Health Pivot – Mitigating US Healthcare Challenges to Create Better Patient Care

Note: This is the first part of a three-part blog series detailing how Nitor has created a futuristic framework that aims to nullify the challenges of the US Healthcare industry.

 Healthcare is experiencing a radical change around the U.S market. A dramatic overhaul of guidelines fused with disruptive digital technologies, has caused major changes in payer-provider model.

Payers and Providers mostly work in silos with restricted patient data sharing – limited to claims and financials. While both of them aim to reduce cost and provide quality care, they face the challenges of having restricted access to patient information. What is needed here is a collaboration in leveraging payer and provider data to assess gaps in care. This could be achieved easily if the data is used meaningfully, for instance if the providers combine EHR and payer data, they would be able to infuse meaningful insights into patient health. It is only possible if the providers start thinking beyond processing the financial information available in the payers data.

Payers are increasingly feeling the need for payer-provider collaboration and are willing to invest and take the initiative to assess the gaps in care, which will lead to improved patient management and lowered claim value.

Nevertheless, there is still plenty of work, which needs accomplishment; healthcare industry conflicts are nothing new. Legislation and technology will continue to modify its landscape. Doctors, and their medical teams must evolve their focus & approach to meet those challenges. Let us have a look at some of the challenges in the current industry workflow.

Ever Changing Compliance

 The US healthcare industry is monitored rigorously against stringent regulatory norms. As many of these regulations undergo routine changes, the healthcare industry is under constant pressure to keep up with the changes.

Recent study shows that healthcare executives are additionally burdened to comply with an assortment of freshly revised standards including the Health Insurance Portability and Accountability Act (HIPAA) and many more. On the top of standalone reporting requirements that each of these standards bring in, healthcare providers need to take care of interdependencies as well.

For instance, the healthcare reform legislation increases the number of people covered under Medicaid by more than 25 million. Consequently, the healthcare industry is faced with the prospect of creating, storing, encrypting and protecting 25 million more EHRs. Combine this with the need to report on the actions taken in a regular manner, HITECH compliance will increase volumes in CMS reporting needs.

Data Aggregation & Breaches

 The problem in healthcare lies with the aggregation of the data. To derive insights from data, it is critical that they be accurate and relatively complete. When data is divided and systematically biased through either errors or omissions, the correlations that give rise to new insights will be missed or turn spurious, and could result in misguided confidence or scarce resources dedicated to chasing down dead ends.

Additionally, patient privacy issues, including worries about data breaches, continue to be a challenge for providers & payers.

Providers and payers are constantly looking for the best practices for data security to avoid the type of HIPAA violations that can negatively affect an organization.

Assessing Gaps in Care 

 Health systems are trying to put together integrated techniques to delivering care, which enhance the overall quality for the patient.

The problem that still remains- what level within the provider healthcare system should be held responsible for quality, and how can this be achieved most effectively. One of the major problem is that providers do not have sufficient time to look at the complete health record of a patient and subsequently write a care plan for the patient.

Other most common and prominent difficulties are: data transfer and data merging across different information systems with secure protection of sensitive patient data.

Technology Framework: The Saviour of the Hour

Despite the challenges, many clinicians and health care organizations are making progress by using right technology to provide better care for their patients.

As we charge headlong into the future, those of us in the healthcare industry are striving to create a better system overcoming challenges. Some of the recent use cases are helping to achieve the ultimate goal of quality care and improved patient engagement. Is there a one-size-fits-all solution that can tackle some of the major challenges discussed above?

The answer is Rule Engine – A smart, customizable healthcare data aggregator framework for enhancing patient care journey. Rule Engines help healthcare organizations around the world make better, more informed decisions that increase outcomes, grow revenues, cut costs and liability. Additionally, Rule Engines integrate data from multiple sources providing meaningful insights. This means smarter decisions about products, claims and care in challenging environment.

Let us look at some of the Rule engine use cases, which proves it is a boon.

1) MACRA MIPS Solution:

With CMS introducing MACRA-MIPS program to replace PQRS and other quality programs, providers have turned skeptics. An ideal rule engine allows you to implement MACRA MIPS solution by looking at the available provider data and suggest which rules could be reported to the CMS.

2) Alert Engine:

Prevention is better than cure is a dictum suited to all but what is important is to treat it in time for a higher survival rate. A Rule Engine is capable of setting alerts when patient parameter goes beyond normal range, with the user able to set custom alerts as per standard practices.

3) Financial Reports:

One of the major advantage of the Rule Engine is that it allows setting financial reports as per business needs with custom visualization for the report.

4) Payer-Provider Collaboration:

US healthcare is moving towards patient quality care rather than quantity, complete picture of the patient health; using payer and provider data becomes an important aspect in assessing gaps in care. A rule engine is capable of combining payer and provider data to get complete health record of the patient. It ultimately helps to derive gaps in care, which is the need of the hour.

Importance of Rule Engines and how it changes the dynamics in healthcare

 It is quite clear that a Rule Engine is the solution for the challenges above. Not only does it combine data from multiple sources but also works in real time as per the business needs. It makes it easy for the users to configure rules and set the notifications, alerts, automation, predictive maintenance and much more. An advanced Rule Engine can fulfil that role by ingesting real-time data, reasoning on those data and invoking automated actions based on the result of that reasoning process.

Check out our next blog where we discuss in detail about how an ideal rule engine should look like!

How to Skyrocket Your Venture’s Funding with ICOs

ICOs (Initial Coin Offering) have gained tremendous traction in today’s world of digital currency. Built upon the security, trust and transparency of the Blockchain paradigm, ICOs have helped companies raise 7 billion USD as of May 1, 2018. This is a rise from 5 billion USD in 2017.These facts, coupled with the recent favorable economic climate, indicate that this the optimal time to capitalize upon the rising tide of cryptocurrency.

