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.
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