Wednesday, January 29, 2014

Healthcare among most opportunistic use cases for boundaryless information flow improvement

Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: The Open Group.

Healthcare, like no other sector of the economy, exemplifies the challenges and the opportunity for improving how the various participants in a complex ecosystem interact.

The Open Group, at its next North American conference on Feb. 3, has made improved information flow across so-called boundaryless organizations the theme of its gathering of IT leaders, enterprise architects, and standards developers and implementers.

And so the next BriefingsDirect discussion explores what it takes to bring rigorous interactions, process efficiency, and governance to data and workflows that must extend across many healthcare participants with speed and dependability.

Learn now how improved cross-organization collaboration plays a huge part in helping to make healthcare more responsive, effective, safe, and cost-efficient. And also become acquainted with what The Open Group’s new Healthcare Industry Forum is doing to improve the situation.

The panel of experts consists of Larry Schmidt, the Chief Technologist at HP for the America’s Health and Life Sciences Industries, as well as the Chairman of The Open Group Healthcare Industry Forum, and Eric Stephens, an Oracle Enterprise Architect. The moderator is Dana Gardner, Principal Analyst at Interarbor Solutions. [Disclosure: HP is a sponsor of BriefingsDirect podcasts. The views of the panelists are theirs alone and not necessarily those of their employers.]

Here are some excerpts:
Gardner: Why is healthcare such a tough nut to crack when it comes to this information flow? Is there something unique about healthcare that we don't necessarily find in other vertical industries?

Schmidt: We’ve progressed in healthcare from a delivery model that was more based on acute care -- that is, I get sick, I go to the doctor -- to more of a managed care-type capability with the healthcare delivery, where a doctor at times is watching and trying to coach you. Now, we’ve gotten to where the individual is in charge of their own healthcare.

A lot of fragmentation

With that, the ecosystem around healthcare has not had the opportunity to focus the overall interactions based on the individual. So we see an awful lot of fragmentation occurring. There are many great standards across the powers that exist within the ecosystem, but if you take the individual and place that individual in the center of this universe, the whole information model changes.

Then, of course, there are other things, such as technology advances, personal biometric devices, and things like that that come into play and allow us to be much more effective with information that can be captured for healthcare. As a result, it’s the change with the focus on the individual that is allowing us the opportunity to redefine how information should flow across the healthcare ecosystem.

The scenario of the individual being more in charge of their healthcare -- care of their health would be a better way to think of this -- is a way to see both improvements in the information flow  as well as making improvements in the overall cost of healthcare going forward.
Schmidt
Because the ecosystem had pretty much been focused around the doctor's visit, or the doctor’s work with an individual, as opposed to the individual’s work with the doctor, we see tremendous opportunity in making advancements in the communications models that can occur across healthcare.

Gardner: Larry, is this specific to the United States or North America, is this global in nature, or is it very much a mixed bag, market to market as to how the challenges have mounted?

Schmidt: I think in any country, across the world, the individual being the focus of the ecosystem goes across the boundaries of countries. Of course, The Open Group is responsible and is a worldwide standards body. As a result of that, it's a great match for us to be able to focus the healthcare ecosystem to the individual and use the capabilities of The Open Group to be able to make advances in the communication models across all countries around healthcare.

Gardner: Eric, thinking about this from a technological point of view, as an enterprise architect, we’re now dealing with this hub and spoke with the patient at the middle. A lot of this does have to do with information, data, and workflow, but we’ve dealt with these things before in many instances in the enterprise and in IT.

Is there anything particular about the technology that is difficult for healthcare, or is this really more a function of the healthcare verticals and the technology is really ready to step up to the plate?

Information transparency

Stephens: Well, Dana, the technology is there and it is ready to step up to the plate. I’ll start with transparency of the information. Let’s pick a favorite poster child, Amazon. In terms of the detail that's available on my account. I can look at past orders. I can look up and see the cost of services, I can track activity that's taking place, both from a purchase and a return standpoint. That level of visibility that you’re alluding to exists. The technology is there, and it’s a matter of applying it.

Stephens
As to why it's not being applied in a rapid fashion in the healthcare industry, we could surmise a number of reasons. One of them is potentially around the cacophony of standards that exist and the lack of a “Rosetta Stone” that links those standards together to maximum interoperability.

