Monthly Archives: May 2014

The Onion & The Open Group Open Platform 3.0™

By Stuart Boardman, Senior Business Consultant, KPN Consulting, and Co-Chair of The Open Group Open Platform 3.0™

Onion1

The onion is widely used as an analogy for complex systems – from IT systems to mystical world views.Onion2

 

 

 

It’s a good analogy. From the outside it’s a solid whole but each layer you peel off reveals a new onion (new information) underneath.

And a slice through the onion looks quite different from the whole…Onion3

What (and how much) you see depends on where and how you slice it.Onion4

 

 

 

 

The Open Group Open Platform 3.0™ is like that. Use-cases for Open Platform 3.0 reveal multiple participants and technologies (Cloud Computing, Big Data Analytics, Social networks, Mobility and The Internet of Things) working together to achieve goals that vary by participant. Each participant’s goals represent a different slice through the onion.

The Ecosystem View
We commonly use the idea of peeling off layers to understand large ecosystems, which could be Open Platform 3.0 systems like the energy smart grid but could equally be the workings of a large cooperative or the transport infrastructure of a city. We want to know what is needed to keep the ecosystem healthy and what the effects could be of the actions of individuals on the whole and therefore on each other. So we start from the whole thing and work our way in.

Onion5

The Service at the Centre of the Onion

If you’re the provider or consumer (or both) of an Open Platform 3.0 service, you’re primarily concerned with your slice of the onion. You want to be able to obtain and/or deliver the expected value from your service(s). You need to know as much as possible about the things that can positively or negatively affect that. So your concern is not the onion (ecosystem) as a whole but your part of it.

Right in the middle is your part of the service. The first level out from that consists of other participants with whom you have a direct relationship (contractual or otherwise). These are the organizations that deliver the services you consume directly to enable your own service.

One level out from that (level 2) are participants with whom you have no direct relationship but on whose services you are still dependent. It’s common in Platform 3.0 that your partners too will consume other services in order to deliver their services (see the use cases we have documented). You need to know as much as possible about this level , because whatever happens here can have a positive or negative effect on you.

One level further from the centre we find indirect participants who don’t necessarily delivery any part of the service but whose actions may well affect the rest. They could just be indirect materials suppliers. They could also be part of a completely different value network in which your level 1 or 2 “partners” participate. You can’t expect to understand this level in detail but you know that how that value network performs can affect your partners’ strategy or even their very existence. The knock-on impact on your own strategy can be significant.

We can conceive of more levels but pretty soon a law of diminishing returns sets in. At each level further from your own organization you will see less detail and more variety. That in turn means that there will be fewer things you can actually know (with any certainty) and not much more that you can even guess at. That doesn’t mean that the ecosystem ends at this point. Ecosystems are potentially infinite. You just need to decide how deep you can usefully go.

Limits of the Onion
At a certain point one hits the limits of an analogy. If everybody sees their own organization as the centre of the onion, what we actually have is a bunch of different, overlapping onions.

Onion6

And you can’t actually make onions overlap, so let’s not take the analogy too literally. Just keep it in mind as we move on. Remember that our objective is to ensure the value of the service we’re delivering or consuming. What we need to know therefore is what can change that’s outside of our own control and what kind of change we might expect. At each visible level of the theoretical onion we will find these sources of variety. How certain of their behaviour we can be will vary – with a tendency to the less certain as we move further from the centre of the onion. We’ll need to decide how, if at all, we want to respond to each kind of variety.

But that will have to wait for my next blog. In the meantime, here are some ways people look at the onion.

Onion7   Onion8

 

 

 

 

SONY DSCStuart Boardman is a Senior Business Consultant with KPN Consulting where he leads the Enterprise Architecture practice and consults to clients on Cloud Computing, Enterprise Mobility and The Internet of Everything. He is Co-Chair of The Open Group Open Platform 3.0™ Forum and was Co-Chair of the Cloud Computing Work Group’s Security for the Cloud and SOA project and a founding member of both The Open Group Cloud Computing Work Group and The Open Group SOA Work Group. Stuart is the author of publications by KPN, the Information Security Platform (PvIB) in The Netherlands and of his previous employer, CGI as well as several Open Group white papers, guides and standards. He is a frequent speaker at conferences on the topics of Open Platform 3.0 and Identity.

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Filed under Uncategorized, Enterprise Architecture, Cloud/SOA, Standards, Service Oriented Architecture, Cloud, Conference, Open Platform 3.0

ArchiMate® Users Group Meeting

By The Open Group

During a special ArchiMate® users group meeting on Wednesday, May 14 in Amsterdam, Andrew Josey, Director of Standards within The Open Group, presented on the ArchiMate certification program and adoption of the language. Andrew is currently managing the standards process for The Open Group, and has recently led the standards development projects for TOGAF® 9.1, ArchiMate 2.1, IEEE Std 1003.1-2008 (POSIX), and the core specifications of the Single UNIX Specification, Version 4.

ArchiMate®, a standard of The Open Group, is an open and independent modeling language for Enterprise Architecture that is supported by different vendors and consulting firms. ArchiMate provides instruments to enable Enterprise Architects to describe, analyze and visualize the relationships among business domains in an unambiguous way. ArchiMate is not an isolated development. The relationships with existing methods and techniques, like modeling languages such as UML and BPMN, and methods and frameworks like TOGAF and Zachman, are well-described.

