Healthcare Garden Architecture

Welcome to the Healthcare Garden Architecture discussion. Covid-19, the first worldwide pandemic, has fundamentally changed how we live and work online. Members want more than appointments and diagnoses from their primary care doctor. They crave an engaging experience with a trusted community, care providers, and partners.

The Healthcare Garden Architecture is a shift from a moment in time visit to a continuous journey. In other words, the Garden Architecture focuses on the member experience prior to login. The adventure begins with a customizable welcome landing page, choosing a journey, receiving notifications from connected devices and partners, messaging community group support, exploring self-care tools, engaging AI modules, and maybe, just maybe, exiting the garden and login into the clinical healthcare ecosystem.

The following will explain the Healthcare Garden Architecture shift in focusing on guest experiences, i.e., non-authenticated members, and the technical implementation of the Garden Architecture.

First, why does it called the “Healthcare Garden Architecture”? As a Solution Architect, I am reaching for a metaphor to explain a healthcare architecture different from traditional mobile apps and websites, such as MyChart and Epic ecosystem. The goal is to create a symbiotic relationship with the existing healthcare ecosystem. In other words, a Garden architecture enhances the users’ experience and does not compete with healthcare apps, such as MyChart and Epic.

Hospitals, insurance, and healthcare providers keep Electronic Health Records (EHR) behind a firewall, protected and in a secured system. You need to be qualified before logging in to the EHR system. It is a prudent safeguard because EHR is private and governed by complex laws on accessibility.

Thus, as the metaphor goes, EHR is housed in a fortress, while the Garden Architecture is the garden outside the fort. It’s free for anyone to enter, engage with the community, and follow their wellness journeys. In other words, the garden focuses on the users and members, entices them with values, and ensures their enjoyment of the healthcare experiences.

The guiding principle is to spend more time living healthy and informed in the Garden Architecture. When you need to receive care from a health professional, you enter [login] to the EHR ecosystem, such as Epic. It is a win-win proposition.

The Garden Architecture is not a free-for-all space like TicToc, Facebook, or Twitter. It is a garden and not a grassland. The garden does not allow coyotes, wolves, or wild turkeys with fake news, hateful, violent, and misogynistic language. Health professionals vetted the Lego components. Thus, the widgets built by the community have to be submitted and vetted before they are available.

Let’s get to it. Analyzing healthcare statistics is an acceptable method to gauge the direction of healthcare pivoting from an enclosed, firewall, exclusive clinical health ecosystem to an open garden landscape.

Health spending in the U.S. increased by 4.6% in 2019 to $3.8 trillion or $11,582 per capita. This growth rate is in line with 2018 (4.7%) and slightly faster than what was observed in 2017 (4.3%), based on the American Medical Association (AMA) research article “Trends in Health Care Spending” in 2020.

The U.S. spent $ 3.8 trillion on healthcare in 2019, broken down into the following categories:

• Hospital care (31.4%)
• Other personal health care costs (15.5%)
• Physician services (14.9%)
• Prescription drugs (9.7%)
• Clinical services (5.4%)
• Investment (5.3%)
• and others include health insurance, government admin, nursing care, and home care.

Hospital care is less than a third of the total cost. Thus any effort to engage the member in healthy living prior to logging in to the hospital care, physician, and clinical system, is a worthwhile shift in strategy. The report does not detail the “Other personal health care cost” components. It is not from any category listed above, so one could surmise it could be from activities depicted in the Garden Architecture.

Many companies are disrupting the healthcare industry. For example:

• Accolate — “Accolade One is the first-of-its-kind solution in the industry — and we’re guaranteeing measurable health outcomes through a value-based care delivery model. We integrate clinically and benefit specialists trained to build long-term relationships and overcome barriers to care with a platform that provides best-in-class access to primary and specialist care, urgent medical care, mental health care, expert medical opinions, and chronic care management.”
• Walmart Health — “Walmart is committed to making healthcare more affordable and accessible for customers in the communities we serve. To expand on this commitment, we launched Walmart Health to provide affordable, transparent pricing for key health center services for local customers, regardless of insurance status. The customer is at the heart of all we do, and it is the same at Walmart Health; we are focused on the needs of the patient and customer. We are partnering with several on-the-ground health providers to be a first-of-its-kind health center to deliver primary and urgent care, labs, x-ray and diagnostics, counseling, dental, optical, and hearing services all in one facility.”
• One Medical & Iora Health — “As of September 1, One Medical and Iora Health are joining forces to deliver exceptional, human-centered, technology-powered primary care to more people in more places — across every stage of life. By acquiring Iora, we’re able to better address the needs of seniors, an important step in our mission to transform healthcare for all.”
• Walgreen — “Walgreens and VillageMD to open 500 to 700 full-service doctor offices within the next five years in a major industry first. This integrated model has never been more important — six in 10 Americans today live with at least one chronic condition requiring multiple daily medications. This rollout is a major advancement of one of Walgreens Boots Alliance’s four key strategic priorities, Creating Neighborhood Health Destinations, said Stefano Pessina, executive vice chairman and CEO of Walgreens Boots Alliance.”

Many other disruptive companies focus on different healthcare segments. Still, the undeniable common threads are that they all are focused on:

• Improving the member experiences,
• Delivering value to members,
• Customizing design to the member-specific needs,
• Ensuring members achieve their goals.

In short, we are describing the Garden Architecture. Before unveiling the Healthcare Garden Architecture diagram, let’s reimagine a few member journeys inside the Garden Architecture.

Living with Diabetes Journey — is the first example of an interactive user experience inside the Garden Architecture.

• Users see and click on a campaign on social media, paid sponsor search, or email. The Customer Relation Management (CRM) system manages the campaign.
• It prompts the users to install the app if it is their first time.
• The landing page/screen is targeted because the CRM provides the users’ segmentation information in the deep link. Thus, the greeting message, e.g., “Welcome to the {company} Healthcare app. Your living with diabetes begins here.” The background image or video can be dynamic from the Digital Assets Management (DAM) system. Assuming the campaign is for diabetes awareness month.
• In this article, “segmentation” is a rule-based content (experiences) for pre-defined audiences, while “personalization” is the user’s choice or an AI approach to serving content dynamically.
• Users click on the “start” button from the landing screen to go to the welcome screens.
• The welcome screens are dynamically generated based on the users’ segmentation profiles. Think of them as using Lego pieces (or components) to assemble the screen. It could be an AI Chatbot asking about the users’ feelings.
• The users can change topics at this stage, e.g., “no, I don’t feel like talking about it, but how do I lose weight?”
• Once the users choose or the AI Chatbot concludes, e.g., “Your personalized living with diabetes journey is assembled and ready.”
• The users click “go” and enter into the journey screen.
• The journey screen has the following segment, or in other words, Lego components. The users can add, remove, or change the order of the components on the journey screen. Thus, the following are some of the popular components that the users can interact with or click through for more information and deeper engagement. The users scroll down to see more segments on the iPhone or Android phone.
• A short daily “Inspiration” video, e.g., “Alex does not let Type 1 Diabetes slow her down,” a 4 minutes video. This video Lego component can be from a Mayo Clinic partnership or the American Medical Association (AMA). Naturally, the videos can be produced by your company too. The user can click “View video” or scroll down to see the next widget.
• The next segment is a fantastic “Diabetes Calculator” explaining the different types of diabetes. The users can click through to take a test to see what type of diabetes they have or scroll down.
• The “Feature Topic” component is a daily newsfeed on the most discussed or shared healthcare topics, e.g., “What is insulant?” Users can click through to read the article, join the discussion, or scroll down.
• The “How to” video segment is a collection of short videos about exercise. It rotates based on the users’ segmentation, e.g., “Diabetes: How exercise can help.” Users can click to view the video, swipe left to see more videos, or scroll down.
• The “Content Hub” segment is curated articles by partners, e.g., Mayo Clinic or AMA. They are informative, such as “Drinking Alcohol While Having Diabetes” and many others. Users can click to view the video, swipe left to see more articles, or scroll down.
• The “Health Recommended” component is a diary tracking your diabetes progress, e.g., a topic such as “regulating and tracking your blood sugar level.” Users can click to create a journal or scroll down.
• The “Primary Doctor” is a component provided by {your company}. Users can click through and “log in” to their health provider or insurance company. They chose to leave the Garden Architecture and enter your clinical ecosystem temporarily. It could be a direct link to the myChart app from Epic or your company’s healthcare app, or the users can skip and scroll down.
• The “Clinical Alert” is a widget that your clinical healthcare system pushes the anonymized data to the community, e.g., “The Covid-19 infection rate is high in your area. Login to {your company} to schedule a free vaccination.” It is a one-way push, meaning no login is required, and the Garden Architecture can not initiate a request for data or post data to your clinical healthcare system. There is no compromising in the data security path. Users can click to schedule an appointment or scroll down.
• The “Diabetes Community” widget is a gateway to live chat with your diabetes friends. Users can click on a custom messaging app (e.g., Viper, SnapChat, Telegraph, LINE, Facebook Messenger, Google Hangout, etc.) and chat with old and new friends who shared the same infliction or scroll down.
• The “AI Empathy” component is a Deep Learning Natural Language Processing (NLP) module. It is an excellent listener. The users can share their thoughts and feelings without fear of being judged. The users can click through and talk with an artificial empathic soul.
• It is worth mentioning again that the users are totally in control. They can add, remove, and reorder the Lego components. In the Garden Architecture, new Lego components are continuously added by {your company}, partners, third parties, and the user community. It is personalization at its best.

