Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: The Open Group.
This latest BriefingsDirect discussion, leading into
The Open Group Conference on July 15 in Philadelphia, brings together a panel of experts to explore how new IT trends are
empowering improvements, specifically in the area of healthcare. We'll
learn how healthcare industry organizations are
seeking large-scale transformation and what are some of the paths they're taking to realize
that.
We'll see how improved
cross-organizational collaboration and such trends as
big data and
cloud computing are
helping to make healthcare more responsive and efficient.
The panel:
Jason Uppal, Chief Architect and Acting CEO at
clinicalMessage;
Larry Schmidt, Chief Technologist at
HP for the Health and Life Sciences Industries, and
Jim Hietala, Vice President of Security at The Open Group. The discussion is moderated by
Dana Gardner, Principal Analyst at
Interarbor Solutions.
This special
BriefingsDirect thought leadership interview comes in conjunction with
The Open Group Conference, which is focused on enterprise
transformation in the finance, government, and healthcare sectors.
Registration to the conference remains open. Follow the conference on Twitter at #ogPHL. [Disclosure:
The Open Group and HP are sponsors of
BriefingsDirect podcasts.]
Here are some excerpts:
Gardner:
Let’s take a look at this very interesting and dynamic healthcare
sector. What, in particular, is so special about healthcare and why
do things like enterprise architecture and allowing for better interoperability and communication across organizational boundaries seem to be so relevant here?
Hietala:
There’s general acknowledgement in the industry that, inside of
healthcare and inside the healthcare ecosystem, information either
doesn’t flow well or it only flows at a great cost in terms of custom
integration projects and things like that.
Fertile ground
From
The Open Group’s perspective, it seems that the healthcare industry and
the ecosystem really is fertile ground for bringing to bear some of the
enterprise architecture concepts that we work with at The Open Group in
order to improve, not only how information flows, but ultimately, how
patient care occurs.
Gardner: Larry Schmidt,
similar question to you. What are some of the unique challenges that are
facing the healthcare community as they try to improve on
responsiveness, efficiency, and greater capabilities?
Schmidt: There are several things that have not really kept up with what technology is able to do today.
For example, the whole concept of personal observation comes into play in what we would call "value chains" that exist right now between a patient and a doctor. We look at things like mobile technologies
and want to be able to leverage that to provide additional observation
of an individual, so that the doctor can make a more complete diagnosis
of some sickness or possibly some medication that a person is on.
We
want to be able to see that observation in real life, as opposed to
having to take that in at the office, which typically winds up
happening. I don’t know about everybody else, but every time I go see my
doctor, oftentimes I get what’s called white coat syndrome. My blood
pressure will go up. But that’s not giving the doctor an accurate
reading from the standpoint of providing great observations.
Technology
has advanced to the point where we can do that in real time using
mobile and other technologies, yet the communication flow, that
information flow, doesn't exist today, or is at best, not easily
communicated between doctor and patient.
There are plenty of places that additional collaboration and communication can improve the whole healthcare delivery model.
If
you look at the ecosystem, as Jim offered, there are plenty of places
that additional collaboration and communication can improve the whole
healthcare delivery model.
That’s what we're about. We
want to be able to find the places where the technology has advanced,
where standards don’t exist today, and just fuel the idea of building
common communication methods between those stakeholders and entities,
allowing us to then further the flow of good information across the
healthcare delivery model.
Gardner: Jason Uppal,
let’s think about what, in addition to technology, architecture, and
methodologies can bring to bear here? Is there also a lag in terms of
process thinking in healthcare, as well as perhaps technology adoption?
Uppal: I'm going to refer to a presentation that I watched from a very well-known surgeon from Harvard, Dr. Atul Gawande.
His point was is that, in the last 50 years, the medical industry has
made great strides in identifying diseases, drugs, procedures, and
therapies, but one thing that he was alluding to was that medicine
forgot the cost, that everything is cost.