Read on to discover how and why you should raise maximum funds with this innovative business model.

Why ICO?

ICOs merge the power of crowdfunding with the allure of cryptocurrency.

In an ICO, internet users view your value proposition and invest in your vision by buying tokens. Note that this happens before the actual token-based marketplace is released to the world. The next step is a full exchange in which the issued tokens can be traded for other currencies. This structure motivates the public to participate in the ICO and own as many tokens as possible to gain on future enrollment into cryptocurrency exchanges. Because Blockchain technology underlies ICOs, users can be assured of security, transparency, and trust.

Building an ICO Platform

Nitor’s ICO platform follows certain best practices to ensure that your ICO is a success. First, all necessary ICO information is presented on an intuitive website. This includes token information, ICO duration, the beneficiary wallet address, and interfaces to popular cryptocurrency wallets. After this critical step, it is advisable to ask white-listed users to register and share their information so you are sure that every payment is legitimate.

During the ICO, it is useful to display the token status. This is usually shown as Total Tokens Sold vs. Total Tokens Allocated (known as a hard cap). It is also a good idea to have a token calculator, which shows the relationship between one token and a cryptocurrency such as Ether, Bitcoin etc. You will also need to display a transaction history. This is a list or record of transactions showing wallet addresses, amount invested, transaction costs and transaction signatures. This also helps in maintaining accurate records.

If issues arise, architectural modularity helps quickly identify and fix problems so that token sale can progress. An AML (Anti-Money Laundering) feature ensures that if, based on data analysis, you see an issue with a particular transaction post-payment, you can reclaim the issued token. Finally, remember that it is important to market your ICO. A strong integrated email notification engine automatically feeds ICO highlights to subscribed users. This has the potential to be used as a powerful marketing tool.

Ethereum-based Engineering Guidelines

Some helpful guidelines for Ethereum-based engineering include:

  1. Choose Modular HTML5 frameworks for front-end development as you may be looking to integrate an existing website instead of developing from scratch.
  2. Leverage the Truffle framework. This is useful for the creation of Smart Contracts.
  3. Follow the best practices in writing solidity files.
  4. Use a sandbox/test network such as Ropsten for integrated tests.
  5. Ensure 100% code coverage for all development.
  6. Modularize Smart Contracts for maintainability.
  7. Ensure that a third-party auditor, instead of the developers involved in writing code, conducts the security audit of Smart Contracts.
  8. Deploy your Smart Contracts to the Ethereum public network.

Nitor implements all these and more so that you can hold a profitable ICO.

Key Considerations

Before running your ICO, decide on a minimum funding goal (known as a soft cap). Complete the requisite research beforehand to understand what this number should be. Next, remember to avoid issuing tokens before the sale ends. This is important as record keeping becomes easier. Issue tokens only after the minimum funding goal is achieved and the token sale officially ends. If the minimum funding goal is not achieved, however, it is best to refund the money and modify your approach. With the guidance of Nitor’s dedicated experts, you can avail the benefits of a secure sandbox ICO platform to pre-test token sales.

Nitor’s services can help you at every stage of the ICO process. Nitor can get to the heart of the complicated code of Smart Contracts, leaving you free to strategize and innovate. We also help you drive innovation with 70% of ICO contract features already in place. With our knowledgeable teams, you can set the stage with your ICO website within two short weeks.

ICOs are one of the most useful, secure, and transparent tools for fundraising today. Nitor can help you leverage the brilliant power of Blockchain technology with the application of the aforementioned tips. With our experts, you can craft a brilliant strategy to generate the funding that your revolutionary product deserves.

If you would like to benefit from our world-leading Blockchain arsenal to raise funds for your venture, reach out to us at

Nitor at HIMSS18

Nitor is presenting at HIMSS 18 Conference. HIMSS brings together 45,000+ professionals from around the world for five full days of education, innovation and collaboration to help uncover the promise of health information and technology. No other conference brings you world-class healthcare education, cutting-edge products and solutions, and the unique networking opportunities you need to solve your biggest health information and technology challenges –  all in one place.

Nitor will be exhibiting at HIMSS18 in Las Vegas, from March 5th  to March 9th , 2018, at booth #11013. We are excited to highlight the transformation that Nitor has brought to the healthcare industry. Our modern frameworks and technology approach enables care teams to deliver innovative, patient-centric programs across case, disease, utilization and wellness management.

Come meet us to discuss  everything related to Care Management, check out our live demos, and win exciting raffle prizes!

Top 3 reasons to visit Nitor at HIMSS 18:

Care Management

Learn how Nitor helps unlock and integrate the full breadth of information for care providers, automates care management workflows, and scales to meet the ever-changing demands of population health .

Understand how Nitor’s Modern Care Management accelerators are improving risk stratification, deploying machine algorithms for effective care plans & offering advanced analytics for with top-notch data quality for deeper insights.

Live Demo

Come watch live demos highlighting our cutting-edge accelerators that enable effective care management, increasing patient engagement, improved wellness applications, and superior payer-provider collaboration. The following is a  list of demos we will showcase at HIMSS 2018:

  • Patient portal & App Framework
  • Out-of-pocket calculation framework
  • Bundle payments framework
  • Payer-provider collaboration framework
  • Emergency care (IOT) Framework
  • Wellness (Wearable Device Integration) Framework
  • Interoperability (HL7 2 * FHIR), rule engine

Additionally, check out the live demos of Nitor’s smart accelerator, Health Pivot. Discover how Health Pivot allows users to create  customized rules, generate reports, set alerts, and much more for better health outcomes, lower costs and a rapid response to change.