In this talk, Andrew provided an overview of the ArchiMate 2 certification program, including information on the adoption of the ArchiMate modeling language. He gave an overview of the major milestones in the development of Archimate and referred to the Dutch origins of the language. The Dutch Telematica Institute created the Archimate language in the period 2002-2004 and the language is now widespread. There have been over 41,000 downloads of different versions of the ArchiMate specification from more than 150 countries. At 52%, The Netherlands is leading the “Top 10 Certifications by country”. However, the “Top 20 Downloads by country” is dominated by the USA (19%), followed by the UK (14%) and The Netherlands (12%). One of the tools developed to support ArchiMate is Archi, a free open-source tool created by Phil Beauvoir at the University of Bolton in the UK. Since its development, Archi also has grown from a relatively small, home-grown tool to become a widely used open-source resource that averages 3,000 downloads per month and whose community ranges from independent practitioners to Fortune 500 companies. It is no surprise that again, Archi is mostly downloaded in The Netherlands (17.67%), the United States (12.42%) and the United Kingdom (8.81%).

After these noteworthy facts and figures, Henk Jonkers took a deep dive into modeling risk and security. Henk Jonkers is a senior research consultant, involved in BiZZdesign’s innovations in the areas of Enterprise Architecture and engineering. He was one of the main developers of the ArchiMate language, an author of the ArchiMate 1.0 and 2.0 Specifications, and is actively involved in the activities of the ArchiMate Forum of The Open Group. In this talk, Henk showed several examples of how risk and security aspects can be incorporated in Enterprise Architecture models using the ArchiMate language. He also explained how the resulting models could be used to analyze risks and vulnerabilities in the different architectural layers, and to visualize the business impact that they have.

First Henk described the limitations of current approaches – existing information security and risk management methods do not systematically identify potential attacks. They are based on checklists, heuristics and experience. Security controls are applied in a bottom-up way and are not based on a thorough analysis of risks and vulnerabilities. There is no explicit definition of security principles and requirements. Existing systems only focus on IT security. They have difficulties in dealing with complex attacks on socio-technical systems, combining physical and digital access, and social engineering. Current approaches focus on preventive security controls, and corrective and curative controls are not considered. Security by Design is a must, and there is always a trade-off between the risk factor versus process criticality. Henk gave some arguments as to why ArchiMate provides the right building blocks for a solid risk and security architecture. ArchiMate is widely accepted as an open standard for modeling Enterprise Architecture and support is widely available. ArchiMate is also suitable as a basis for qualitative and quantitative analysis. And last but not least: there is a good fit with other Enterprise Architecture and security frameworks (TOGAF, Zachman, SABSA).

“The nice thing about standards is that there are so many to choose from”, emeritus professor Andrew Stuart Tanenbaum once said. Using this quote as a starting point, Gerben Wierda focused his speech on the relationship between the ArchiMate language and Business Process Model and Notation (BPMN). In particular he discussed Bruce Silver’s BPMN Method and Style. He stated that ArchiMate and BPMN can exist side by side. Why would you link BPMN and Archimate? According to Gerben there is a fundamental vision behind all of this. “There are unavoidably many ‘models’ of the enterprise that are used. We cannot reduce that to one single model because of fundamentally different uses. We even cannot reduce that to a single meta-model (or pattern/structure) because of fundamentally different requirements. Therefore, what we need to do is look at the documentation of the enterprise as a collection of models with different structures. And what we thus need to do is make this collection coherent.”

Gerben is Lead Enterprise Architect of APG Asset Management, one of the largest Fiduciary Managers (± €330 billion Assets under Management) in the world, with offices in Heerlen, Amsterdam, New York, Hong Kong and Brussels. He has overseen the construction of one of the largest single ArchiMate models in the world to date and is the author of the book “Mastering ArchiMate”, based on his experience in large scale ArchiMate modeling. In his speech, Gerben showed how the leading standards ArchiMate and BPMN (Business Process Modeling Notation, an OMG standard) can be used together, creating one structured logically coherent and automatically synchronized description that combines architecture and process details.

Marc Lankhorst, Managing Consultant and Service Line Manager Enterprise Architecture at BiZZdesign, presented on the topic of capability modeling in ArchiMate. As an internationally recognized thought leader on Enterprise Architecture, he guides the development of BiZZdesign’s portfolio of services, methods, techniques and tools in this field. Marc is also active as a consultant in government and finance. In the past, he has managed the development of the ArchiMate language for Enterprise Architecture modeling, now a standard of The Open Group. Marc is a certified TOGAF9 Enterprise Architect and holds an MSc in Computer Science from the University of Twente and a PhD from the University of Groningen in the Netherlands. In his speech, Marc discussed different notions of “capability” and outlined the ways in which these might be modeled in ArchiMate. In short, a business capability is something an enterprise does or can do, given the various resources it possesses. Marc described the use of capability-based planning as a way of translating enterprise strategy to architectural choices and look ahead at potential extensions of ArchiMate for capability modeling. Business capabilities provide a high-level view of current and desired abilities of the organization, in relation to strategy and environment. Enterprise Architecture practitioners design extensive models of the enterprise, but these are often difficult to communicate with business leaders. Capabilities form a bridge between the business leaders and the Enterprise Architecture practitioners. They are very helpful in business transformation and are the ratio behind capability based planning, he concluded.