At what price?
Today, in his view, we can cure a lot of diseases and lot of issues, but at what price? Can anybody actually afford it?
His view is that if healthcare is going to change and
improve, it has to be outside of the medical industry. The tools that
we have are better today, like collaborative tools that are available
for us to use, and those are the ones that he was recommending that we
need to explore further.
That is where enterprise
architecture is a powerful methodology to use and say, "Let’s take a
look at it from a holistic point of view of all the stakeholders. See
what their information needs are. Get that information to them in real
time and let them make the right decisions."
Therefore,
there is no reason for the health information to be stuck in
organizations. It could go with where the patient and providers are, and
let them make the best decision, based on the best practices that are
available to them, as opposed to having siloed information.
So
enterprise-architecture methods are most suited for developing a very
collaborative environment. Dr. Gawande was pointing out that, if
healthcare is going to improve, it has to think about it not as
medicine, but as healthcare delivery.
There are definitely complexities that occur based on the different
insurance models and how healthcare is delivered across and between
countries.
Gardner: And it seems that not
only are there challenges in terms of technology adoption and even
operating more like an efficient business in some ways. We also have
very different climates from country to country, jurisdiction to
jurisdiction. There are regulations, compliance, and so forth.
Going
back to you, Larry, how important of an issue is that? How complex does
it get because we have such different approaches to healthcare and
insurance from country to country?
Schmidt:
There are definitely complexities that occur based on the different
insurance models and how healthcare is delivered across and between
countries, but some of the basic and fundamental activities in the past
that happened as a result of delivering healthcare are consistent across
countries.
As Jason has offered, enterprise
architecture can provide us the means to explore what the art of the
possible might be today. It could allow us the opportunity to see how
innovation can occur if we enable better communication flow between the
stakeholders that exist with any healthcare delivery model in order to
give us the opportunity to improve the overall population.
After
all, that’s what this is all about. We want to be able to enable a
collaborative model throughout the stakeholders to improve the overall
health of the population. I think that’s pretty consistent across any
country that we might work in.
Ongoing work
Gardner:
Jim Hietala, maybe you could help us better understand what’s going on
within The Open Group and, even more specifically, at the conference in Philadelphia.
There is the Population Health Working Group and there is work towards a
vision of enabling the boundaryless information flow between the
stakeholders. Any other information and detail you could offer would be
great. [Registration to the conference remains open. Follow the conference on Twitter at #ogPHL.]
Hietala: On Tuesday of the conference, we have a healthcare focus day. The keynote that morning will be given by Dr. David Nash, Dean of the Jefferson School of Population Health. He'll give
what’s sure to be a pretty interesting presentation, followed by a
reactors' panel, where we've invited folks from different stakeholder
constituencies.
We're are going to have clinicians there. We're going
to have some IT folks and some actual patients to give their reaction
to Dr. Nash’s presentation. We think that will be an interesting and
entertaining panel discussion.
The balance of the day,
in terms of the healthcare content, we have a workshop. Larry Schmidt is
giving one of the presentations there, and Jason and myself and some
other folks from our working group are involved in helping to facilitate
and carry out the workshop.
The goal of it is to look
into healthcare challenges, desired outcomes, the extended healthcare
enterprise, and the extended healthcare IT enterprise and really gather
those pain points that are out there around things like interoperability
to surface those and develop a work program coming out of this.
We want to be able to enable a collaborative model throughout the stakeholders to improve the overall health of the population.
So
we expect it to be an interesting day if you are in the healthcare IT
field or just the healthcare field generally, it would definitely be a
day well spent to check it out.
Gardner: Larry,
you're going to be talking on Tuesday. Without giving too much away,
maybe you can help us understand the emphasis that you're taking, the
area that you're going to be exploring.