Maternity Journey — remarkably follows the same sequence as the “Living with Diabetes Journey,” but the Garden Architecture customizes different content and Lego components to a new journey. You will see re-usable Lego components across many journeys. The content is customized to your current journey, but essentially, it’s the same component. After all, the concept is Lego pieces, so you will reuse standard Lego blocks whether you are building a house or a rocket.

• Users see and click on a campaign on social media, paid sponsor search, or email. The Customer Relation Management (CRM) system manages the campaign.
• It prompts the users to install the app if it is their first time.
• The landing page/screen is targeted because the CRM provides the users’ segmentation information in the deep link. Thus, the greeting message, e.g., “Welcome to the {company} Healthcare app. Congratulations, are you ready to begin your maternity journey?” The background image or video can be dynamic from the Digital Assets Management (DAM) system. Assuming the campaign is focusing on motherhood.
• Users click on the “start” button from the landing screen to go to the welcome screens.
• The welcome screens are dynamically generated based on the users’ segmentation profiles. Think of them as using Lego pieces (or components) to assemble the screen. It could be an AI Chatbot asking about the users’ families.
• The users can change topics at this stage, e.g., “thanks, but can we talk about healthy eating now?”
• Once the users choose or the AI Chatbot concludes, e.g., “Your personalized maternity journey is assembled and ready.”
• The users click “go” and enter into the journey screen.
• The journey screen has the following segment, or in other words, Lego components. The users can add, remove, or change the order of the components on the journey screen. Thus, the following are some of the popular components that the users can interact with or click through for more information and deeper engagement. The users scroll down to see more segments on the iPhone or Android phone.
• The “Baby Vaccination” is a Lego component for tracking and scheduling baby-required vaccination. Users can click through to activate it or deep-link to a partner application specializing in baby vaccination, e.g., the iVaccine app, or scroll down.
• The “Mom Time” is a component of a collection of top videos shared by the community on the importance of having “mon alone time.” The users can click to view the video, swipe left to see more, or scroll down.
• A short daily “Inspiration” video, e.g., “Top Five Bedtime Lullabies,” an 8 minutes video. This video component can be from a Mayo Clinic partnership or the American Medical Association (AMA). Naturally, the videos can be produced by your company too. The users can click “View video” or scroll down to see the next widget.
• The “Featured Topic” component is a daily newsfeed on the most discussed or shared healthcare topics, e.g., “Breast Milk versus Formula” Users can click to read the article, join the discussion, or scroll down.
• The “How to” video segment is a collection of short videos about exercise. It rotates based on the users’ segmentation, e.g., “Happy Yoga for Mom” Users can click to view the video, swipe left to see more videos, or scroll down.
• The “Content Hub” segment is curated articles by partners, e.g., Mayo Clinic or AMA. They are informative, such as “Demystify Baby and Classical Music” and many others. Users can click to read the article, swipe left to see more articles or scroll down.
• The “Pediatrician” is a component provided by {your company}. Users can click through and “log in” to their pediatrician. They chose to leave the Garden Architecture and enter your clinical ecosystem temporarily. It could be a direct link to the myChart app from Epic or your company’s healthcare app, or the users can skip and scroll down.
• The “Clinical Alert” is a widget that your clinical healthcare system pushes the anonymized data to the community, e.g., “Free yoga class for mom and baby every Monday at your friendly hospital.” It is a one-way push, meaning no login is required, and the Garden Architecture can not initiate a request for data or post data to your clinical healthcare system. There is no compromising in the data security path. Users can click to schedule an appointment or scroll down.
• The “Mom Community” widget is a gateway to live chat with your diabetes friends. Users can click on a custom messaging app (e.g., Viper, SnapChat, Telegraph, LINE, Facebook Messenger, Google Hangout, etc.) and chat with old and new friends who shared the same infliction or scroll down.
• The “AI Empathy” component is a Deep Learning Natural Language Processing (NLP) module. It is an excellent listener. The users can share their thoughts and feelings without fear of being judged. The users can click through and talk with an artificial empathic soul.
• It is worth mentioning again that the users are totally in control. They can add, remove, and reorder the Lego components. In the Garden Architecture, new Lego components are continuously added by {your company}, partners, third parties, and the user community. It is personalization at its best.