Furthermore, learn about our machine learning capabilities in Health Pivot that enable you to set flexible rules to create and deliver the most effective, personalized treatment plan for the patient’s condition.

Raffle Prize

Last but not  least, don’t miss out on an amazing chance to win an all-new  Amazon Echo Spot. Drop your business card at our booth to try your luck!.

We would love to meet you!For more information, please visit

About Nitor’s Healthcare Offerings:

With innovation in both healthcare  and technology, Nitor provides accelerator frameworks that significantly improve product time-to-market. This helps  ISVs to stay ahead of the curve and deliver quality healthcare applications, better engagement and flexibility. With our accelerator frameworks, we enable healthcare ISVs to build innovative solutions which improve consumer engagement, payer and provider operations, and payer-provider collaboration.

Visit to discover more.

Top Healthcare technology advances for 2018

In  2017, the new U.S. Presidency pushed industries to follow the ‘wait-and-watch’ approach. Unlike other factors, a change in the government always brings new compliances and strategies, which could impact business plans and product roadmaps. During the presidential campaign, President Trump’s vocal contempt for Obamacare was evident. Due to this, the healthcare industry was a little skeptical about the health IT systems investments.

We experienced that healthcare IT  transformed a lot since 2010, i.e. from the early days of Obamacare. Since the last two years, healthcare professionals have started talking about various new technologies such as AI, machine learning, blockchain for healthcare, etc. This is an obvious reaction from the healthcare industry, as it is usually the last one to adapt. Though everybody refers  to advanced technologies for business, in our conversation, we found  that the real penetration of such technology is still in the nascent stage..

Because of all these lows and a few other factors, the industry  slowed down. It has now just started to open up with new product plans, new technology adoption plans, business expansion roadmaps and many other plans for growth. Let us look at the Healthcare technologies you should keep an eye on this year:

1. Artificial Intelligent (AI) and Machine Learning

AI and machine learning require enormous amounts of  data to be functional. Professionals have spent a decade  building such data repositories that can be fed into the algorithm.  Until the end of 2017, professionals we spoke to mentioned that they felt comfortable with the tech after verifying a few use cases on basic modules to check feasibility. This year, they want to focus on taking this further by moving from  pilot to real projects.

From 2000 to 2017, the majority of paper-based systems  transformed into  paperless electronic systems. In this timeframe, a majority of  healthcare professionals were busy converting these paper-based systems to different web technologies.

In 2013, the industry sensed that  the enormous amount of healthcare data could be leveraged through web technologies and utilized  for better insights.

This year, we predict that the following functional areas will be in focus to implement AI and machine learning.

Care management –  improve patient insights for better care management

Wellness platforms –  plot patient’s health roadmap and work on disease prevention through wellness

Provider/ payer operations – to reduce the operation cost, improve relationship (satisfaction score) and time for provider and payers

2.  Internet of Things (IoT), Internet of Medical Things (IoMT) and Wearables

According to Gartner, “By 2020 more than 95% of new product designs featuring electronics will incorporate connected sensor component”.

Last year, various IoT, IoMT, and major tech companies launched their wearable device collections into the market. Apple has made a huge investment in the advancing carekit and research kit to track  vital health stats.

‘Prevention’ is the big reason behind the soaring popularity of wearable healthcare devices. Features such as tracking patient data and identifying the patient’s risk score, and suggesting wellness activities through which a patient could lead a healthy life, are very popular

This year, we expect more hospital devices to turn into BLE devices to gather more data. One more functional area in which we can expect massive changes through IoT technologies is in homecare and hospice. IoT devices become very handy when it comes to virtually tracking a patient’s statistics.

3. Voice and chatbots

In the current healthcare market, penetration of voice bots and chatbots is low compared to other technologies. Google and Amazon are trying to grab the maximum market share through their voice bots, Google Home and Alexa respectively. This year, many tech companies will incorporate chatbots and voice bots into their existing applications. Consider the use of voice bots in the homecare and hospice setup. We saw an increased request from our customers to add a chatbot and voice bot feature in the patient portal for extra comfort and better engagement. It also does not hurt, if in the process we can gather better data for insights.

 Bots are crucial because they act as a supplement to machine learning and AI algorithms. We spoke earlier about how these AI algorithms hog  data. Bots leverage focused conversations to easily gather patient data . Bots not only help to capture patient vital stats but can also gather behavioral data.

4. Augmented reality and Virtual reality 

At the last HIMSS conference, Microsoft showcased how ‘Microsoft Hololense’ could be useful in healthcare. Google also re-launched the ‘Google glass’. Augmented reality and virtual reality will be very useful for physicians to view a patient’s data  in a completely different manner.

This year, we can assume that various tech companies will evaluate feasibility by implementing basic functional modules. Although the technology penetration will remain low for the year, we see the tremendous potential.

In  2018, the Blockchain technologies will evolve to the next level. We are sure of one thing – by the end of 2018, we might have taken a few more steps towards matured data engineering market in healthcare industry.

Lets us know what you think of it!


Nitor Healthcare Team


Best Practices for Fixed Price Proposals

Fixed Price proposals are tricky to deal with. Any fixed price and fixed schedule proposal has the chances of budget and/or schedule overrun. This can affect the profitability of the project.

Best practices on writing the fixed price proposal to cover the risks are as below.