Schmidt:
I've titled the presentation "Remixing Healthcare through Enterprise Architecture." Jason offered some thoughts as to why we want to leverage
enterprise architecture to discipline healthcare. My thoughts are that
we want to be able to make sure we understand how the collaborative
model would work in healthcare, taking into consideration all the
constituents and stakeholders that exist within the complete ecosystem
of healthcare.
This is not just collaboration across
the doctors, patients, and maybe the payers in a healthcare delivery
model. This could be out as far as the drug companies and being able to
get drug companies to a point where they can reorder their raw materials
to produce new drugs in the case of an epidemic that might be
occurring.
Real-time model
It
would be a real-time model that allows us the opportunity to understand
what's truly happening, both to an individual from a healthcare
standpoint, as well as to a country or a region within a country and so
on from healthcare. This remixing of enterprise architecture is the
introduction to that concept of leveraging enterprise architecture into
this collaborative model.
Then, I would like to talk
about some of the technologies that I've had the opportunity to explore
around what is available today in technology. I believe we need to have
some type of standardized messaging or collaboration models to allow us
to further facilitate the ability of that technology to provide the
value of healthcare delivery or betterment of healthcare to individuals.
I'll talk about that a little bit within my presentation and give some
good examples.
It’s really interesting. I just
traveled from my company’s home base back to my home base and I thought
about something like a body scanner that you get into in the airport. I
know we're in the process of eliminating some of those scanners now
within the security model from the airports, but could that possibly be
something that becomes an element within healthcare delivery? Every time
your body is scanned, there's a possibility you can gather information
about that, and allow that to become a part of your electronic medical
record.
There is a lot of information available today that could be used in helping our population to be healthier.
Hopefully,
that was forward thinking, but that kind of thinking is going to play
into the art of the possible, with what we are going to be doing, both
in this presentation and talking about that as part of the workshop.
Gardner: Larry, we've been having some other discussions with The Open Group around what they call Open Platform 3.0, which is the confluence of big data, mobile, cloud computing, and social.
One of the big issues today is this avalanche of data, the Internet of things,
but also the Internet of people. It seems that the more work that's
done to bring Open Platform 3.0 benefits to bear on business decisions, it
could very well be impactful for centers and other data that comes from
patients, regardless of where they are, to a medical establishment,
regardless of where it is.
So do you think we're really on the cusp of a significant shift in how medicine is actually conducted?
Schmidt:
I absolutely believe that. There is a lot of information available
today that could be used in helping our population to be healthier. And
it really isn't only the challenge of the communication model that we've
been speaking about so far. It's also understanding the information
that's available to us to take that and make that into knowledge to be
applied in order to help improve the health of the population.
As
we explore this from an as-is model in enterprise architecture to
something that we believe we can first enable through a great
collaboration model, through standardized messaging and things like
that, I believe we're going to get into even deeper detail around how
information can truly provide empowered decisions to physicians and
individuals around their healthcare.
So it will carry forward into the big data and analytics challenges that we have talked about and currently are talking about with The Open Group.
Healthcare framework
Gardner:
Jason Uppal, we've also seen how in other business sectors, industries
have faced transformation and have needed to rely on something like
enterprise architecture and a framework like TOGAF in order to manage that process and make it something that's standardized, understood, and repeatable.
It
seems to me that healthcare can certainly use that, given the pace of
change, but that the impact on healthcare could be quite a bit larger in
terms of actual dollars. This is such a large part of the economy that
even small incremental improvements can have dramatic effects when it
comes to dollars and cents.
So is there a benefit to
bringing enterprise architect to healthcare that is larger and greater
than other sectors because of these economics and issues of scale?
Uppal:
That's a great way to think about this thing. In other industries,
applying enterprise architecture to do banking and insurance may be
easily measured in terms of dollars and cents, but healthcare is a
fundamentally different economy and industry.
It's not
about dollars and cents. It's about people’s lives, and loved ones who
are sick, who could very easily be treated, if they're caught in time
and the right people are around the table at the right time. So this is
more about human cost than dollars and cents. Dollars and cents are
critical, but human cost is the larger play here.
