Showing posts with label Larry Schmidt. Show all posts
Showing posts with label Larry Schmidt. Show all posts

Wednesday, January 29, 2014

Healthcare Among Thorniest and Yet Most Opportunistic Use Cases for Boundaryless Information Flow Improvement

Transcript of a BriefingsDirect podcast on how The Open Group is addressing the information needs and challenges in the healthcare ecosystem.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: The Open Group.

Dana Gardner: Hello, and welcome to a special BriefingsDirect panel discussion coming to you in conjunction with The Open Group Conference on February 3 in San Francisco.

Gardner
I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator as we examine how the healthcare industry can benefit from improved and methodological information flow.

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, 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.

Join us now, as we explore 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 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.

With that, please join me in welcoming our guests, 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. Welcome, Larry. [Disclosure: HP is a sponsor of BriefingsDirect podcasts. The views of the panelists are theirs alone and not necessarily those of their employers.]

Larry Schmidt: Thank you.

Gardner: We’re also here with Eric Stephens, an Oracle Enterprise Architect. Welcome, Eric.

Eric Stephens: Thank you, Dana.

Gardner: Gentlemen, we have you both here because you are going to be at The Open Group Conference in February in San Francisco. We want to get into this new Healthcare Forum, but before we get into the particulars of what we can do to help the healthcare situation, let’s try to define a little bit better the state of affairs. [Register for the event here.]

So first to you, Larry. 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: What’s unique about healthcare right now is that in order to answer the question we have to go back to some of the challenges we’ve seen in healthcare.

We’ve progressed in healthcare from a healthcare 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.

Gardner: So I guess it’s interesting, Larry, that the individual is at the center or hub of this ongoing moving ecosystem with many spokes, if you will. Is that a characterization, or is there no hub and that’s perhaps one of the challenges for this?

Schmidt: What you said first is a good way to categorize it. 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
As I offered earlier, 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.

Gardner: I suppose, gentlemen, that we should also recognize that we are going about this in the larger context of change in the IT and business landscapes. We’re seeing many more mobile devices. We’re probably going to see patients accessing more information that we have been discussing through some sort of a mobile device, which is good news, because more and more patients and their providers can access information regardless of where they are. So mobility, I think, is a fairly important accelerant to some of this.

And, of course, there’s big data, the ability to take reams and reams of information, deal with it rapidly, analyze it in near real-time and then scale accordingly for cost issues. It’s also another big thing.

Larger context

So let’s just quickly step aside from the forum activities and look at how the larger context of change is perhaps fortuitously timed for what we we’d like to do in terms of transformation around healthcare. Let me first direct that to you, Larry. How important are things like mobile and big data in making significant progress in the issues facing healthcare?

Schmidt: Well, that’s interesting, because when we first stared with mobility devices, I actually built and think that the mobile devices become, what I will call a personal integration server. It will help the individual who wants to take charge of their healthcare or care of their health. It will give them the opportunity to capture information using other devices, such as biometric devices, blood pressure monitors, and things like that, and have that captured on a mobile device and placed in a repository someplace to allow either a physician or others, or even that individual, to look at trending over time.

To me, the mobile device, from a standpoint of being able to gather data, is a great technology enabler that has come of age. It allows us the opportunity to streamline that information gathering that is necessary to provide the right diagnoses of working with your health coach or your provider.

Of course, that has the possibility, at the individual level, of producing a lot of data, and it could be massive amount of data, depending on how the data is actually gathered. So big data and analytics, even at the individual level, being able to decipher or to understand trending and things that are happening to the individual over time outside of the doctor’s office, is something I think will really enable improvements in healthcare.
One of the key success factors that is going to have to be addressed is interoperability.

All that, of course, is fueled by the “Internet of things” and technology advances such as IPv6 to allow us to use devices like this across a network and actually keep them identified. Those two technologies that we see in IT trends, will be a great help in advancing healthcare and of course the possibility of it enabling boundaryless information flow.

Gardner: Eric Stephens, do you want to weigh in as well on where these new advances in IT can play a huge role if those standards and the framework approach methodologies are in play?

Stephens: Larry really hit the points well. I was thinking about the new terminology, the Internet of things or machine to machine, where mobile devices could end up being the size of a fingernail at some point.

Do we get to the point where there is real-time monitoring of critical patients, going back through other mobile devices and into a doctor’s office or something, will we have the ability to do a virtual office visit, and how much equipment will you need in a home, for example, to go through and do routine checkups on children and such?