For more information on ArchiMate, please visit:

http://www.opengroup.org/subjectareas/enterprise/archimate

For information on the Archi tool, please visit: http://www.archimatetool.com/

For information on joining the ArchiMate Forum, please visit: http://www.opengroup.org/getinvolved/forums/archimate

 

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The Open Group Summit Amsterdam 2014 – Day Three Highlights

By Loren K. Baynes, Director, Global Marketing Communications, The Open Group

May 14, day three of The Open Group Summit Amsterdam, was another busy day for our attendees and presenters.  Tracks included ArchiMate®The Open Group Open Platform 3.0™-Big Data, Open CITS, TOGAF®, Architecture Methods and Professional Development.

Mark Skilton, Professor of Practice, Information Systems Management, Warwick Business School, UK presented “Creating Value in the Digital Economy”. Skilton discussed how the digital media in social, networks, mobile devices, sensors and the explosion of big data and cloud computing networks is interconnecting potentially everything everywhere – amounting to a new digital ecosystem.  These trends have significantly enhanced the importance of IT in its role and impact on business and market value locally, regionally and globally.

Other notable speakers included Thomas Obitz, Principal Advisor, KPMG, LLK, UK, and Paul Bonnie, Head of Architecture Office, ING, The Netherlands, who shared how standards, such as TOGAF®, an Open Group standard, are necessary and effective in the financial services industry.

During a special users group meeting in the evening, Andrew Josey, Director of Standards within The Open Group, presented the ArchiMate certification program and adoption of the language. . Andrew is currently managing the standards process for The Open Group, and has recently led the standards development projects for TOGAF® 9.1, ArchiMate 2.1, IEEE Std 1003.1-2008 (POSIX), and the core specifications of the Single UNIX Specification, Version 4.

Andrew provided an overview of the ArchiMate 2 certification program, including information on the adoption of the ArchiMate modeling language. He discussed the major milestones in the development of ArchiMate and referred to the Dutch origins of the language. The ArchiMate language was developed beginning in 2002 and is now widespread.  There have been over 41,000 downloads of ArchiMate specifications from more than 150 countries.

Henk Jonkers, senior research consultant involved in BiZZdesign’s innovations in Enterprise Architecture (EA) and one of the main developers of the ArchiMate language, took a deep dive into modeling risk and security.

Henk JonkersHenk Jonkers, BiZZdesign

As a final farewell from Amsterdam, a special thanks goes to our sponsors and exhibitors during this dynamic summit:  BiZZdesign, MEGA, ARCA Strategic Group, Good e-Learning, Orbus Software, Corso, Van Haren, Metaplexity, Architecting the Enterprise, Biner and the Association of Enterprise Architects (AEA).

For those of you who attended the Summit, please give us your feedback! https://www.surveymonkey.com/s/AMST2014

Stay tuned for Summit proceedings to be posted soon!  See you at our event in Boston, Massachusetts July 21-22!

 

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The Open Group Summit Amsterdam 2014 – Day Two Highlights

By Loren K. Baynes, Director, Global Marketing Communications, The Open Group

On Tuesday, May 13, day two of The Open Group Summit Amsterdam, the morning plenary began with a welcome from The Open Group President and CEO Allen Brown. He presented an overview of the Forums and the corresponding Roadmaps. He described the process of standardization, from the initial work to a preliminary standard, including review documents, whitepapers and snapshots, culminating in the final publication of an open standard. Brown also announced that Capgemini is again a Platinum member of The Open Group and contributes to the realization of the organization’s objectives in various ways.

Charles Betz, Chief Architect, Signature Client Group, AT&T and Karel van Zeeland, Lead IT4IT Architect, Shell IT International, presented the second keynote of the morning, ‘A Reference Architecture For the Business of IT’.  When the IT Value Chain and IT4IT Reference Architecture is articulated, instituted and automated, the business can experience huge cost savings in IT and significantly improved response times for IT service delivery, as well as increasing customer satisfaction.

AmsterdamPlenaryKarel van Zeeland, Charles Betz and Allen Brown

In 1998, Shell Information Technology started to restructure the IT Management and the chaos was complete. There were too many tools, too many vendors, a lack of integration, no common data model, a variety of user interfaces and no standards to support rapid implementation. With more than 28 different solutions for incident management and more than 160 repositories of configuration data, the complexity was immense. An unclear relationship with Enterprise Architecture and other architectural issues made the case even worse.

Restructuring the IT Management turned out to be a long journey for the Shell managers. How to manage 1,700 locations in 90 countries, 8,000 applications, 25,000 servers, dozens of global and regional datacenters,125,000 PCs and laptops, when at the same time you are confronted with trends like BYOD, mobility, cloud computing, security, big data and the Internet of Things (IoT).  According to Betz and van Zeeland, IT4IT is a promising platform for evolution of the IT profession. IT4IT however has the potential to become a full open standard for managing the business of IT.

Jeroen Tas, CEO of Healthcare Informatics Solutions and Services within Philips Healthcare, explained in his keynote speech, “Philips is becoming a software company”. Digital solutions connect and streamline workflow across the continuum of care to improve patient outcomes. Today, big data is supporting adaptive therapies. Smart algorithms are used for early warning and active monitoring of patients in remote locations. Tas has a dream, he wants to make a valuable contribution to a connected healthcare world for everyone.

In January 2014, Royal Philips announced the formation of Healthcare Informatics Solutions and Services, a new business group within Philips’ Healthcare sector that offers hospitals and health systems the customized clinical programs, advanced data analytics and interoperable, cloud-based platforms necessary to implement new models of care. Tas, who previously served as the Chief Information Officer of Philips, leads the group.

In January of this year, The Open Group launched The Open Group Healthcare Forum whichfocuses on bringing Boundaryless Information Flow™ to the healthcare industry enabling data to flow more easily throughout the complete healthcare ecosystem.