The other challenge that exists is simply the focus in healthcare around the healthcare technology that’s being used, the surgical instruments, the diagnostic tools, and such. There is focus and great innovation there, but when it comes to the plumbing of IT, oftentimes that will suffer.

Gardner: So we have some hurdles on a number of fronts, but not necessarily the technology itself. This is a perfect case study for this concept of the boundaryless information flow, which is really the main theme of The Open Group Conference coming up on February 3. [Register for the event here.]

Back to you, Larry, on this boundaryless issue. There are standards in place in other industries that help foster a supply-chain ecosystem or a community of partners that work together.

Is that what The Open Group is seeking? Are they going to take what they’ve done in other industries for standardization and apply it to healthcare, or do you perhaps need to start from scratch? Is this such a unique challenge that you can't simply retrofit other standardization activities? How do you approach something like healthcare from a standards perspective?
I think it's a great term to reflect the vast number of stakeholders that would exist across the healthcare ecosystem.

Schmidt: The first thing we have to do is gain an appreciation for the stakeholders that interact. We’re using the term “ecosystem” here. I think it's a great term to reflect the vast number of stakeholders that would exist across the healthcare ecosystem. Anywhere from the patient, to the doctor, to payment organization for paying claims, the life sciences organizations, for pharmaceuticals, and things like that, there are so many places that stakeholders can interact seamlessly.

So it’s being able to use The Open Group’s assets to first understand what the ecosystem can be, and then secondly, use The Open Group’s capabilities around things like security, TOGAF from an architecture methodology, enablement and so on. Those assets are things that we can leverage to allow us to be able to use the tools of The Open Group to make advances within the healthcare industry.

It’s an amazing challenge, but you have to take it one step at a time, and the first step is going to be that definition of the ecosystem.

Gardner: I suppose there’s no better place to go for teasing out what the issues are and what the right prioritization should be than to go to the actual participants. The Open Group did just that last summer in Philadelphia at their earlier North American conference. They had some 60 individuals representing primary stakeholders in healthcare in the same room and they conducted some surveys.

Larry, maybe you can provide us an overview of what they found and how that’s been a guide to how to proceed?

Participant survey

Schmidt: What we wanted to do was present the concept of boundaryless information flow across the healthcare ecosystem. So we surveyed the participants that were part of the conference itself. One of the questions we asked was about the healthcare quality of data, as well as the efficiency and the effectiveness of data. Specifically, the polling questions, were designed to gauge the state of healthcare data quality and effective information flow.

We understood that 86 percent of those participants felt very uncomfortable with the quality of healthcare information flows, and 91 percent of the participants felt very uncomfortable with the efficiency of healthcare information flows.

In the discussion in Philadelphia, we talked about why information isn’t flowing much more easily and freely within this ecosystem. We discovered that a lot of the standards that currently exist within the ecosystem are very much tower-oriented. That is, they only handle a portion of the ecosystem, and the interoperability across those standards is an area that needs to be focused on.

But we do think that, because the individual should be placed into the center of the ecosystem, there's new ground that will come into play. Our Philadelphia participants actually confirmed that, as we were working through our workshop. That was one of the big, big findings that we had in the Philadelphia conference.
We understood that 86 percent of those participants felt very uncomfortable with the quality of healthcare information flows.

Gardner: Just so our audience understands, the resulting work that’s been going on for months now will culminate with the Healthcare Industry Forum being officially announced and open for business,, beginning with the San Francisco Conference. [Register for the event here.]

Tell us a little about how the mission statement for the Healthcare Industry Forum was influenced by your survey. Is there other information, perhaps a white paper or other collateral out there, that people can look to, to either learn more about this or maybe even take part in it?

Schmidt: We presented first a vision statement around boundaryless information flow. I’ll go ahead and just offer that to the team here. Boundaryless information flow of healthcare data is enabled throughout a complete healthcare ecosystem to standardization of both vocabulary and messaging that is understood by all participants within the system. This results in higher quality outcomes, streamlined business processes, reduction of fraud, and innovation enablement.

When we presented that in the conference, there was big consensus among the participants around that statement and buy in to the idea that we want that as our vision for a Healthcare Forum to actually occur.

Since then, of course, we’ve published this white paper that is the findings of the Philadelphia Conference. We’re working towards the production of a treatise, which is really the study of the problem domain that we believe we can be successful in. We also can make a major impact around this individual communication flow, enabling individuals to be in charge of more of their healthcare.