Whatever systems and methods are developed, they have to work for everybody in the world.
Secondly,
when we think about applying enterprise architecture to healthcare,
we're not talking about just the U.S. population. We're talking about
global population here. So whatever systems and methods are developed,
they have to work for everybody in the world. If the U.S. economy can
afford an expensive healthcare delivery, what about the countries that
don't have the same kind of resources? Whatever methods and delivery
mechanisms you develop have to work for everybody globally.
That's
one of the thing that a methodology like TOGAF brings out and says to
look at it from every stakeholder’s point of view, and unless you have
dealt with every stakeholder’s concerns, you don't have an architecture,
you have a system that's designed for that specific set of audience.
The cost is not this 18 percent of the gross domestic product
in the U.S. that is representing healthcare. It's the human cost, which
is many multitudes of that. That's is one of the areas where we could
really start to think about how do we affect that part of the economy,
not the 18 percent of it, but the larger part of the economy, to improve
the health of the population, not only in the North America, but
globally.
If that's the case, then what really will be
the impact on our greater world economy is improving population health,
and population health is probably becoming our biggest problem in our
economy.
We'll be testing these methods at a greater
international level, as opposed to just at an organization and industry
level. This is a much larger challenge. A methodology like TOGAF is a
proven and it could be stressed and tested to that level. This is a
great opportunity for us to apply our tools and science to a problem
that is larger than just dollars. It's about humans.
All "experts"
Gardner:
Jim Hietala, in some ways, we're all experts on healthcare. When we're
sick, we go for help and interact with a variety of different services
to maintain our health and to improve our lifestyle. But in being
experts, I guess that also means we are witnesses to some of the
downside of an unconnected ecosystem of healthcare providers and payers.
One of the things I've noticed in that vein is that I
have to deal with different organizations that don't seem to
communicate well. If there's no central process organizer, it's really
up to me as the patient to pull the lines together between the different
services -- tests, clinical observations, diagnosis, back for results
from tests, sharing the information, and so forth.
Have
you done any studies or have anecdotal information about how that
boundaryless information flow would be still relevant, even having more
of a centralized repository that all the players could draw on, sort of a
collaboration team resource of some sort? I know that’s worked in other
industries. Is this not a perfect opportunity for that boundarylessness
to be managed?
Hietala: I would say it is. We
all have experiences with going to see a primary physician, maybe
getting sent to a specialist, getting some tests done, and the
boundaryless information that’s flowing tends to be on paper delivered
by us as patients in all the cases.
So the opportunity
to improve that situation is pretty obvious to anybody who's been in
the healthcare system as a patient. I think it’s a great place to be
doing work. There's a lot of money flowing to try and address this
problem, at least here in the U.S. with the HITECH Act and some of the government spending around trying to improve healthcare.
We'll be testing these methods at a greater international level, as opposed to just at an organization and industry level.
You've
got healthcare information exchanges that are starting to develop, and
you have got lots of pain points for organizations in terms of trying to
share information and not having standards that enable them to do it.
It seems like an area that’s really a great opportunity area to bring
lots of improvement.
Gardner: Let’s look for
some examples of where this has been attempted and what the success
brings about. I'll throw this out to anyone on the panel. Do you have
any examples that you can point to, either named organizations or
anecdotal use case scenarios, of a better organization, an architectural
approach, leveraging IT efficiently and effectively, allowing data to
flow, putting in processes that are repeatable, centralized, organized,
and understood. How does that work out?
Uppal:
I'll give you an example. One of the things that happens when a patient
is admitted to hospital and in hospital is that hey get what's called a
high-voltage care. There is staff around them 24x7. There are lots of
people around, and every specialty that you can think of is available to
them. So the patient, in about two or three days, starts to feel much
better.
