Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.

Software lifecycle management is a complex phenomenon with each stage posing its unique technical and other challenges. Maintenance and enhancement of software brings in its own share of complexities to this phase. While uncertainties associated with software baseline in themselves pose a huge challenge in planning and estimation of maintenance activities, there are several other factors that contribute to overall success of software maintenance project especially in an outsourcing scenario. This paper brings out the results of an analysis of some such factors, their interrelationship and influence on software maintenance activities and effort.

IT outsourcing, which commenced as a cost reduction operation, has now become an essential parameter for measuring the operational efficiency of an organization. An increasing number of operational IT systems are moving into the maintenance phase, becoming potential candidates for outsourcing. Human and organizational factors, typical to maintenance activities, such as organization climate, customer attitude, engineers' attitude, etc., have a significant influence on software maintenance effort and make the task of effort estimation complex. In this paper we present the results of an empirical study, carried out to identify and study the influence of such factors on software maintenance effort.

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