Putting it all together, the Healthcare Garden Architecture is as follows. The Healthcare Garden Architecture is complimentary to your clinical healthcare ecosystem, e.g., Epic, from a thousand feet. The two co-exist side by side in a semiotic relationship.

The benefits of the Garden Architecture are:

• Improving the user experiences,
• Delivering value to users,
• Customizing design to the member-specific (or client-specific) needs,
• Ensuring members achieve their goals,
• Encouraging users to share experiences with the community,
• Personalize the user journey experience,
• Powered by AI for a “true” personalized experience.

( #1 Marker on the diagram)

The first-time user sequences were in the examples above. They are:

• View deep-link from a CRM campaign,
• If users do not have the app, then download and install it,
• The “landing screen” is customized via the CRM segmentation,
• The “Welcome screen(s)” are powered by the Machine Learning Natural Language Processing (NLP) module to help the users to assemble, i.e., to personalize their journey.
• The journey is a collection of Lego components.

( #2 Marker on the diagram)

The Journey screen is a collection of Lego components assembled by you or by the AI modules based on the user segmentation information from the CRM. Some of the widgets are reusable across many journeys. The content is customized to your current journey, but essentially, it’s the same widget. After all, the concept is Lego blocks, so you will reuse standard Lego blocks whether you are building a house or a rocket. There are as many journeys as there are in your imagination. A few examples are:

• Living with Diabetes Journey
• Accepting Cancer Journey
• Maternity Journey
• Outdoor Healthy Living Journey
• Lose Weight Journey
• Train for Iron-man Competition Journey
• Vegetable Gardening Journey
• Reduce Stress Journey
• Managing Depression Journey
• and many more.

( #3 Marker on the diagram)

The AI modules are unique Lego components. Using the same analogy as Lego building blocks, these AI are Lego blocks with motors, sensors, and batteries. Two “true” personalization options are available for companies with 10+ million members and potential members using the Garden Architecture app.

The first personalization method is giving the users the ability to add, delete, and reorder components in their journey. The results may differ from the original journey, but that is acceptable. As a matter of fact, it is by design. You may start using the Garden Architecture app because you want to lose weight, but you could morph it into an Iron-man training journey. The beauty is that the Journey screen continues to morph as you continue to use it daily.

The first personalization method drawback is that the users tend to be lazy to start or do all the work. The second method uses AI, particularly Machine Learning and Deep Learning, to automatically personalize the users’ journey. The AI module will adapt from the users’ segmentation data in CRM, social footprint, and clinical data to continuously personalize their journey.

