Category Archives: Uncategorized

premature optimization IS BAD

Product development is very challenging for various reasons. I personally feel that premature optimization is bad. This directly contradicts the tenets of MVP. When we are developing a product, we should aim to skip couple of generations and think beyond (dream big) .

I decided to write this blog after a recent incident that happened in our product design/development team.

I knew that we have a very good design which is built for accommodating changes. So I got the idea of virtual offices so that I can easily include the counseling and nutritionist aspects in the cancer patient care process. People started screaming at me and accused me (in a friendly way of course) of expanding the scope. In my mind, I was focused on the business value and had abandoned all other constraints.

After few design sessions, we all found out that, with very little refactoring, we could accommodate the ‘virtual office’ concept. The point of I am trying to make is, don’t unnecessarily constraint your self if you don’t have to. IMO, this is single most important virtue that differentiates startups (small companies) from big corporations. If you search for ‘corporate innovation’ on Google, you find many articles on why that has become such a hot topic.

Our product Piiker has taken a very different approach at solving the needs of cancer providers and patients. It has put together all the required pieces of puzzle in an innovative manner. This would not have been possible if I had focused more on constraints. Innovation thrives when you abandon the constraints!.


“Our regimen designer plays an integral part in our platform. For example, when it comes to agents used in the cancer treatment, we have professional information and patient related information. In this blog I am going to write about how we deliver patient pertinent details  through our oncology specific patient portal. Patient engagement is very critical in the cancer world. A good patient portal will help in engaging patients to provide an effective treatment and contain costs.”

The following screen shot taken from our oncology specific patient portal shows list of regimens assigned to a patient. Just by a click of button, patient can see many useful aspects about his/her regimen. Providing ultimate UX (user experience) is a very deliberate design in every part of our application.

patient portal blog

Here when patient expands the regimen to see more details, there is an option to see list of agents. Next to the names of these agents, there is a document icon. When use clicks on this icon, they will be presented with the patient centric information about that regimen. You may be wondering how this agent information gets into the platform. That is where our regimen designer comes into picture.

In our platform, we are digitizing all the content related to cancer. It lets us deliver this content in many scenarios, including this particular scenario in patient portal. Regimen designer is the tool which will let you manage this digital content.

If we are able to provide such a rich experience in patient portal, you can imagine how much more information is made available in our provider facing solutions. At the point of care, we cannot have enough information to make a good judgment call. We present all the information you need without compromising the UX (user experience).

In order for the treatment to be effective, patient adherence is critical. In our patient portal, we provide rich calendaring options. We can deliver reminders (optional) through email and/or text.

patient portal - calendar

This screen shot taken from our oncology specific patient portal, shows scheduled events for this patient.

It is important to deliver clinical information in a patient friendly manner. The following screen shot shows how we deliver lab information to patients through our oncology specific patient portal.

patient portal - lab information

ignorance and confidence

“All you need is ignorance and confidence and the success is sure”

                                                                                         Mark Twain


I hope there is some element of truth in this quote from Mark Twain.

On one hand we have companies like McKesson, ABC(ABSG), Altos, FlatIron and Varian, who have team of super talented people building cancer related solutions. Besides talented people, they are big, have long history and credibility in the industry (not to mention the access to cash to make anything happen).

On the other hand, we have my tiny company trying to build the cancer related solutions and compete in the same market place. As you can tell, I have plenty of ignorance and confidence. Going by Mark Twain’s quote, I do have chance for success Smile

Kidding aside, what we have in our product PIIKER ( is really amazing. In order to build a comprehensive cancer solution many things have to be place (agent management, cancer site and ICD 9 & 10 management, side effects, ability to manage regimens, EMR, chemo therapy administration, scheduling, security, user management, scalability, multi-tenancy, performance, patient portal and plenty other factors). How do you architect a product which has seem less integration of these factors yet very simple to use and provides best UX (user experience)? We have done it, it is hosted in Microsoft Cloud (Azure).


