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.
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.
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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