( #4 Marker on the diagram)

The Lego components are self-contained modules or tiles for other applications or services. For example, the “Inspiration, Featured Topic, and Content Hub” are self-contained components, i.e., the users do not need to leave the app to use it. The content is dynamically based on the users’ segmentation. On the other hand, the “Diabetes Community or Primary Doctor” components are tiles representing an app or website, where users temporarily choose to leave the Garden Architecture. They could be your company app or a third-parties app.

For the Garden Architecture to be viable, you must have sizable widgets available at the launch. Too few, and the users quickly tired of the same option repeatedly. The Garden Architecture matured with additional partnerships, third parties, and community components, i.e., widgets created by the community users. The goal is that as user engagement increases, so will the number of features available.

( #5 Marker on the diagram)

There is one noteworthy component. The “Clinical Alert” is a widget that your clinical healthcare system pushes the anonymized data to the community, e.g., “The Covid-19 infection rate is high in your area. Login to {your company} to schedule a free vaccination.” It is a one-way push, meaning no login is required, and the Garden Architecture can not initiate a request for data or post data to your clinical healthcare system. There is no compromising in the data security path.

( #6 Marker on the diagram)

The hardware architecture is deceptively simple. Where are the databases, caching, docker, and load balancing servers? It’s all in there.

The “Application Server” is the Google serverless engine or (Amazon) AWS Elastic Computing services. You don’t need to manage the hardware, servers, dockers, load balancer, or cache servers. The system will automatically scale up and down based on your users’ traffic. It handles auto-provisioning, maintaining updates, security, deployment, monitoring failure, and auto-recovery. In short, you deploy your “source code,” and the serverless engine manages everything else.

The orchestration layer is no other than GraphQL and not standard REST API. GraphQL is a relatively new technology for mobile phone apps, tablets, and websites to request information from the backend server.

The big breakthrough is that diverse clients can request different data using the same API endpoint from the server. In the old days, the server responded with the same data for everyone.

It is significant to note that GraphQL is a concept and not a software package to replace your REST API. GraphQL is a powerful new concept like Objected Oriented (OO) or Software Design Patterns (SDP). You can code without using inheritance, polymorphism, Factory Patterns, Composite, Decorator, Iterator, or Singleton. However, using the established patterns will make the code more resilient, less buggy, flexible, and easier to maintain. GraphQL brings the same benefits as using OO and SDP.

The standard functionality modules are in the Software as a Service (SaaS) partners. They are:

• Customer Relationship Management (CRM) — is a software system that helps business owners easily track all communications and nurture relationships with their leads and clients. For example, Salesforce.com.
• Content (or Contentful) Management System (CMS) — is software that helps users create, manage, and modify content on a website without specialized technical knowledge. For example, Adobe Experience Manager (AEM).
• Digital Asset Management (DAM) — is a platform that has the power to store, share and organize all digital content in a secure and centralized location. For example, Canto or Cloudinary.
• Analytics Engine — is a platform that lets you measure user interactions with your business across various devices and environments. The platform provides all the computing resources to collect, store, process, and report on these user interactions. Analytics collection can take place on both the client and server-side. For example, Google Analytics.
• Universal Identity Platform and Single-Sign-On (SSO) — provide organizations with a unified view of the identities they engage with, allowing them to centralize all personas within one platform and solve security and identity management issues in a single place. For example, Auth0.
• AB Testing — is a platform that refers to a randomized experimentation process wherein two or more versions of a variable (web page, page element, etc.) are shown to different segments of website visitors at the same time to determine which version leaves the maximum impact and drives business metrics. For example, Optimizely.

That concludes our relatively short discussion on the Healthcare Garden Architecture. If you want to have an in-depth discussion on how to build a Garden Architecture POC or full development and deployment, please reach out to me directly. As always, I apologize for any unintentional errors. The intentional errors are mine and mine alone. :-)

Have a great day.

* {Credits} The illustrations are created by Katerina Limpitsouni. https://undraw.co/

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