One of the key success factors that is going to have to be addressed is interoperability. Back when we were all starting to cut our teeth on the Internet, one of the things that was fascinating to me is that, you have a handful of standards and all these vendors are conforming to them, such that you don’t have to think about plugging in a laptop to a network or accessing website. All that’s driven by standardization.

Drive standardization

One of the things that we can do in the Forum is start to drive some of that standardization, so that we have these 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: I should think makes for a high incentive to work on these issues of standardization, taxonomy, definitions, and methodologies so that you can take advantage of these great technologies and the scale and efficiency they afford.

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.

Gardner: Eric, anything to add to that, I didn't realize you are both doing this as a joint presentation?

Stephens: Yes, and thanks to Larry for allowing me to participate in it. One of the areas I will be focusing on, and you alluded to this earlier, Dana, is around the information architecture.

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. Thanks so much, Larry.

Schmidt: You bet. Glad to be here.

Gardner: And thank you, too, to Eric Stephens, an Oracle Enterprise Architect. We appreciate your time Eric.

Stephens: Thanks for having me, Dana.

Gardner: This is 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. Download the transcript. 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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Friday, July 12, 2013

The Open Group Conference to Emphasize Healthcare as Key Sector for Ecosystem-Wide Interactions

Transcript of a BriefingsDirect podcast on how the healthcare industry is poised to take advantage of enterprise architecture to bring benefits to patients, doctors, and allied health professionals.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: The Open Group.

Dana Gardner: Hello, and welcome to a special BriefingsDirect Thought Leadership Interview series, coming to you in conjunction with The Open Group Conference on July 15, in Philadelphia. Registration to the conference remains open. Follow the conference on Twitter at #ogPHL.

Gardner
I'm Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator throughout these discussions on enterprise transformation in the finance, government, and healthcare sector.

We're here now with 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.

With that, please join me in welcoming our panel, Jason Uppal, Chief Architect and Acting CEO at clinicalMessage. Welcome, Jason.

Jason Uppal: Thank you, Dana.
Inside of healthcare and inside the healthcare ecosystem, information either doesn’t flow well or it only flows at a great cost.

Gardner: And we're also joined by Larry Schmidt, Chief Technologist at HP for the Health and Life Sciences Industries. Welcome, Larry.

Larry Schmidt: Thank you.

Gardner: And also, Jim Hietala, Vice President of Security at The Open Group. Welcome back, Jim. [Disclosure: The Open Group and HP are sponsors of BriefingsDirect podcasts.]

Jim Hietala: Thanks, Dana. Good to be with you.

Gardner: Let’s take a look at this very interesting and dynamic healthcare sector, Jim. 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?

Uppal
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.

Hietala
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.

Gardner: Of course having conferences like this, where you have a cross pollination between vertical industries, will perhaps allow some of the technical people to talk with some of the government people too and also have a conversation with some of the healthcare people. That’s where some of these ideas and some of the collaboration could also be very powerful.
We've seen encouraging signs from folks in government that are encouraging to us in bringing this work to the forefront.

I'm afraid we're almost out of time. We've been talking about an interesting healthcare transition, moving into a new phase or even era of healthcare.

Our panel of experts have been looking at some of the trends in IT and how they are empowering improvement for how healthcare can be more responsive and efficient. And we've seen how healthcare industry organizations can take large scale transformation using cross-organizational collaboration, for example, and other such tools as big data, analytics, and cloud computing to help solve some of these issues.

This special BriefingsDirect discussion comes to you in conjunction with The Open Group Conference this July in Philadelphia. Registration to the conference remains open. Follow the conference on Twitter at #ogPHL, and you will hear more about healthcare or Open Platform 3.0 as well as enterprise transformation in the finance, government, and healthcare sectors.

With that, I'd like to thank our panel. We've been joined today by Jason Uppal, Chief Architect and Acting CEO at clinicalMessage. Thank you so much, Jason.

Uppal: Thank you, Dana.

Gardner: And also Larry Schmidt, Chief Technologist at HP for the Health and Life Sciences Industries. Thanks, Larry.

Schmidt: You bet, appreciate the time to share my thoughts. Thank you.

Gardner: And then also Jim Hietala, Vice President of Security at The Open Group. Thanks so much.

Hietala: Thank you, Dana.

Gardner: This is Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator throughout these thought leader interviews. Thanks again for listening and come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: The Open Group.

Transcript of a BriefingsDirect podcast on how the healthcare industry is poised to take advantage of enterprise architecture to bring benefits to patients, doctors, and allied health professionals. Copyright Interarbor Solutions, LLC, 2005-2013. All rights reserved.

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