Ed Reynolds, HP Fellow and responsible for the HP Enterprise Security Services in the US, described the role of information risk in a new technology landscape. How do C-level executives think about risk? This is a relevant and urgent question because it can take more than 243 days before a data breach is detected. Last year, the average cost associated with a data breach increased 78% to 11.9 million dollars. Critical data assets may be of strategic national importance, have massive corporate value or have huge significance to an employee or citizen, be it the secret recipe of Coca Cola or the medical records of a patient. “Protect your crown jewels” is the motto.

Bart Seghers, Cyber Security Manager, Thales Security and Henk Jonkers, Senior Research Consultant of BiZZdesign, visualized the Business Impact of Technical Cyber Risks. Attacks on information systems are becoming increasingly sophisticated. Organizations are increasingly networked and thus more complex. Attacks use digital, physical and social engineering and the departments responsible for each of these domains within an organization operate in silos. Current risk management methods cannot handle the resulting complexity. Therefore they are using ArchiMate® as a risk and security architecture. ArchiMate is a widely accepted open standard for modeling Enterprise Architecture. There is also a good fit with other EA and security frameworks, such as TOGAF®. A pentest-based Business Impact Assessment (BIA) is a powerful management dashboard that increases the return on investment for your Enterprise Architecture effort, they concluded.

Risk Management was also a hot topic during several sessions in the afternoon. Moderator Jim Hietala, Vice President, Security at The Open Group, hosted a panel discussion on Risk Management.

In the afternoon several international speakers covered topics including Enterprise Architecture & Business Value, Business & Data Architecture and Open Platform 3.0™. In relation to social networks, Andy Jones, Technical Director, EMEA, SOA Software, UK, presented “What Facebook, Twitter and Netflix Didn’t Tell You”.

The Open Group veteran Dr. Chris Harding, Director for Interoperability at The Open Group, and panelists discussed and emphasized the importance of The Open Group Open Platform 3.0™. The session also featured a live Q&A via Twitter #ogchat, #ogop3.

The podcast is now live. Here are the links:

Briefings Direct Podcast Home Page: http://www.briefingsdirect.com/

PODCAST STREAM: http://traffic.libsyn.com/interarbor/BriefingsDirect-The_Open_Group_Amsterdam_Conference_Panel_Delves_into_How_to_Best_Gain_Business_Value_From_Platform_3.mp3

PODCAST SUMMARY: http://briefingsdirect.com/the-open-group-amsterdam-panel-delves-into-how-to-best-gain-business-value-from-platform-30

In the evening, The Open Group hosted a tour and dinner experience at the world-famous Heineken Brewery.

For those of you who attended the summit, please give us your feedback! https://www.surveymonkey.com/s/AMST2014

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The Open Group Summit Amsterdam 2014 – Day One Highlights

By Loren K. Baynes, Director, Global Marketing Communications, The Open Group

The Open Group Summit Amsterdam, held at the historic Hotel Krasnapolsky, began on Monday, May 12 by highlighting how the industry is moving further towards Boundaryless Information Flow™. After the successful introduction of The Open Group Healthcare Forum in San Francisco, the Governing Board is now considering other vertical Forums such as the airline industry and utilities sector.

The morning plenary began with a welcome from Steve Nunn, COO of The Open Group and CEO of the Association of Enterprise Architects (AEA). He mentioned that Amsterdam has a special place in his heart because of the remembrance of the 2001 event also held in Amsterdam, just one month after the 9/11 attacks which shocked the world. Today, with almost 300 registrations and people from 29 different countries, The Open Group is still appealing to a wide range of nationalities.

Allen Brown, President and CEO of The Open Group, took the audience on a journey as he described the transformation process that The Open Group has been on over the last thirty years from its inception in 1984. After a radically financial reorganization and raising new working capital, The Open Group is flourishing more than ever and is in good financial health.

It is amazing that 40 percent of the staff of 1984 is still working for The Open Group. What is the secret? You should have the right people in the boat with shared values and commitment. “In 2014, The Open Group runs a business, but stays a not-for-profit organization, a consortium”, Brown emphasized. “Enterprise Architecture is not a commercial vehicle or a ‘trendy’ topic. The Open Group always has a positive attitude and will never criticize other organizations. Our certification programs are a differentiator compared to other organizations. We collaborate with other consortia and standard bodies like ISO and ITIL”, Brown said.

Now the world is much more complex. Technology risk is increasing. A common language based on common standards is needed more than ever. TOGAF®, an Open Group standard, was in its infancy in 1998 and now it is the common standard for Enterprise Architects all over the world. In 1984, the UNIX® platform was the first platform of The Open Group. The Open Group Open Platform 3.0™, launched last year, focuses on new and emerging technology trends like mobility, big data, cloud computing and the Internet of Things converging with each other and leading to new business models and system designs. “The Open Group is all about building relationships and networking”, Brown concluded.

Leonardo Ramirez, CEO of ARCA SG and Chair of AEA Colombia, talked about the role of interoperability and Enterprise Architecture in Latin America. Colombia is now a safe country and has the strongest economy in the region. In 2011 Colombia promoted the electronic government and TOGAF was selected as the best choice for Enterprise Architecture. Ramirez is determined to stimulate social economic development projects in Latin America with the help of Enterprise Architecture. There is a law in Colombia (Regulation Law 1712, 2014) that says that every citizen has the right to access all the public information without boundaries.