  1. Proposing a Discovery Phase where the clarity is around 70%. This helps in:

a. Locking the scope of the entire project, in the interests of predictability. A Flexiblity Matrix, for example, will help guide initial scope and planning discussions. A WBS (Work Breakdown Structure) can organize the work to be completed by the entire team.

b. Finalizing the technology stack

c. Finalizing the UI/UX

d. Finalizing the business rules

e. Finalizing the hardware/devices etc. to be supported

f. Creating a technical rapport with the customer team

g. The deliverables of the discovery phase should be as follows:

  • Architectural recommendations
  • Detailed user stories documented for the project along with acceptance criteria
  • UI/UX defined along with wireframes/mock-ups
  • Detailed release plan created along with sprints defined in all releases
  • Commercials & milestones defined as per the defined scope

2. Proposing an MVP-Minimum Viable Productwhere clarity is low

a. This helps the customer to gain confidence

b. A customer can approach the market and get market feedback

c. Customer can define the next plan of action

3. Proposing creation of a Proof of Concept (POC) for technical items for  the clarity of requirements if the  technical approach is unclear

a. This helps in finalizing the approach, which can be estimated

b. Customer gains confidence about the approach

4. Proposing multiple approaches:

a. Multiple technologies approach

b. Multiple timelines and budget approaches

c. This helps in gauging the customer’s budget and technology preference. In turn, the understanding evolves.

5. During estimation, appropriate padding/buffer needs to be added:

a. The padding or buffer should be over and above base development efforts. The development efforts should include the infrastructure setup, design, architecture and user interface efforts.

b. The Rough Order of Magnitude (ROM) estimate should be also be calculated. A ROM is a cost estimate provided for budgeting purposes. Seventy-five percent accuracy of a ROM is considered acceptable.

c. If the number of resources allocated to the modules of project is more than 5 per module, redundancy has to be considered

6. Mapping of customer’s objectives to our approach plan

a. List all customer’s objectives –technical, strategic, operational, go-to-market, process, etc.

b. Map these objectives and provide action plan with periodic reviews


7. Documenting the assumptions in detail

a. Assumptions are the basis of estimates. Therfore they must be documented in detail

b. Assumptions should be classified as :

  • Scope related – This are assumptions about the overall scope of project/engagement
  • Technical assumptions – These can involve the technology stack, integration with existing software, globalization, devices/browsers etc. supported, user interface, interfaces exposed etc.
  • Non-functional requirements related – These can involve security, performance, scalability, hosting etc.
  • Project Execution – Execution methodology, execution and documentation tools, collaboration techniques, points of contact etc.
  • Expectations from customer – Customer specific requirements such as infrastructure, VPN/network, software/hosting licenses etc. should be documented

8. Attaching appropriate case studies in the proposal – technical, domain, process-related

9. Having sync-ups with customers before the proposal due date to get as many details as needed

10. Change requests  are important for any fixed price proposal as scope creeps can affect the cost and/or schedule, leading to situations in which it may become necessary to re-baseline immediately.

a. Change request process should be documented. This includes:

b. Change management process for scope and schedule changes

c. Change request logs – documentation of change requests

d. Change request steering committee definition – this is for approval of CRs and escalation handling

f. Change request approval process

g. Procedure for change request addendum for cost and/or schedule changes

h. The proposal should also define the upper limit of the cost of a change request as a percentage of the overall cost of the project.

11. Providing an appropriate governance structure as per customer characterization

a. Strategic customers should have a fortnightly review with the steering committee, including the leadership team and a weekly sync up with the management team

b. Mid-size customers should have a monthly sync-up with the steering committee, including the leadership team and a weekly sync up with management team

c. Start-ups should have a heightened sync-up – twice a week reviews with the management team

12. Define payment milestones as below:

a. Kick-off should have a major chunk of payment – 30-40%

b. Milestones until QA should be defined as per actual resource loading

c. UAT and defect fixes milestones should be for 2-3 weeks and should have 10% final payments

d. Documenting all payment details – travel, payment realization etc. and appraising customers

Patient Engagement beyond Patient Portal

The healthcare industry has evolved at a rapid pace after the Affordable Care Act (ACA) was enacted in 2010. In the last 7 years, the dimensions of business and technology for every entity of healthcare were changed. The changes in the payment model (fee for value-based service) put the patient at the center  of this  horizon.

This helped to go toward achieving the ‘Triple Aim’ of healthcare:


Providers are facing multiple challenges while implementing the processes to achieve holistic population health management.’. Mostproviders offer a Patient Portal (a type of health portal) to their patients as a way of modernizing their patient engagement solutions. However, do  patients use the Patient Portal to the fullest? In our opinion, providers have a wide scope to implement new features to enhance patient engagement and optimally leverage their patient engagement strategies

Most providers jumped at adopting the Patient Portal to meet the MU1 and MU2 compliance requirements. However, the true benefits and potential of this patient engagement technology  has not been achieved. The patient and providers will experience the true benefit of the Patient Portal when proactive patient participation is part of the system. To achieve this,providers need to partner with patients at multiple levels. This will bolster patient participation.

Patient Engagement challenges in the existing ecosystem:

In the current healthcare ecosystem, most  providers are facilitate patient portals for compliance purposes only. If your Patient Portal is not utilized by the patient at the fullest, then the cost of the Patient Portal is an overhead for your practice. Beyond compliance, the organic usage of the Patient Portal by patients will be very helpful for practices.

Proposed changes in Patient Engagement Strategy


Patient Registration:

Patient registration, which needs admin staff,is always an activity for providers. . In busy hours, there could be more messy situations in which chances are high that admin staff would enter wrong patient information. This small mistake could lead to claim denial when the provider sends patient’s information to the payer.