Before iPhone, we had BlackBerry and PocketPc as smartphone options. I used to own PocketPc. Microsoft did manage to shrink the whole OS onto this small device. Then came the iPhone, they took subset of what was there and focused on simplicity, UX and ease of use. Rest is history.

Similar things are going to happen in the oncology solutions. Cancer regimen is complicated. How do provide all the important information to the decision maker at the point of care? How can we do this  an effective and simpler way? How can we still maintain a great user experience?


Like BlackBerry and Pocket, we have had some great solutions from McKesson, Varian and Altos. There is no end for innovation. People are seeking to make things better. Recent news of Varian and FlatIron  collaborating to build oncology solution is a big step in that direction.

We ( are a very small company compared these companies I have mentioned above. But, we are not short on innovation. The way we present the regimen information at the point of care, the kind of UX we are providing is awesome.

Cancer world needs better tools and solutions. I am glad to be part of the innovation driving this.

Collaborative Inventory, Dispense & Payment


Most of the Rheumatology practices manage their drug inventory and dispensing information on paper. Current breed of EMR/EHR solutions do not have very good support to help with this workflow.

Our product Koduq is designed from ground up to help these medical practices to be more productive and reduce errors.


Track drugs entering your practice from the time it is placed into inventory, through dispensing, the billing cycle, until full payment is received. Eliminate unbilled, misfiled or misplaced drugs. If your practice is currently managing drug inventory with spreadsheets or paper then use the best product in the industry to modernize your practice. With KoduQ you will instantly save valuable staff time and cost.




Mobile Access


When information is easily accessible, stake holders can take timely actions to make their businesses run smoothly and cost effectively. Our solution has rich support for mobile access to information. Users can access information from their computer browsers, iPhone and iPad. To enhance the practice workflow for dispensing, native iPad application is provided to manage daily dispenses.







pic 2



Key Benefits



Add a given drug shipment into inventory and track the usage. Manage thresholds for drugs and be notified when inventory goes below threshold.


Schedule infusion patient and know what drug & quantity is required. Make sure that, when patient arrives for infusion, you have the drug in the inventory.


Record drug dispensed for a patient in just few clicks. Electronically capture clinical and financial information. It virtually takes same amount of time as your current paper based process.


Determine if a drug has been accurately billed based on actual dispense. Current paper based process will not let the stakeholder access this information easily. 


Eliminate staff hours spent tracking drug doses. Know when to order and what to order easily.


No more manual recordings on paper which is error prone. Record who did the inventory and dispense operations for auditing purposes.


Powerful Reports for Inventory, Dispense and Billing. Find Current Available Counts, Dispensed Counts, Historical Counts (Monthly, Yearly, Daily).


Configure alerts for low inventory, Expiring Drugs, Unbilled Doses.


Identify LOTs that have been dispensed or in current inventory.



Our platform is built using latest industry standard protocols. This will enable us to integrate with various EMR, BILLING and other software systems. Our system also supports importing of EDI ASN files, so that medical practices don’t have to manually key in inventory information when drugs are received.


You can access information from mobile devices from anywhere and anytime. In order to help the physician office workflow for dispensing, a convenient iPad solution is provided.


It is normal practice that when medical practices buy drugs, payment to drug supplier is made through practice account. However, at the tax time, profit-loss should consider who used what drugs (and how many). Our software makes this process very simple. By click of a button, required reports can be generated and sent to CPA for tax purposes.


We do not expect you to sign any binding contracts. If you don’t realize ROI, you can cancel anytime. There is no contract obligation.


Our solution is securely hosted in cloud. There is no need to install any additional software in your practice.


Our system and software are hosted in secure Microsoft Cloud Datacenter. Information is made available only to the authorized users in a given practice.





7 Years ago, I was responsible for delivering a BI solution in which we had to slice and dice the oncology clinical and financial data/information.