Dr. Jonas Ridderstråle, Chairman, Mgruppen and Visiting Professor, Ashridge (UK) and IE Business Schools (Spain), said in his keynote speech, “Womenomics rules, the big winners of the personal freedom movement will be women. Women are far more risk averse. What would have happened with Lehman Brothers if it was managed by women? ‘Lehman Sisters’ probably had the potential to survive. Now women can spend 80 percent of their time on other things than just raising kids.” Ridderstråle continued to discuss life-changing and game-changing events throughout his presentation. He noted that The Open Group Open Platform 3.0 for instance is a good example of a successful reinvention.

“Towards a European Interoperability Architecture” was the title of one of the afternoon sessions led by Mr. R. Abril Jimenez. Analysis during the first phase of the European Interoperability Strategy (EIS) found that, at conceptual level, architecture guidelines were missing or inadequate. In particular, there are no architectural guidelines for cross-border interoperability of building blocks. Concrete, reusable interoperability guidelines and rules and principles on standards and architecture are also lacking. Based on the results achieved and direction set in the previous phases of the action, the EIA project has moved into a more practical phase that consists of two main parts: Conceptual Reference Architecture and Cartography.

Other tracks featured Healthcare, Professional Development and Dependability through Assuredness™.

The evening concluded with a lively networking reception in the hotel’s Winter Garden ballroom.

For those of you who attended the summit, please give us your feedback!  https://www.surveymonkey.com/s/AMST2014

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Improving Patient Care and Reducing Costs in Healthcare

By Jason Lee, Director of Healthcare and Security Forums, The Open Group

Recently, The Open Group Healthcare Forum hosted a tweet jam to discuss IT and Enterprise Architecture (EA) issues as they relate to two of the most persistent problems in healthcare: reducing costs and improving patient care. Below I summarize the key points that followed from a rather unique discussion. Unique how? Unique in that rather than address these issues from the perspective of “must do” priorities (including EHR implementation, transitioning to ICD-10, and meeting enhanced HIPAA security requirements), we focused on “should do” opportunities.

We asked how stakeholders in the healthcare system can employ “Boundaryless Information Flow™” and standards development through the application of EA approaches that have proven effective in other industries to add new insights and processes to reduce costs and improve quality.

Question 1: What barriers exist for collaboration among providers in healthcare, and what can be done to improve things?
• tetradian: Huge barriers of language, terminology, mindset, worldview, paradigm, hierarchy, role and much more
• jasonsleephd: Financial, organizational, structural, lack of enabling technology, cultural, educational, professional insulation
• jim_hietala: EHRs with proprietary interfaces represent a big barrier in healthcare
• Technodad: Isn’t question really what barriers exist for collaboration between providers and patients in healthcare?
• tetradian: Communication b/w patients and providers is only one (type) amongst very many
• Technodad: Agree. Debate needs to identify whose point of view the #healthcare problem is addressing.
• Dana_Gardner: Where to begin? A Tower of Babel exists on multiple levels among #healthcare ecosystems. Too complex to fix wholesale.
• EricStephens: Also, legal ramifications of sharing information may impede sharing
• efeatherston: Patient needs provider collaboration to see any true benefit (I don’t just go to one provider)
• Dana_Gardner: Improve first by identifying essential collaborative processes that have most impact, and then enable them as secure services.
• Technodad: In US at least, solutions will need to be patient-centric to span providers- Bring Your Own Wellness (BYOW™) for HC info.
• loseby: Lack of shared capabilities & interfaces between EHRs leads to providers w/o comprehensive view of patient
• EricStephens: Are incentives aligned sufficiently to encourage collaboration? + lack of technology integration.
• tetradian: Vast numbers of stakeholder-groups, many beyond medicine – e.g. pharma, university, politics, local care (esp. outside of US)
• jim_hietala: Gap in patient-centric information flow
• Technodad: I think patents will need to drive the collaboration – they have more incentive to manage info than providers.
• efeatherston: Agreed, stakeholder list could be huge
• EricStephens: High-deductible plans will drive patients (us) to own our health care experience
• Dana_Gardner: Take patient-centric approach to making #healthcare processes better: drives adoption, which drives productivity, more adoption
• jasonsleephd: Who thinks standards development and data sharing is an essential collaboration tool?
• tetradian: not always patient-centric – e.g. epidemiology /public-health is population centric – i.e. _everything_ is ‘the centre’
• jasonsleephd: How do we break through barriers to collaboration? For one thing, we need to create financial incentives to collaborate (e.g., ACOs)
• efeatherston: Agreed, the challenge is to get them to challenge (if that makes sense). Many do not question
• EricStephens: Some will deify those in a lab coat.
• efeatherston: Still do, especially older generations, cultural
• Technodad: Agree – also displaying, fusing data from different providers, labs, monitors etc.
• dianedanamac: Online collaboration, can be cost effective & promote better quality but must financially incented
• efeatherston: Good point, unless there is a benefit/incentive for provider, they may not be bothered to try
• tetradian: “must financially incented” – often other incentives work better – money can be a distraction – also who pays?

Participants identified barriers that are not atypical: financial disincentives, underpowered technology, failure to utilize existing capability, lack of motivation to collaborate. Yet all participants viewed more collaboration as key. Consensus developed around:
• The patient (and by one commenter, the population) as the main driver of collaboration, and
• The patient as the most important stakeholder at the center of information flow.