Our Recommendations: Currently very few patient portals allow patients to pre-register before entering the hospital. This results in  extra costs the hospital needs to bear on registration staff. It also leads to chaos at hospital registration counters.. Patient portals should provide pre-registration to patients by entering all their demographic details and insurance information.

Patient Access:

In existing Patient Portal systems, the patient can view very limited and previously known information such asdemographic and scheduling .  The Patient Portal  should showcase the patient’s 360-degree view which gives a snapshot of actionable insights.

Our Recommendations: As mentioned above,  providers started providing patient information access to patients to meet MU compliance. Currently, a patient can view only limited information, which he/she already knows. The patient should able to view all his/her electronic health records, including episodic level medical history, real-time vital stats, and personalized patient education. This will be helpful to go towards patient participation. To implement these changes, wearable device integration and patient education material needs to be incorporated into the patient portal.

 Patient Participation:

The current Patient Portal gives very few opportunities to patients to participate in the care delivery process. One more reason for little patient participation is having limited information to view. If the patient can get access to more information, he/she might participate actively and get a better quality of care.

Our Recommendations: Currently patient participation is limited to scheduling. The patient should feel that he/she is a part of this system. This could be achieved by implementing new functionalities in a Patient Portal such as health related assessments at the time of scheduling an appointment, personalizing preferences for patient education, feedback for provider’s services, etc. In the long run, telemedicine could be a part of a Patient Portal to enhance patient participation.

Patient Conferring:

The goal of the Patient Portal should be the proactive participation of patients in the care delivery process. This will enable physicians to get more patient-centric data, which will be more insightful while generating actionable data. Currently, patient participation is limited to scheduling or sharing medical reports, etc. Sharing behavioral trends/changes and an intense feedback system will be helpful in  managing chronic diseases or for long term coordinated care.

Our Recommendations: The next level of patient participation will be patient conferring. Currently, very few patient portals allow the patient to participate in the care delivery process. The proactive participation of patients will be very  helpful for physicians to arrive  at an exact conclusion in a  short period. A continuous feedback system, sharing emotions,  behavioral patterns, and healthcare gamification scores are some  things which will enable patients to proactively participate in the care delivery process.

Patient’s Wellness:

In the last couple of years, wearable technologies have emerged. These can disrupt the growth of patient engagement. Tracking real-time vital stats via, for example, telehealth can be easily used to move from illness to wellness.

Our Recommendations: We feel that patient engagement can be achieved at its peak only if both clinical information and wellness information used in an appropriate way. Wearable device integration, real-time activity tracking, personalized and team wellness goals, rewards for goal accomplishment, etc. are viable avenues for investment. This type of wellness information will be very helpful for physicians to ensure quality of care and  clinical information.

As we know, a Patient Portal is not  the only tool for patient engagement. However, we feel that a Patient Portal is a platform in which most of the other patient engagement tools or ways could be merged seamlessly; for example, telemedicine, wearable data integration and much more.. We feel that ‘Patient Portal 2.0’ is an opportunity for providers to take their practice to the next level by offering an integrated patient experience.

Demystifying FHIR Components and Resources

Healthcare records are increasingly becoming digitized. As patients navigate the healthcare ecosystem, their electronic health records must be available, discoverable, and understandable. Further, to support automated clinical decision support, interoperability, and other machine-based processing, the data must also be structured and standardized.

FHIR is a new specification based on emerging industry approaches and informed by years of lessons about requirements, successes, and challenges gained through defining and implementing HL7 v2, HL7 v3, RIM (Reference Information Model), and CDA (Clinical Document Architecture). FHIR is used as a stand-alone data exchange standard. FHIR standards are based on the latest tech stack – JSON, RESTful APIs, XML, HTTP, etc. However, it also has its uses in partnership with widely used standards. FHIR has resources (data formats and elements) and API (Application Programming Interface) to exchange the data from EHR (Electronic Health Record).


The basic building block in FHIR is a Resource. All exchangeable content is defined as a Resource. All Resources share the following set of characteristics:

  • A common definition and representation, built from data types for common reusable patterns of elements
  • A common set of metadata
  • A human readable part

Differentttypes of resources  can be used to exchange and/or store data to solve a wide range of healthcare related problems, both clinical and administrative.This specification also defines several different ways of exchanging the resources.

A resource is an entity that:

  • has a known identity (an URL) by which it can be addressed
  • identifies itself as one of the types of resource defined
  • contains a set of structured data items as described by the definition of the resource type
  • has an identified version that changes if the contents of the resource change

Resource Example: Patient

This simple example shows the important parts of a resource: a local extension, the human readable HTML presentation, and the standard defined data content.

FHIR has resources for administrative concepts such as a patient, provider, organization and device as well as a wide variety of clinical concepts covering problems, medications, diagnostics, care plans, financial concerns and more.

The resources are described in several different ways:

  • A hierarchical table that presents a logical view of the content
  • An UML diagram that summarizes the content graphically
  • A pseudo-XML syntax that provides a visual sense of what the end resource instances will look like in XML
  • A pseudo-JSON syntax that provides a visual sense of what the end resource instances will look like in JSON
  • A pseudo-Turtle syntax that provides a visual sense of what the end resource instances will look like in Turtle

FHIR Implementation

FHIR aims to simplify implementation without sacrificing information integrity. FHIR has built-in mechanisms for traceability to the HL7 RIM and other important content models. This ensures alignment to HL7’s previously defined patterns and best practices without requiring the implementer to have intimate knowledge of RIM or any HL7 V3 derivations.