Very quickly I realized, if we model the regimen details differently , all the systems down stream (designing the regimen, delivering chemo therapy, cost estimation of a regimen, adherence etc.) could benefit tremendously.

We  have built a powerful system to make this vision a reality. I will be blogging about the system in next few episodes.



Everything a starts with a regimen (which tells how a given type of cancer has to be treated). A typical chemotherapy regimen is quite complicated. It has to take lot of things in to consideration.

We have seen some complex civil structures (bridges, multi-story buildings, roads etc.) being  built. Civil engineers use tools such as AutoCAD to design and model this. Why don’t we provide a similar designer tool to oncologists? Theoretically it is possible to model a given regimen where a clinician can express the details of the regimen. This includes things such as numbers of cycles and length of each cycle, what agents are given on what day in a cycle, if the agents need supportive drugs (to increase the white blood cells, to stop patient from getting anemic etc.).

Well, we took that vision and built a cool designer (think of this a AutoCAD version for Oncologists). For example, the following screen shows a scenario where a clinician is designing a regimen (Happens to be ACT Version 4.0) and modeling the fact that this regimen could be used to treat set of breast cancers









Chemotherapy administration is a very collaborative task. Lot of people have to co-ordinate to deliver chemo agents. Our solution shines in this aspect also.



So much could be done in the area of cancer research and treatment. We are doing our part. Innovations/Improvements will make us productive and reduce errors.

More detail in upcoming posts….

Porting our cancer application to HTML5

When Microsoft released WPF and Silverlight , I thought it was the perfect technology to build healthcare applications. We invested lot of money and time to build a very comprehensive product.

To everyone’s surprise, Microsoft decided to phase out Silverlight and embrace HTML5 wave. I was not sure what to do. Finally decided to invest time and money to convert our Silverlight Application to HTML5


I just wanted to share one of the screens (still in the alpha phase). Intention is to show the patient’s diagnosis in a very effective manner.

I am contemplating on showing tumor size and Tumor response details also (there is enough real estate in there). Decided to show the Onset Date on its own column (even though it is taking so much space) so that users will have the ability to sort (and filter if needed!)




I had blogged this on DEC 22nd 2012. All of a sudden there is spike in the number of views today.

I am pretty sure in principle many people will agree with me. IMHO, Microsoft is primarily a technology company. Whoever happens to be the next CEO must have a very good balance of both worlds (technology and sales). Anything less, will be a mistake. Both Steve Jobs and Bill Gates could visualize lot of new ideas at the same time, they were brilliant sales fellows.


I have seen this trend in many organizations. In their IT department, there is a tendency to be penny wise pound foolish. Instead of buying a a fast computer, they let their resources use computers which are slow.

Let us do a simple math:

Average benefit of your development staff : $100/Hour.

Let us assume that, by using a fast computer (32GB RAM, i7 Processor, SSD etc.) this developer can save 20 minutes per day. This 20 minutes translate to $33/Day. Assuming there are 200 working days in an year this amounts to $6600/Year.

Recently I went to a near by Micro Center and selected the following:

  • A nice mother board
  • Intel i7
  • Two 256GB Solid State hard drives
  • DVD drive
  • 32GB RAM
  • Nice fancy case

Including the assembly cost and taxes, it came up to $1400.00

So, if you invest $1400.00, it will be paid off in first 50 days and you can reap the benefits for next three years (minimum).

OPEN SOURCE SECURITY MODEL FOR Multi-Tenant Applications – part 1

Even though application security exists (role based, permissions, claims etc.) for long time, there is no out of box security which will help us in Multi-Tenant scenario.

I am developing an OPEN SOURCE (FREE) software to tackle this. Source code and other details can be found at:

Most of the ground work is complete. A complete solution which includes data access layer, business layer, REST API, SOAP API, unit test etc. is already in place.

As it is the case with many applications, getting the UI is the most tricky part. In this blog I am going to write about the ADMIN application which is built as part of this open source project.