Question 2: Does implementing remote patient tele-monitoring and online collaboration drive better and more cost-effective patient care?
• EricStephens: “Hell yes” comes to mind. Why drag yourself into a dr. office when a device can send the information (w/ video)
• efeatherston: Will it? Will those with high deductible plans have ability/understanding/influence to push for it?
• EricStephens: Driving up participation could drive up efficacy
• jim_hietala: Big opportunities to improve patient care thru remote tele-monitoring
• jasonsleephd: Tele-ICUs can keep patients (and money) in remote settings while receiving quality care
• jasonsleephd: Remote monitoring of patients admitted with CHF can reduce rehospitalization w/i 6 months @connectedhealth.org
• Dana_Gardner: Yes! Pacemakers now uplink to centralized analysis centers, communicate trends back to attending doctor. Just scratches surface
• efeatherston: Amen. Do that now, monthly uplink, annual check in with doctor to discuss any trends he sees.
• tetradian: Assumes tele-monitoring options even exist – very wide range of device-capabilities, from very high to not-much, and still not common.
• tetradian: (General request to remember that there’s more to the world, and medicine, than just the US and its somewhat idiosyncratic systems?)
• efeatherston: Yes, I do find myself looking through the lens of my own experiences, forgetting the way we do things may not translate
• jasonsleephd: Amen to point about our idiosyncrasies! Still, we have to live with them, and we can do so much better with good information flow!
• Dana_Gardner: Governments should remove barriers so more remote patient tele-monitoring occurs. Need to address the malpractice risks issue.
• TerryBlevins: Absolutely. Just want the information to go to the right place!
• Technodad: . Isn’t “right place” someplace you & all your providers can access? Need interoperability!
• TerryBlevins: It requires interoperability yes – the info must flow to those that must know.
• Technodad: Many areas where continuous monitoring can help. Improved IoT (internet of things) sensors e.g. cardio, blood chemistry coming. http://t.co/M3xw3tNvv3
• tetradian: Ethical/privacy concerns re how/with-whom that data is shared – e.g. with pharma, research, epidemiology etc
• efeatherston: Add employers to that etc. list of how/who/what is shared

Participants agreed that remote patient monitoring and telemonitoring can improve collaboration, improve patient care, and put patients more in control of their own healthcare data. However, participants expressed concerns about lack of widespread availability and the related issue of high cost. In addition, they raised important questions about who has access to these data, and they addressed nagging privacy and liability concerns.

Question 3: Can a mobile strategy improve patient experience, empowerment and satisfaction? If so, how?
• jim_hietala: mobile is a key area where patient health information can be developed/captured
• EricStephens: Example: link blood sugar monitor to iPhone to MyFitnessPal + gamification to drive adherence (and drive $$ down?)
• efeatherston: Mobile along with #InternetOfThings, wearables linked to mobile. Contact lens measuring blood sugar in recent article as ex.
• TerryBlevins: Sick people, or people getting sick are on the move. In a patient centric world we must match need.
• EricStephens: Mobile becomes a great data acquisition point. Something as simple as SMS can drive adherence with complication drug treatments
• jasonsleephd: mHealth is a very important area for innovation, better collaboration, $ reduction & quality improvement. Google recent “Webby Awards & handheld devices”
• tetradian: Mobile can help – e.g. use of SMS for medicine in Africa etc
• Technodad: Mobile isn’t option any more. Retail, prescription IoT, mobile network & computing make this a must-have. http://t.co/b5atiprIU9
• dianedanamac: Providers need to be able to receive the information mHealth
• Dana_Gardner: Healthcare should go location-independent. Patient is anywhere, therefore so is care, data, access. More than mobile, IMHO.
• Technodad: Technology and mobile demand will outrun regional provider systems, payers, regulation
• Dana_Gardner: As so why do they need to be regional? Cloud can enable supply-demand optimization regardless of location for much.
• TerryBlevins: And the caregivers are also on the move!
• Dana_Gardner: Also, more machine-driven care, i.e. IBM Watson, for managing the routing and prioritization. Helps mitigate overload.
• Technodad: Agree – more on that later!
• Technodad: Regional providers are the reality in the US. Would love to have more national/global coverage.
• Dana_Gardner: Yes, let the market work its magic by making it a larger market, when information is the key.
• tetradian: “let the market do its work” – ‘the market’ is probably the quickest way to destroy trust! – not a good idea…
• Technodad: To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• tetradian: “Regional providers are the reality in the US.” – people move around: get info follow them is _hard_ (1st-hand exp. there…)
• tetradian: danger of hype/fear-driven apps – may need regulation, or at least regulatory monitoring
• jasonsleephd: Regulators, as in FDA or something similar?
• tetradian: “Regulators as in FDA” etc – at least oversight of that kind, yes (cf. vitamins, supplements, health-advice services)
• jim_hietala: mobile, consumer health device innovation moving much faster than IT ability to absorb
• tetradian: also beware of IT-centrism and culture – my 90yr-old mother has a cell-phone, but has almost no idea how to use it!
• Dana_Gardner: Information and rely of next steps (in prevention or acute care) are key, and can be mobile. Bring care to the patient ASAP.

Participants began in full agreement. Mobile health is not even an option but a “given” now. Recognition that provider ability to receive information is lacking. Cloud viewed as means to overcome regionalization of data storage problems. When the discussion turned to further development of mHealth there was some debate on what can be left to the market and whether some form of regulatory action is needed.