In a nutshell, FHIR is the future of healthcare interoperability given that it can be extended to mobile, iPads, etc. One does not need to be an HL7 expert but an understanding of FHIR structure components and resources, how to use them, backward compatibility use will suffice the need for implementation. FHIR will help data exchange and data integration to progress by leaps and bounds so that we can achieve global ideals such as ehealth and connected health.

Upcoming topics that you can find shortly are:

  • Detail analysis to early adopters of FHIR standards
  • Migration Roadmap to FHIR from your current HL7 version

Hybrid Mobile Application Development Technologies

The advent of Digital Transformation has instigated Mobile Application Development, especially hybrid mobile app frameworks, as an integral part of the digital transformation strategy for enterprises.

Rapid release cycles, cost-effective pricing and a Native Look and Feel are the key success criteria for mobile apps in this era. To achieve all these three success criteria, Hybrid Mobile Application Development is the strategy used by enterprises for key differentiation between native vs. hybrid apps

This blog provides insights into the technology trends & evolution of Hybrid Mobile Application Development platforms with the comfort of Native look and feel.

The two most promising candidates in Hybrid Mobile Application Development frameworks with Native look and feel are:

React Native:

  • Salient Features
    • React Native scores over Android System WebView-based tools in achieving 60 FPS and a Native look & feel (e.g. Button, timer, sound, proximity, alert, calendar, ImageView, etc.) to apps
    • Target multiple platforms (Android, iOS, Web, Windows, and Mac OS) with React Native APIs

Write once use everywhere’ with React-Native

  • About
    • First announced by Facebook in 2015
    • Latest release: 0.41 in Jan 2017
  • Technical Insights
    • Uses JSX – syntax extension to JavaScript. JSX looks like a template language, but it comes with the full power of JavaScript
    • JS(npm) is the React Native CLI
  • Redux:
    • Predictable state container for JavaScript apps
    • Helps you write applications that behave consistently, run in different environments (client, server, and native), and are easy to test. On top of that, it provides a great developer experience, such as live code editing combined with a time traveling debugger
  • Flux
    • Flux is an architecture that Facebook uses internally when working with React
    • It is a new kind of architecture that complements React and the concept of unidirectional data flow


  • Salient Features
    • With NativeScript and Angular 2, a single code base can be used to create web apps and native mobile apps with 100% native performance and power
    • Provides direct access to 100% of the native platform APIs via JavaScript and reuse of packages from NPM, CocoaPods, and Gradle
    • Enjoy glorious 60 FPS without being a CSS or JavaScript wizard, even on Android & iOS
  • About
    • Backed by Telerik
    • Latest release: 2.5 in Jan 2017
  • Technical Insights
    • Telerik NativeScript (tns) is the CLI
    • You can use the tns create command to scaffold apps at a variety of different starting points e.g. tsc for typescript template and ng for angular template
    • Native API Reflection (A.K.A 0-Day Access)
      • Instead of separate binding layers between NativeScript and each mobile platform API, NativeScript uses reflection to gain information and metadata about the native platform APIs
      • As JavaScript (or TypeScript/Angular) can talk directly to native code, no need to write binding layers in Objective-C, Swift or Java

Other two previous generation platforms i.e. “PhoneGap (Apache Cordova)” and “Sencha Ext JS” have been documented to provide historical insights for the journey of Hybrid Mobile App Development.

PhoneGap (Apache Cordova):

  • Salient Features
    • PhoneGap (distributed by Apache Cordova) is a Hybrid App Development Framework that allows you to compile and deploy apps across multiple platforms
    • Uses a Webview component to render the apps
    • It allows you to use standard web technologies – HTML5, CSS3, and JavaScript for cross-platform development. Applications execute within wrappers targeted to each platform and rely on standards-compliant API bindings to access each device’s capabilities such as sensors, data, network status, etc.
  • About
    • Open source mobile development platform by Apache
    • Latest release: 6.x
  • Technical Insights
    • Cordova CLI is a high-level tool that allows you to build projects for many platforms at once, abstracting away much of the functionality of lower-level shell scripts. The CLI copies a common set of web assets into subdirectories for each mobile platform, makes any necessary configuration changes for each, and runs/build scripts to generate application binaries
    • The Apache Cordova project maintains a set of plugins called the Core Plugins to access the accelerometer, battery, camera, contacts, media, vibration, etc.

Sencha Ext JS

  • Sencha Ext JS is used to create data-intensive HTML5 applications using JavaScript. Ext JS leverages HTML5 features on modern browsers while maintaining compatibility and functionality for legacy browsers.
  • Salient Features
  • Features rich Data Analytics using D3, Sophisticated Data Visualization
  • Accessibility package for Section 508 compliance
  • Customizable out-of–the-box themes
  • About
    • Sencha Ext JS is made available under Commercial License or the GNU General Public License version 3 (GPLv3)
    • Latest release: 6.2.1
  • Technical Insights
    • Sencha Cmd is the cornerstone for building Ext JS applications. Cmd provides a full set of lifecycle management features including Scaffolding, Code Minification, Production build generation, and more, to complement your Sencha projects
    • IDE plugins, Themer, Architect, Inspector, Stensils provide platform for rapid development

Facebook and Telerik are spearheaded by Hybrid Application Development with “React Native” and “NativeScript” frameworks. Clearly, the industry is moving towards JavaScript frameworks-based mobile application development, leaving behind native languages (Objective C, Swift, and Java).

Please write to us at if you are interested in joining us as a Hybrid Mobile App Developer.


Open Source Full-Stack Millennial Programmers (MPs) at Nitor

Software Products and Enterprise Digital Platforms are disrupting the market  So are development tools, programming languages, and development platforms. All of these  impact the job description of a software developer. The paradigm of the Full stack and Cross stack developers (often used interchangeably) has been there for some time now. However, the compelling options offered by brand new development platforms are  making this paradigm almost inevitable to adapt.

