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When the Mission Truly Is Critical

.NET in the real world of health care

.NET Developer's Journal Editor-in-Chief Derek Ferguson recently chatted with John Gomez, CTO of Eclipsys. In this exclusive interview, Gomez talks about the role of .NET in mission-critical software for the health-care industry, and how he merged his love of technology with his interest in health care.

.NETDJ: Tell me about yourself.
I'm the chief technology officer for Eclipsys Corporation. At least that's what our Web site says. Day-to-day, I'm the lead geek for a team of very talented and passionate software engineers, product managers, quality assurance and test engineers, architects, and documentation specialists who help build one of the most advanced and widely adopted suites of health-care IT solutions in the country.

Outside of that, I spend a lot of time trying to figure out hard questions - like why we park in a driveway and drive on a parkway - that one just drives me nuts. But, I hope that with the right amount of computing power I will have the answer to that perplexing question very soon.

.NETDJ: What does Eclipsys do?
Eclipsys is The Outcomes Company. We were founded with a simple mission: better health care through knowledge. Today, Eclipsys is a leading provider of advanced clinical, financial, and management information software and service solutions. More than 1,500 health-care facilities use Eclipsys solutions to improve patient safety, revenue-cycle management, and operational efficiency.

Our advanced solutions put the right knowledge into the hands of the right person, at the right time and place, on the right device. With relevant knowledge at their fingertips, physicians, nurses, and administrators can make the best possible decisions throughout the organization.

.NETDJ: Where are you based?
Our corporate headquarters is located in Boca Raton, FL, but we have technology centers throughout the U.S. Our primary technical development labs are in Boston, MA; Malvern, PA; and Vancouver, BC.

.NETDJ: What is the history of Eclipsys?
Eclipsys was established in 1995 and has grown significantly through a number of strategic acquisitions, as well as internal development. We continue to develop, recruit, and innovate to ensure that our solutions support health-care organizations at all stages of operation.

.NETDJ: Why did you join Eclipsys?
I've been developing software since I was 9 years old and have always wanted to be involved in medicine. At one point I aspired to become a trauma surgeon, and I was even the first emergency medical technician under age 18 in my home state of New Jersey.

After years of being involved in commercial software with companies like Microsoft, H&R Block, KYMA, Group Espada, and others, I saw this as an opportunity to do something that blends my love of technology and my aspiration to do something in health care. I also found it intellectually challenging to know that the solutions we're crafting can make a very real difference in the quality of someone's life - there aren't many areas of technology that can make that statement and know quality is defined by life or death.

.NETDJ: What is the main business challenge that Eclipsys faces going forward?
I believe our biggest challenge is keeping up with the demands of our current and future customers. Health care is changing rapidly, with patient safety and quality of care paramount issues. We are fortunate to be at the forefront of this evolution with the solutions we offer. Yet we need to take things to a whole new level and continue to not only meet, but exceed our customers' expectations.

.NETDJ: How will .NET help you meet that challenge?
.NET and some of the related Microsoft technologies that we utilize help us to reduce our time-to-market and make good on the promise of having the most advanced and feature-rich clinical information platform in the industry. .NET allows us to focus on what we do best and not be concerned about those areas that developers traditionally need to worry about - like writing file-handling routines or our own HTTP handlers or wrappers. We get to focus on building world-class systems, and we have the awards to prove it. I believe .NET lets us simply do what we do best.

.NETDJ: Who are your main competitors?
There are several companies that try to compete with us, but typically it is through the age-old practice of FUD. I honestly believe that hands-down our employment of .NET and other technologies has got to worry the competition.

.NETDJ: Where do you have your development done?
We do all our development in-house. We employ our development teams and lately have worked to minimize the use of consultants. We do some small amount of work with Microsoft Consulting and one or two other consulting firms.

I'm a huge believer that unless you are using someone like John Robbins from Wintellect for a short burst of knowledge, you shouldn't be using consultants.

.NETDJ: When do you expect to see the first fruits of your .NET effort?
We are already seeing the fruits of .NET. Our clinical documentation system is a rewrite of our Sunrise Critical Care system, which was an AIX platform and is now 100% .NET. The original system took years to write. With .NET we wrote it from the ground up in a little over a year and added more features and functionality than the original system. That product is set to ship in June.

.NETDJ: Why .NET instead of another platform?
It really comes down to a mix of things. First, if you read the Java licensing agreement, it talks about not using Java for real-time, mission-critical systems; that is something we just can't have. Clinical systems are all about being mission critical, and you need to know that the software you build is going to be highly reliable. When we evaluated the field of technologies, we found that the mix of .NET, SQL Server, BizTalk, and Windows 2000 - and now 2003 - was the right mix to help us reduce time-to-market and meet our requirements of high availability and scalability.

.NETDJ: How difficult is it to find qualified .NET experts?
I don't think it's that difficult to find .NET expertise. What is more difficult for us - and it is partly due to how high we set our hiring bar - is finding people who are truly the best of the best when it comes to writing efficient and reliable software. We have full-time, in-house recruiters, and they do a great job of finding .NET developers.