When that patient gets discharged, they get
discharged to home most of the time. They go from very high-voltage care
to next to no care. This is one of the areas where in one of the
organizations we work with is able to discharge the patient and, instead
of discharging them to the primary care doc, who may not receive any
records from the hospital for several days, they get discharged to into a
virtual team. So if the patient is at home, the virtual team is
available to them through their mobile phone 24x7.
Connect with provider
If,
at 3 o’clock in the morning, the patient doesn't feel right, instead of
having to call an ambulance to go to hospital once again and get
readmitted, they have a chance to connect with their care provider at
that time and say, "This is what the issue is. What do you want me to do
next? Is this normal for the medication that I am on, or this is
something abnormal that is happening?"
When that
information is available to that care provider who may not necessarily
have been part of the care team when the patient was in the hospital,
that quick readily available information is key for keeping that person
at home, as opposed to being readmitted to the hospital.
We
all know that the cost of being in a hospital is 10 times more than it
is being at home. But there's also inconvenience and human suffering
associated with being in a hospital, as opposed to being at home.
Those
are some of the examples that we have, but they are very limited,
because our current health ecosystem is a very organization specific,
not patient and provider specific. This is the area there is a huge
room for opportunities for healthcare delivery, thinking about health
information, not in the context of the organization where the patient
is, as opposed to in a cloud, where it’s an association between the
patient and provider and health information that’s there.
Extending that model will bring infinite value to not only reducing the cost, but improving the cost and quality of care.
In the past, we used to have emails that were within our four walls. All of a sudden, with Gmail and Yahoo Mail,
we have email available to us anywhere. A similar thing could be
happening for the healthcare record. This could be somewhere in the
cloud’s eco setting, where it’s securely protected and used by only
people who have granted access to it.
Those are some
of the examples where extending that model will bring infinite value to
not only reducing the cost, but improving the cost and quality of care.
Schmidt:
Jason touched upon the home healthcare scenario and being able to
provide touch points at home. Another place that we see evolving right
now in the industry is the whole concept of mobile office space. Both
countries, as well as rural places within countries that are developed,
are actually getting rural hospitals and rural healthcare offices
dropped in by helicopter to allow the people who live in those
communities to have the opportunity to talk to a doctor via satellite
technologies and so on.
The whole concept of a architecture around and being able to deal with an extension of what truly lines up being telemedicine
is something that we're seeing today. It would be wonderful if we could
point to things like standards that allow us to be able to facilitate
both the communication protocols as well as the information flows in
that type of setting.
Many corporations can jump on
the bandwagon to help the rural communities get the healthcare
information and capabilities that they need via the whole concept of
telemedicine.
That’s another area where enterprise
architecture has come into play. Now that we see examples of that
working in the industry today, I am hoping that as part of this working
group, we'll get to the point where we're able to facilitate that much
better, enabling innovation to occur for multiple companies via some of
the architecture or the architecture work we are planning on producing.
Single view
Gardner:
It seems that we've come a long way on the business side in many
industries of getting a single view of the customer, as it’s called, the
customer relationship management, big data, spreading the analysis around
among different data sources and types. This sounds like a perfect fit
for a single view of the patient across their life, across their care
spectrum, and then of course involving many different types of
organizations. But the government also needs to have a role here.
Jim Hietala, at The Open Group Conference in Philadelphia,
you're focusing on not only healthcare, but finance and government.
Regarding the government and some of the agencies that you all have as
members on some of your panels, how well do they perceive this need for
enterprise architecture level abilities to be brought to this healthcare
issue?
Hietala: We've seen encouraging signs
from folks in government that are encouraging to us in bringing this
work to the forefront. There is a recognition that there needs to be
better data flowing throughout the extended healthcare IT ecosystem, and
I think generally they are supportive of initiatives like this to make
that happen.
Listen to the podcast. Find it on iTunes. Read a full transcript or download a copy. Sponsor: The Open Group.
You may also be interested in: