Combining Agile and Traditional Methodologies in Medical Information Systems Development Process

Having experience with different traditional and agile methodologies in medical information system development and upgrade projects, we support the statement that no single methodology can be used with its full potential in all cases. Instead, mentioned methodologies have their own place in complex software projects and within certain category of sub-projects give the best results. In this paper we presented the guideline on choosing adequate methodology in different development and upgrade projects. All examined projects are defined within the scope of larger medical information system called Medis.NET developed by our research group, and deployed in 30 healthcare institutions. The bottom-line is that during requirement collection we rely on model and feature driven development supported by automatic code generation tools, which lead to faster prototype generation. Next, dividing the set of functionalities to sub-projects we group them in three categories – core projects, useroriented, and loosely coupled application. For core projects we find traditional methodologies suitable since their outcome is a stable process and rich documentation. User-oriented sub-projects are developed under standard SCRUM, while for loosely coupled applications we chose Lean. We measured the effects of chosen approaches comparing time spent against estimated time for development, and by analyzing code metrics. Code metrics were automatically generated by our development environment, Microsoft Visual Studio, and we take into account few major values such are maintainability index, lines of codes, class coupling and cyclomatic complexity. In addition, we propose an adaptation for Lean model which gave us promising results in software upgrade projects. The proposed approach put additional responsibility to lead architects, since have to properly identifies all pros and cons for different methodologies and, knowing this well, wisely choose the right methodology for the right sub-project.