We at Nitor call this evolution in software development as an era of “Open Source Full Stack**” software development. This era is reflective of Millennial Programmers (MPs) who have the attitude and aptitude to embrace Full Stack development. A quick glimpse of how these  millennial developers think, work and adapt based on some real incidents:

Functional Programming (FP) Languages: One of our groups of MPs was tasked with evaluating the possible usage of functional programming languages like Scala or Kotlin (which interoperates with Java) to specifically benchmark performance and code maintainability. MPs self-trained themselves on Kotlin. We reviewed these prototypes on Kotlin in a matter of days. It was overwhelming to see how these guys were able to adapt to complex FP concepts such as pure functions, lambda calculus and higher order functions with equal ease as that of traditional object-oriented programming concepts.

Design thinking in action: We were challenged to build a very complex document parsing engine which would parse terabytes of documents every day. Given the tight timelines, our team convinced the customer to use design thinking to do rapid prototyping instead of a  lengthy design (documentation) phase. What followed was a crisp prototype built using open source cloud-based software, and design that could seamlessly auto-scale and parse TBs of documents daily. Machine learning was applied for identifying the right document template to parse, and an open source rule engine was used to configure rules for the parsing algorithm – all in just a month’s time!

Patterns and Practices in Software: Robust software products should be built using principles of configurability, modularity with security, interoperability, and interfaces (APIs, queues, and service bus), monitoring and health checks. Traditionally, architects used to toil hard to build these blocks as custom frameworks in the software. However, things have evolved very fast in this area. Fast forward to last week, when one of our developers used Spring Boot just to click through and add some annotations to create a solution structure with most of these abilities plugged into the software.

Overall, the whole approach and lingo have changed. Here’s how:

  1. The debate of the API-first approach has been settled, and MPs are now widely using new frameworks to build loosely coupled microservices.
  2. JavaScript (JS) and JS stack programming has evolved. Typescript is the new JavaScript. ReactJS has emerged as a preferred hybrid mobile-first platform for many. MPs have adapted to this change with great ease.
  3. First Time Quality is an old mantra. However, advanced tooling for TDD/BDD/DevOps have empowered MPs to make it the de-facto way to build code.
  4. Docker is disrupting the manner in which cloud-based software is built – this needs a learning curve to design around these new capabilities
  5. Serverless code architecture with Amazon Lambda and Azure Functions is re-defining the paradigm of pay.

Data lakes and high- performance columnar DBs are replacing traditional DWH (Data Warehouses) and traditional MPP (Massively Parallel Processing) DWH. Data Analytics has become synonymous with predictive analytics and Machine Learning. They have started to build visual tools for data scientists and data analytics. The important  point is that the fine line between application developers and data developers is getting blurred.

In fact, Microsoft, which was once a very close development platform for Windows OS, is now making forays into Open Source. It has been  in the news for its open source platforms,.Net/ASP.Net Core, which have introduced modular deployments. Java 9 with Modular JDK and Modular Source code stands toe to toe.

All these changes call for full stack developers who can keep learning and adapting faster than ever before. Organizations will find it compelling to hire “Open Source Full Stack Millennial Programmer” instead of  specialist developers.

Nitor being a niche technology company in software product engineering services, we at Nitor see an increase in demand from our customers for such developers. Our target is to incubate, i.e.hire and ensure that we increase the head count of full stack developers at least four-fold by the end of this year.

For organizations like us, this also calls for a major cultural and mindset change in how we incubate and manage these programmers, including adapting ourselves to the technology of millennials. Please watch this space for more on how we plan to do this. Till then, Go Full Stack!

** Please write to us at if you want to join us as a Full Stack Developer.  

Sneak Peak of iOS 10

What’s New in iOS 10

In August 2016, Apple came out with the iOS 10 version at the Worldwide Developers Conference and since then, the popularity of iOS 10 is on the rise.

The iOS 10 updates need to be integrated with your existing  and upcoming apps. I have  summarized the key updates, so that iOS users can get started with these right away.


  • One needs Xcode 8 to build apps using iOS 10
  • Working with iOS 10 requires you to code using Swift 3 unless you specifically request Swift 2.3



  • First among the new iOS 10 features is updates to iMessage. With the Messages framework, you can build a standalone iMessage app, or an extension to an iOS app that lets users interact with your iOS app without leaving Messages.
  • For example, using iMessage, users can easily create and share content, add stickers, make payments and more, without leaving their conversations.
  • Furthermore, similar to Maps extensions, you can provide a custom user interface inside Messages by using theMSMessagesAppViewController
  • For Creation of interactive messages – i.e., messages that live inside a session that’s shared across multiple users, it can be updated as a group. Using MSSessionand MSMessage, users can collaborate to modify the same message multiple times.
  • MSMessagehas built-in support for expiring messages: just set shouldExpire to true to have the message deleted after a short while.
  • One feature you will particularly love is the new Xcode 8 Simulator, which has a developer mode. It lets you see both sides of the conversation, which makes debugging easier.


  • Although this feature was introduced in iOS 8, creating animations was a complex procedure.
  • The iOS 10 version has revamped it, making the process simpler and easier.
  • You now have much more minute control over animations, including the ability to pause, resume, stop, and work through animations for any of the following properties – positions, alpha, transform, and more.
  • All you need is the UIViewPropertyAnimatorclass, which lets you create reusable animations and trigger them whenever needed.
  • The animator acts directly on the views you specify. It can perform operations like startAnimation(), pauseAnimation(), fractionCompleteand more.

