Healthcare Integration Methodologies – Agile, Waterfall, or Combined?

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Jul 17, 2019

Healthcare Integration Methodologies – Agile, Waterfall, or Combined?

Written by Impact Advisors

Category: IT Strategy & Implementation

I’ve been managing projects and programs for over 24 years and in this time I’ve seen all different types of methodologies and approaches to projects. Most have fallen under the traditional Waterfall methodology, while others have been vendor-specific. In the last three years or so, Agile has been gaining traction in healthcare. So which methodology works the best?

When picking a methodology, there are several factors to consider:
u2022 Are timelines, resources, and budgets known up front?
u2022 What methodologies does the client use and what methodologies do they know?
u2022 What methodologies do you know and what are you comfortable with?

In my experience the methodology used is not as important as delivering quality outcomes on time and on budget. Generally, any methodology will work as long as you stick to it and make sure that your team(s) know and understand it. With that said, the factors I’ve listed above will help in picking the best methodology for your project, but first we need to understand the intended use of each methodology.


Agile – initially designed for software development projects

  • Flexible for short timelines or when the timeline is ever-changing
  • Good for projects where requirements are evolving
  • Higher end-user satisfaction than other methodologies, as they see progress along the way
  • Difficult for budget approval due to an iterative process with no fixed date

Note: Not all projects/programs are suitable for this methodology

Waterfall – traditional project methodology

  • Best when the timelines, resources, and budget are known up front
  • Most customers are all familiar with this methodology
  • Has clearly defined outcomes
  • Lower end-user satisfaction than Agile, as end-users do not often see the result until the end
  • Generally requires optimization after the project is completed
  • Not as flexible to timeline changes
  • Scope creep can be costly and can impact timeline

Now, how do we apply the factors to the methodology when it comes to integration projects or programs? If we look at a traditional interface project, we generally have a budget for the interfaces and resources along with specific due dates. An interface project would fit nicely into the Waterfall methodology.

Next, let’s look at my current integration program. I’m working with a large healthcare organization that is bringing up a new service line. They have brought in the top three surgeons in the nation for this program and the goal is to make this a world-class program u2026 no pressure. The EHR in use doesn’t offer one view into the patient’s chart, therefore requiring a large integration effort which includes the following:

  • Build/Design – EHR optimization and workflow changes
  • Affiliate EHR’s requiring Interfaces
  • New third-party applications with interfaces and API’s
  • One portal view for all of the above for the clinical staff
  • No fixed timelines, changing requirements, and no allocated budget

My client originally started with Waterfall, but it failed due to constant scope changes and evolving requirements. Then they tried Agile, but that failed because all parties involved had not been trained in Agile. When I arrived and looked at the factors I mentioned earlier, we began using a Combined methodology.

Since the client didn’t understand Agile terms, we used the Waterfall steps of Plan, Design, Build, Test, and Deploy and put them into Agile Sprints/Quick Wins called “Bundles”. Each month we roll out workflow, EHR functionality, and integration bundles. These bundles allow clinical staff to give us input along the way and see progress monthly. If the clinical staff has an issue with something, we’ll resolve it in the next bundle. If the clinical staff has an issue with something, we’ll resolve it in the next bundle.

The result? The clinical staff is now seeing progress and feels heard. The program team has a structured approach we can stick to and deliver. This program has several phases that will continue long after I’m gone, but the service line is up and providing quality patient care while we slowly give the staff the tools needed for better outcomes.

As I stated earlier, any methodology will work as long as everyone understands it and sticks to it. In the end, the methodology is secondary to delivering quality outcomes on time and under budget, but picking the best methodology for your project will help contribute to your timeliness and ability to stay within the budget.