some of the effort and cost associated to managing the platform, we can focus our technology on innovation and building and delivering products and services that add value to our customers’ daily lives.”
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