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Winter Growth

When your clients’ lives are at stake, you need software that helps you make the right decisions quickly.

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For nearly 40 years, Winter Growth has been helping people in greater Washington DC care for their older family members in the most kind, attentive and complete way possible. What was once just a day program in the founder’s own living room now spans three facilities and includes everything from wellness and activities programs to full-time assisted living, transportation services and more.

In a setting like this, decisions truly can be life or death. Technology at Winter Growth needs to perform not only standard data and reporting tasks, but it also needs to offer checks and balances against the potential for human error. And, of course, it needs to adhere to all of the guidelines outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Winter Growth’s not a retirement community or a senior center, and it’s not a nursing home or hospice — it’s bits and pieces of all of these. So when its directors went looking for software to help them manage all that they do, they found that no single off-the-shelf product fit the bill, because Winter Growth itself is not off-the-shelf.


Beyond the standard hurdles that any data application faces, this project also offered some unique challenges:

Workflow Complexity
Even though we’ve developed applications that are larger and provide more functionality than what we created with Winter Growth, we’ve never seen a client have to deal with more moving parts, exceptions to rules or logistical acrobatics than what Winter Growth goes through on a daily basis.

User Accountability
Almost all of our work requires some level of restricted access and account-based permissions, but when multiple agencies could show up at your door at any second for an impromptu audit, the stakes are much higher.

Medicaid Billing
With data standards in a seemingly never-ending state of flux and a state government that’s slow to adopt the latest technologies, automating a very arduous task can take as much creativity as technical prowess.

State and Federal Regulations
While laws that protect our rights, privacy and well-being are well worth it, they bring a very deep and complex set of problems to any data project.

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Because it would have been way too expensive and impractical to write a custom medical billing suite for just one company, we had to get particularly creative.


We decided early on that the best way to handle Winter Growth’s workflow complexity was to take a modular and iterative approach to the development process. Following an extensive discovery period, we set about breaking the application up into logical modules that we built clickable wireframes around. This gave us the opportunity to nail down the UX with all of the major stakeholders before things went too far. From there, we worked through a series of design comps with focus groups until we had the UI just right. Finally, it was time to start coding the application. Using very short but well-defined sprints, we worked our way through the workflow, adding layer after layer with each subsequent iteration.

For this project, we needed to track not only who had access to what but also who did what. That is, we needed to log every create, view, edit and delete event, and, in the case of edits, we even had to record what exactly changed. To achieve this, we combined custom JavaScript on the front end with Node.js on the back end to form a logging framework based on promises and callbacks.

As anybody who’s ever worked with medical billing knows, getting even the diagnosis coding right can be a significant challenge. Because it would have been way too expensive and impractical to write a custom medical billing suite for just one company, we had to get particularly creative. The state of Maryland runs its own web-based, Medicaid billing service, but it doesn’t provide a programmatic way to connect to it. So, we gave our application the ability to generate Selenium test suites on the fly that automate the data entry portion of filing a Medicaid claim.

Now, with just the click of a button, Winter Growth staff can watch as our application talks with Maryland’s web application, filling out screens worth of data in seconds.

Finally, we helped Winter Growth stay in compliance with many of the state and federal regulations they’re subject to. First, we created a group of watcher utilities that constantly monitor the data for things like record completeness and submission timeliness. If the utilities notice anything that could be a problem, they alert the appropriate staff members. Next, we enforced strict data entry restraints throughout the application. Rather than being simple input field validators, these restraints consult multiple parts of the application on a patient-by-patient basis before even allowing users to continue. Finally, we conducted a thorough HIPAA audit of the application to ensure compliance, and we worked with Winter Growth to formalize a written strategy for maintaining compliance moving forward.

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Winter Growth

Project Summary
Develop a HIPAA-compliant database application to run medical day and assisted living programs and do electronic Medicaid billing.

Biggest Difficulty
Accommodate a complex workflow in an exremely regulated industry.

Main Technologies
JavaScript, Node.js, PostgreSQL

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