Speech Recognition

  • When it comes to iOS, people think speech recognition only in terms of Siri, however in iOS 10, speech recognition is much more than Siri.
  • iOS 10 has introduced a new Speech framework, which is an API for speech recognition. This is the same underlying technology used in Siri and Dictation.
  • There are four steps to adopt speech recognition in your app.
  • First– Provide a usage description using NSSpeechRecognitionUsageDescription in your app’s info.plist describing how you intend to use speech transcription.
  • Second– Request authorization using the SFSpeechRecognizerSpeech function. Recognition requires transmission of user’s audio over the Internet as the recognition doesn’t happen locally, but on apple’s servers. Therefore, it is mandatory to get the user’s authorization.
  • Third– Start speech recognition. Audio for the API can be provided from either pre-recorded files or a live source (like a microphone). SFSpeechURLRecognitionRequest lets you request transcription of an audio file at the mentioned URL. To recognize audio from a microphone we need to use AVAudioEngine to get a stream of audio buffers.
  • Fourth– Return the result – transcript ready for display or processing using SFTranscription.


  • The rich notifications feature introduced in iOS 10 is a huge update for developers. It affects both Push and Local notifications.
  • You can now send rich media in a push notification, including images, GIFs, audio, and video clips. Including media in your push notification can increase the open rate and drive more engagement to your app.
  • With this new feature, users can take immediate actions without directly opening the app. Notification Actions empower the developer to deliver a push notifications experience tailored for their app. For example,with an events app, you could accept a calendar invite within the notification.
  • There are two new frameworks that allow developers to leverage more interactive and robust system notifications. This has also made it possible to have a unified API across iOS, watchOS and tvOS.
  • frameworkgives developers more control over the timing of their local notifications, which can now be displayed according to various time and location parameters. It gives you power to cancel the notifications before they are displayed and changed to an extent that they are no longer relevant.
  • For example, instead of 15 different notifications about cricket/baseball scores, just one notification that says, “Hey, since the last time you’ve looked at your phone, this is how the score has changed.”
  • iOS 10 also introduces framework, which, as you may have guessed, allows some basic controls over how your app’s notifications look and react to user input. As it is Apple, do not expect complete control; however, you can  build an app extension that can communicate with incoming notifications. This allows your app to serve up live content or visual displays directly within the notification.


  • Siri unlocks a new dimension of functionality in iOS 10, i.e.allowing third-party apps to integrate inline into the Siri voice assistant experience. In simple terms, SiriKit is Siri + Apps. It enables your iOS 10 apps to work with Siri, so users can get things done with your content and services using just their voice.
  • For iOS 10, the Siri API will only work with six kinds of applications: ride booking (think Uber), messaging, Photo Search (find photos and videos in a particular app), payments (‘Send $100 to John with PayTM’), VoIP Calling (say Skype) and Workouts (for starting health and fitness activities).
  • Following are the major steps involved in setting up Siri support for your application:
  • Speech, which is when your user is giving the app a command.
  • Intent, which interprets the command speech and matches it up with something that the application can do.
  • Intents come in two forms: graphical and non-graphical.
  • The non-graphical intents are useful when you want to hook right into Apple Maps – you do the processing, but you want Maps to display the results.
  • Graphical intents are called Intents UI Extensions, and let you extend the UI for Siri or Maps with your own interface design.
  • Action, which is when your app actually does the thing specified in your Intent
  • Response, where the user is asked to confirm that the command has been interpreted correctly and whether they’re sure they’d like to perform the specified action.


  • Apple introduced ReplayKit with iOS 9, allowing apps to offer users the ability to record and share gameplay or screencast videos directly from within the app.
  • With iOS 10, Apple is introducing ReplayKit Streaming, allowing users to also live stream video of their iPhone screen .
  • ReplayKit provides the RPScreenRecorderclass to get user permission for recording and notifying Replay Daemon to start writing app’s data to a movie file. RPpreviewViewController class gives the users an interface where they can preview, edit and share the video that they created.

Xcode Improvements and minor tweaks

  • Xcode 8 includes everything you need to create amazing apps for iPhone, iPad, Mac, Apple Watch, and Apple TV. This radically faster version of the IDE features new editor extensions that you can use to completely customize your coding experience.
  • New runtime issues alert you to hidden bugs by pointing out memory leaks, and a new Memory Debugger dives deep into your object graph. Swift 3 includes more natural and consistent API naming, which you can experiment with in the new Swift Playgrounds app for iPad.
  • Xcode has come up with few welcome improvements. It gives an ability to use both Swift 2.3 and 3.0 at the same time. This means developers can upgrade to iOS 10 but also keep existing Swift code, and migrate to Swift 3.0 only when ready.
  • Xcode 8 gives developers the ability to preview devices with ease. Instead of thinking about design layout in an abstract way, they can now test the code on actual device sizes. Working with image literals is thus easier. All developers need to do is add the images to the project assets and they are immediately available as code. For instance if you have an image name welcome.png you can write like image = welcome. The welcome will also have a thumbnail so that developers know it is working.

We’re confident that the new iOS 10 feature insights will help you optimize your products to the newest operating system.

 Nitor’s Mobility expertise:

  • Our Mobility practice helps you make the right choice of platform (point vs. mobile enterprise application platform), hardware, software, and applications.
  • Our team guides you on accelerating the return on mobility investments and managing upfront capital expenditure, while reducing the operational expenses of licensing, upgrade and support. Nitor develops native, web and hybrid mobile applications across platforms.
  • Our applications that have gained mass acceptance include mobile analytics and reporting apps, store locators, financial advisory services, and business process apps with a line of business integration.

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