Question 4: Does better information flow and availability in healthcare reduce operation cost, and free up resources for more patient care?
• tetradian: A4: should do, but it’s _way_ more complex than most IT-folks seem to expect or understand (e.g. repeated health-IT fails in UK)
• jim_hietala: A4: removing barriers to health info flow may reduce costs, but for me it’s mostly about opportunity to improve patient care
• jasonsleephd: Absolutely. Consider claims processing alone. Admin costs in private health ins. are 20% or more. In Medicare less than 2%.
• loseby: Absolutely! ACO model is proving it. Better information flow and availability also significantly reduces hospital admissions
• dianedanamac: I love it when the MD can access my x-rays and lab results so we have more time.
• efeatherston: I love it when the MD can access my x-rays and lab results so we have more time.
• EricStephens: More info flow + availability -> less admin staff -> more med staff.
• EricStephens: Get the right info to the ER Dr. can save a life by avoiding contraindicated medicines
• jasonsleephd: EricStephens GO CPOE!!
• TerryBlevins: @theopengroup. believe so, but ask the providers. My doctor is more focused on patient by using simple tech to improve info flow
• tetradian: don’t forget link b/w information-flows and trust – if trust fails, so does the information-flow – worse than where we started!
• jasonsleephd: Yes! Trust is really key to this conversation!
• EricStephens: processing a claim, in most cases, should be no more difficult than an expense report or online order. Real-time adjudication
• TerryBlevins: Great point.
• efeatherston: Agreed should be, would love to see it happen. Trust in the data as mentioned earlier is key (and the process)
• tetradian: A4: sharing b/w patient and MD is core, yes, but who else needs to access that data – or _not_ see it? #privacy
• TerryBlevins: A4: @theopengroup can’t forget that if info doesn’t flow sometimes the consequences are fatal, so unblocked the flow.
• tetradian: .@TerryBlevins A4: “if info doesn’t flow sometimes the consequences are fatal,” – v.important!
• Technodad: . @tetradian To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• TerryBlevins: A4: @Technodad @tetradian I have heard that a patient moving on a gurney moves faster than the info in a hospital.
• Dana_Gardner: A4 Better info flow in #healthcare like web access has helped. Now needs to go further to be interactive, responsive, predictive.
• jim_hietala: A4: how about pricing info flow in healthcare, which is almost totally lacking
• Dana_Gardner: A4 #BigData, #cloud, machine learning can make 1st points of #healthcare contact a tech interface. Not sci-fi, but not here either.

Starting with the recognition that this is a very complicated issue, the conversation quickly produced a consensus view that mobile health is key, both to cost reduction and quality improvement and increased patient satisfaction. Trust that information is accurate, available and used to support trust in the provider-patient relationship emerged as a relevant issue. Then, naturally, privacy issues surfaced. Coordination of information flow and lack of interoperability were recognized as important barriers and the conversation finally turned somewhat abstract and technical with mentions of big data and the cloud and pricing information flows without much in the way of specifying how to connect the dots.

Question 5: Do you think payers and providers are placing enough focus on using technology to positively impact patient satisfaction?
• Technodad: A5: I think there are positive signs but good architecture is lacking. Current course will end w/ provider information stovepipes.
• TerryBlevins: A5: @theopengroup Providers are doing more. I think much more is needed for payers – they actually may be worse.
• theopengroup: @TerryBlevins Interesting – where do you see opportunities for improvements with payers?
• TerryBlevins: A5: @theopengroup like was said below claims processing – an onerous job for providers and patients – mostly info issue.
• tetradian: A5: “enough focus on using tech”? – no, not yet – but probably won’t until tech folks properly face the non-tech issues…
• EricStephens: A5 No. I’m not sure patient satisfaction (customer experience/CX?) is even a factor sometimes. Patients not treated like customers
• dianedanamac: .@EricStephens SO TRUE! Patients not treated like customers
• Technodad: . @EricStephens Amen to that. Stovepipe data in provider systems is barrier to understanding my health & therefore satisfaction.
• dianedanamac: “@mclark497: @EricStephens issue is the customer is treat as only 1 dimension. There is also the family experience to consider too
• tetradian: .@EricStephens A5: “Patients not treated like customers” – who _is_ ‘the customer’? – that’s a really tricky question…
• efeatherston: @tetradian @EricStephens Trickiest question. to the provider is the patient or the payer the customer?
• tetradian: .@efeatherston “patient or payer” – yeah, though it gets _way_ more complex than that once we explore real stakeholder-relations
• efeatherston: @tetradian So true.
• jasonsleephd: .@tetradian @efeatherston Very true. There are so many diff stakeholders. But to align payers and pts would be huge
• efeatherston: @jasonsleephd @tetradian re: aligning payers and patients, agree, it would be huge and a good thing
• jasonsleephd: .@efeatherston @tetradian @EricStephens Ideally, there should be no dividing line between the payer and the patient!
• efeatherston: @jasonsleephd @tetradian @EricStephens Ideally I agree, and long for that ideal world.
• EricStephens: .@jasonsleephd @efeatherston @tetradian the payer s/b a financial proxy for the patient. and nothing more
• TerryBlevins: @EricStephens @jasonsleephd @efeatherston @tetradian … got a LOL out of me.
• Technodad: . @tetradian @EricStephens That’s a case of distorted marketplace. #Healthcare architecture must cut through to patient.
• tetradian: .@Technodad “That’s a case of distorted marketplace.” – yep. now add in the politics of consultants and their hierarchies, etc?
• TerryBlevins: A5: @efeatherston @tetradian @EricStephens in patient cetric world it is the patient and or their proxy.
• jasonsleephd: A5: Not enough emphasis on how proven technologies and architectural structures in other industries can benefit healthcare
• jim_hietala: A5: distinct tension in healthcare between patient-focus and meeting mandates (a US issue)
• tetradian: .@jim_hietala A5: “meeting mandates (a US issue)” – UK NHS (national-health-service) may be even worse than US – a mess of ‘targets’
• EricStephens: A5 @jim_hietala …and avoiding lawsuits
• tetradian: A5: most IT-type tech still not well-suited to the level of mass-uniqueness inherent in the healthcare context
• Dana_Gardner: A5 They are using tech, but patient “satisfaction” not yet a top driver. We have a long ways to go on that. But it can help a ton.
• theopengroup: @Dana_Gardner Agree, there’s a long way to go. What would you say is the starting point for providers to tie the two together?
• Dana_Gardner: @theopengroup An incentive other than to avoid lawsuits. A transparent care ratings capability. Outcomes focus based on total health
• Technodad: A5: I’d be satisfied just to not have to enter my patient info & history on a clipboard in every different provider I go to!
• dianedanamac: A5 @tetradian Better data sharing & Collab. less redundancy, lower cost, more focus on patient needs -all possible w/ technology
• Technodad: A5: The patient/payer discussion is a red herring. If the patient weren’t there, rest of the system would be unnecessary.
• jim_hietala: RT @Technodad: The patient/payer discussion is a red herring. If the patient weren’t there, rest of system unnecessary. AMEN