Our mission will be to provide the means to enable boundaryless information flow across the ecosystem. What we’re trying to do is make sure that we work in concert with other standards bodies to recognize the great work that’s happening around this tower concept that we believe is a boundary within the ecosystem.

Additional standards

Hopefully, we’ll get to a point where we’re able to collaborate, both with those standards bodies, as well as work within our own means to come up with additional standards that allows us to make this communication flow seamless or boundaryless.

Gardner: Eric Stephens, back to you with the enterprise architect questions. Of course, it’s important to solve the Tower of Babel issues around taxonomy, definitions, and vocabulary, but I suppose there is also a methodology issue.

Frameworks have worked quite well in enterprise architecture and in other verticals and in the IT organizations and enterprises. Is there something from your vantage point as an enterprise architect that needs to be included in this vision, perhaps looking to the next steps after you’ve gotten some of the taxonomy and definitions worked out?

Stephens: Dana, in terms of working through the taxonomies and such, as an enterprise architect, I view it as part of a larger activity around going through a process, like the TOGAF methodology, it’s architecture development methodology.
In the healthcare landscape, and in other industries, there are a lot of players coming to the table and need to interact.

By doing so, using a tailored version of that, we’ll get to that taxonomy definition and the alignment of standards and such. But there's also the addressing alignment and business processes and other application components that comes into play. That’s going to drive us towards improving the viscosity of the information, that's moving both within an enterprise and outside of the enterprise.

In the healthcare landscape, and in other industries, there are a lot of players coming to the table and need to interact, especially if you are talking about a complex episode of care. You may have two, three, or four different organizations in play. You have labs, the doctors, specialized centers, and such, and all that requires information flow.

Coming back to the methodology, I think it’s bringing to bear an architecture methodology like provided in TOGAF. It’s going to aid individuals in getting a broad picture, and also a detailed picture, of what needs to be done in order to achieve this goal of boundaryless information flow.

Drive standardization

One of the things that we can do in the Forum is start to drive standardization, so that we have the data and devices working together easily, and it provides the necessary medical professionals the information they need, so they can make more timely decisions. It’s giving the right information, to the right decision maker, at the right time. That, in turn, drives better health outcomes, and it's going to, we hope, drive down the overall cost profile of healthcare, specifically here in the United States.

Gardner: Getting back to the conference, I understand that the Healthcare Industry Forum is going to be announced. There is going to be a charter, a steering committee program, definitions, and treatise in the works. So there will be quite a bit kicking off. I would like to hear from you two, Larry and Eric, what you will specifically be presenting at the conference in San Francisco in just a matter of a week or two. Larry, what’s on the agenda for your presentations at the conference? [Register for the event here.]

Schmidt: Actually, Eric and I are doing a joint presentation and we’re going to talk about some of the challenges that we think we can see is ahead of us as a result of trying to enable our vision around boundaryless information flow, specifically around healthcare.
As an enterprise architect, I look at things in terms of the business, the application, information, technology, and architecture.

The culture of being able to produce standards in an industry like this is going to be a major challenge to us. There is a lot of individualization that occurs across this industry. So having people come together and recognize that there are going to be different views, different points of views, and coming into more of a consensus on how information should flow, specifically in healthcare. Although I think any of the forums go through this cultural change.

We’re going to talk about that at the beginning in the conference as a part of how we’re planning to address those challenges as part of the Industry Forum itself.  Then, other meetings will allow us to continue with some of the work that we have been doing around a treatise and other actions that will help us get started down the path of understating the ecosystem and so on.

Those are the things that we’ll be addressing at this specific conference.

Stephens: As an enterprise architect, I look at things in terms of the business, the application, information, technology, and architecture. When we talk about boundaryless information flow, my remarks and contributions are focused around the information architecture and specifically around an ecosystem of an information architecture at a generic level, but also the need and importance of integration. I will perhaps touch a little bit on the standards to integrate that with Larry’s thoughts.

Soliciting opinions

Schmidt: Dana, I just wanted to add the other work that we’ll be doing there at the conference. We’ve invited some of the healthcare organizations in that area of the country, San Francisco and so on, to come in on Tuesday. We plan to present the findings of the paper and the work that we did in the Philadelphia Conference, and get opinions in refining both the observations, as well as some of the direction that we plan to take with the Healthcare Forum.

Obviously we’ve shared here some of the thoughts of where we believe we’re moving with the Healthcare Forum, but as the Forum continues to form, some of the direction of it will morph based on the participants, and based on some of the things that we see happening with the industry.