.NETDJ: Are Web services playing a part in any Eclipsys development?
Yes. We are embarking on a new initiative known as SunriseXA ObjectsPlus. ObjectsPlus exposes our Patient, Orders, Worklist, Results, and other core components through a .NET namespace. This allows third-party developers to build custom clinical workflows or applications that can easily be integrated with our systems. However, we realize that not everyone is using .NET. To maintain our goal of being standards-based, we are also providing a Web service wrapper around our ObjectsPlus layer that will allow those using other languages to easily interact with our systems.

.NETDJ: What kind of dealings with and support do you receive from Microsoft?
We work very closely with Microsoft. While I'm not able to provide details, I can tell you that we have Microsoft personnel in our key development centers and that our relationship is highly bi-directional.

.NETDJ: What do you expect to be the "next big thing" in .NET technology, and what are you doing today to prepare for it?
Wow, that is a huge question. I often wonder why everyone is so interested in the "next" big thing. I believe what people are missing is that .NET is a very mature platform for a 1.0 release - it has a ton of services and features. But, so as not to totally weasel out of your question, I'll take a glance at my crystal ball.

As you know, I write an internals column for .NETDJ, and I think the "next big things" will happen on the inside. I don't believe we will see the monumental shifts we saw from say VB6 and VB.NET until the third release of .NET. I believe we'll see improvements in the heuristics of the GC, better support for precompiling applications, improvements in how the JIT works, and the potential for something I like to call "JIT ahead," where you compile parts of a program based on past heuristics. I would also expect improvements to overall efficiency and speed of the CLR. If I had a wish list I would love to see a release of .NET that could be used in embedded O/S development, and I truly wish Microsoft would stand up and invest in portability projects like Mono.

.NETDJ: What development methodology or methodologies do you employ at Eclipsys (XP, traditional, etc.)?
This is where I typically get people upset, because I don't believe in a lot of things like XP, PMI, CMMI, design patterns, or other fancy techno methodologies. I find it kind of funny that as a technology industry, we have like an 80% failure rate when it comes to delivering projects on time and on budget with a high degree of quality. Over the years I developed what I call "EPM," which is based on military special operations mission planning. At Eclipsys, we use my EPM model and the Microsoft Solutions Framework.

.NETDJ: Why begin a big development surge at this point in the economy? Why not wait for better times?
Like most companies, we are a market-driven company. It is important for us to maintain our competitive edge, and it is even more critical that we continue driving the market. Now is a great time to do big development. We can attract great talent that wants to be part of a fast-growing and challenging organization. And we are able to embrace leading-edge technologies and apply them to interesting problems and do so at a lower cost.

While the economy is challenging for many, the reality is that economic downturns are an excellent point in time to invest in expansion, since the return on investment is greater.

.NETDJ: How do you see the technology wars shaping up over the next several years? Will .NET dominate?
I truly believe that Linux will continue to grow, and I think it will eventually give Microsoft a serious challenge. When you consider that the effort to migrate typical file and print services from NT4 to Windows 2003 is about the same to move from NT4 to Linux - and the cost of migrating to Linux is much less - especially in the out years, there is a lot of market share still up for grabs. I also believe that Novell is making a lot of the right moves and that if it can attract better senior talent it will rapidly become a larger threat to Microsoft in the enterprise space. Also, Borland is starting to make a resurgence and regain many of its original followers. There are also rumblings about the possibility of Borland releasing a Mono IDE that rivals Visual Studio. So I believe that the wars will continue and I think that is great. While I believe that .NET may become more popular than Java, the real question is, will it be Microsoft .NET or a variant on Linux?

.NETDJ: What is the single most interesting thing that you think Eclipsys is doing with .NET technology, from a development standpoint?
I believe that the most interesting thing we are doing is a combination of two projects. What we are doing with our SunriseXA ObjectsPlus initiative and our mobility work. Think about it: without .NET, we would spend the next several years building an object-based platform that is accessible by third parties and probably do it through a primitive API. With .NET, we will be releasing a very mature standards-based object layer that is accessible by C, C++, VB, PERL, COBOL, Java, C#, J#, and a ton of other languages, like LISP, for example. That totally rocks, and it is something that we are doing faster and better than anyone else because of our investments in .NET.

Then there is mobility. I know you said a single thing, but this is just too cool not to talk about. With .NET we are empowering clinicians to be mobile. It goes far beyond a PDA. It is truly integrating their ability to practice medicine with technology. Some things are minor, such as using a PDA or Tablet PC at a bedside and then walking up to a printer that recognizes the clinician and then prints out confidential patient information.

Then there are the more profound things, like the ability to send critical alerts across unreliable networks and being assured that the alert will get to the right clinician, or the ability to transmit waveforms across the wire to enable telemedicine. All of this is being worked on today. We are not just laying the foundation, we are writing code and we are using .NET....It just simply rocks.

About John Gomez
John Gomez, open source editor for .NET Developer's Journal, has over 25 years of software development and architectural experience, and is considered a leader in the design of highly distributed transaction systems. His interests include chaos- and fuzzy-based systems, self-healing and self-reliant systems, and offensive security technologies, as well as artificial intelligence. John started developing software at age 9 and is currently the CTO of Eclipsys Corporation, a worldwide leader in hospital and physician information systems.

More Stories By Derek Ferguson

Derek Ferguson, founding editor and editor-in-chief of .Net Developer's Journal, is a noted technology expert and former Microsoft MVP.

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