Very interesting conversation. Positive signs of progress were noted but so too were indications that healthcare will remain far behind the technology curve in the foreseeable future. Providers were given higher “grades” than payers. Yet, claims processing would seemingly be one of the easiest areas for technology-assisted improvement. One discussant noted that there will not be enough focus on technology in healthcare “until the tech folks properly face the non-tech issues”. This would seem to open a wide door for EA experts to enter the healthcare domain! The barriers (and opportunities) to this may be the topic of another tweet jam, or Open Group White Paper.
Interestingly, part way into the discussion the topic turned to the lack of a real customer/patient focus in healthcare. Not enough emphasis on patient satisfaction. Not enough attention to patient outcomes. There needs to be a better/closer alignment between what motivates payers and the needs of patients.

Question 6: As some have pointed out, many of the EHR systems are highly proprietary, how can standards deliver benefits in healthcare?
• jim_hietala: A6: Standards will help by lowering the barriers to capturing data, esp. for mhealth, and getting it to point of care
• tetradian: .@jim_hietala “esp. for mhealth” – focus on mhealth may be a way to break the proprietary logjam, ‘cos it ain’t proprietary yet
• TerryBlevins: A6: @theopengroup So now I deal with at least 3 different EHR systems. All requiring me to be the info steward! Hmmm
• TerryBlevins: A6 @theopengroup following up if they shared data through standards maybe they can synchronize.
• EricStephens: A6 – Standards lead to better interoperability, increased viscosity of information which will lead to lowers costs, better outcomes.
• efeatherston: @EricStephens and greater trust in the info (as was mentioned earlier, trust in the information key to success)
• jasonsleephd: A6: Standards development will not kill innovation but rather make proprietary systems interoperable
• Technodad: A6: Metcalfe’s law rules! HC’s many providers-many patients structure means interop systems will be > cost effective in long run.
• tetradian: A6: the politics of this are _huge_, likewise the complexities – if we don’t face those issues right up-front, this is going nowhere

On his April 24, 2014 post at www.weblog.tetradian.com, Tom Graves provided a clearly stated position on the role of The Open Group in delivering standards to help healthcare improve. He wrote:

“To me, this is where The Open Group has an obvious place and a much-needed role, because it’s more than just an IT-standards body. The Open Group membership are mostly IT-type organisations, yes, which tends to guide towards IT-standards, and that’s unquestionably of importance here. Yet perhaps the real role for The Open Group as an organisation is in its capabilities and experience in building consortia across whole industries: EMMM™ and FACE are two that come immediately to mind. Given the maze of stakeholders and the minefields of vested-interests across the health-context, those consortia-building skills and experience are perhaps what’s most needed here.”

The Open Group is the ideal organization to engage in this work. There are many ways to collaborate. You can join The Open Group Healthcare Forum, follow the Forum on Twitter @ogHealthcare and connect on The Open Group Healthcare Forum LinkedIn Group.

Jason Lee headshotJason Lee, Director of Healthcare and Security Forums at The Open Group, has conducted healthcare research, policy analysis and consulting for over 20 years. He is a nationally recognized expert in healthcare organization, finance and delivery and applies his expertise to a wide range of issues, including healthcare quality, value-based healthcare, and patient-centered outcomes research. Jason worked for the legislative branch of the U.S. Congress from 1990-2000 — first at GAO, then at CRS, then as Health Policy Counsel for the Chairman of the House Energy and Commerce Committee (in which role the National Journal named him a “Top Congressional Aide” and he was profiled in the Almanac of the Unelected). Subsequently, Jason held roles of increasing responsibility with non-profit organizations — including AcademyHealth, NORC, NIHCM, and NEHI. Jason has published quantitative and qualitative findings in Health Affairs and other journals and his work has been quoted in Newsweek, the Wall Street Journal and a host of trade publications. He is a Fellow of the Employee Benefit Research Institute, was an adjunct faculty member at the George Washington University, and has served on several boards. Jason earned a Ph.D. in social psychology from the University of Michigan and completed two postdoctoral programs (supported by the National Science Foundation and the National Institutes of Health). He is the proud father of twins and lives outside of Boston.

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