So, it’s a really exciting time and I’m actually very much looking forward to presenting the findings of the Philadelphia Conference, getting, as I said, the next set of feedback, and starting the discussion as to how we can make change going toward that vision of boundaryless information flow.
We’re actually able to see a better profile of what the individual is doing throughout their life and throughout their days.

Gardner: I should also point out that it’s not too late for our listeners and readers to participate themselves in this conference. If you’re in the San Francisco area, you’re able to get there and partake, but there are also going to be online activities. There will be some of the presentations delivered online and there will be Twitter feeds.

So if you can't make it to San Francisco on February 3, be aware that The Open Group Conference will be available in several different ways online. Then, there will be materials available after the fact to access on-demand. Of course, if you’re interested in taking more activity under your wing with the Forum itself, there will be information on The Open Group website as to how to get involved.

Before we sign off, I want to get a sense of what the stakes are here. It seems to me that if you do this well and if you do this correctly, you get alignment across these different participants -- the patient being at the hub of the wheel of the ecosystem. There’s a tremendous opportunity here for improvement, not only in patient care and outcomes, but costs, efficiency, and process innovation.

So first to you Larry. If we do this right, what can we expect?

Schmidt: There are several things to expect. Number one, I believe that the overall health of the population will improve, because individuals are more knowledgeable about their individualized healthcare and doctors have the necessary information, based on observations in place, as opposed to observations or, again, through discussion and/or interview of the patient.

We’re actually able to see a better profile of what the individual is doing throughout their life and throughout their days. That can provide doctors the opportunity to make better diagnosis. Better diagnosis, with better information, as Eric said earlier, the right information, at the right time, to the right person, gives the whole ecosystem the opportunity to respond more efficiently and effectively, both at the individual level and in the population. That plays well with any healthcare system around the world. So it’s very exciting times here.

Metrics of success

Gardner: Eric, what’s your perspective on some of the paybacks or metrics of success, when some of the fruits of the standardization begin to impact the overall healthcare system?

Stephens: At the risk of oversimplifying and repeating some of things that Larry said, it comes down to cost and outcomes as the two main things. That’s what’s in my mind right now. I look at these very scary graphs about the cost of healthcare in the United States, and it's hovering in the 17-18 percent of GDP. If I recall correctly, that’s at least five full percentage points larger than other economically developed countries in the world.

The trend on individual premiums and such continues to tick upward. Anything we can do to drive that cost down is going to be very beneficial, and this goes right back to patient-centricity. It goes right back to their pocketbook.

And the outcomes are important as well. There are a myriad of diseases and such that we’re dealing with in this country. More information and more education is going to help drive a healthier population, which in turn drives down the cost. The expenditures that are being spent are around the innovation. You leave room for innovation and you leave room for new advances in medical technology and such to treat diseases going. So again, it’s back to cost and outcomes.
Anything we can do to drive that cost down is going to be very beneficial, and this goes right back to patient centricity.

Gardner: Very good. I’m afraid we will have to leave it there. We’ve been talking with a panel of experts on how the healthcare industry can benefit from improved and methodological information flow. And we have seen how the healthcare industry itself is seeking large-scale transformation and how improved cross-organizational interactions and collaborations seem to be intrinsic to be able to move forward and capitalize and make that transformation possible.

And lastly, we have learned that The Open Group’s new Healthcare Industry Forum is doing a lot now and is getting into its full speed to improve the situation.

This special BriefingsDirect discussion comes to you in conjunction with The Open Group Conference on February 3 in San Francisco. It’s not too late to register at The Open Group website and you can also follow the proceedings during and after the conference online and via Twitter.

So a big thank you to our panel, Larry Schmidt, the Chief Technologist at HP for the America’s Health and Life Sciences Industries, as well as the Chairman of The new Open Group Healthcare Industry Forum, and Eric Stephens, an Oracle Enterprise Architect. We appreciate your time Eric.

I'm Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator for this look at the healthcare ecosystem process. Thanks for listening, and come back next time for more BriefingsDirect podcast discussions.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: The Open Group. Register for the event here.

Transcript of a BriefingsDirect podcast on how The Open Group is addressing the information needs and challenges in the healthcare ecosystem. Copyright The Open Group and Interarbor Solutions, LLC, 2005-2014. All rights reserved.

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