Category Archives: Healthcare

The Open Group Healthcare Forum Publishes First Whitepaper and Announces New Member

By The Open Group

The Open Group Healthcare Forum has published its first whitepaper, “Enhancing Health Information Exchange with the FHIM” which examines the Federal Health Information Model (FHIM) and its efforts to bring semantic interoperability to the Healthcare industry.

The document was developed in response to a 2014 request to the Healthcare Forum made by the Federal Health Architecture program (FHA), an E-Government Line of Business initiative managed by ONC. The Forum was asked to evaluate the FHIM and to detail its potential usefulness to the wider Healthcare ecosystem. In response, The Healthcare Forum developed a whitepaper that highlights the strengths of the FHIM and the challenges it faces. Contributors came from organizations based across the globe including HP (US), Dividend Group (Canada), Sykehuspartner (Norway), and Philips Medical Systems (Germany).

The FHIM is a key component of a multimillion dollar effort to enable data sharing across the Healthcare enterprise. It has relevance worldwide as US federal agencies are among the leading markets for healthcare technology and processes. By identifying examples of FHIM adoption, understanding barriers to its adoption, and relating the FHIM to other major efforts to achieve Healthcare interoperability, the white paper reflects The Healthcare Forum’s support of Boundaryless Information Flow™, which continues to be engaged in this important work and expects to publish new insights in the second white paper in this series, planned for late 2015. The full whitepaper can be found here to download.

At the same time The Open Group Healthcare Forum has also announced that The Office of the National Coordinator for Health Information Technology (ONC – part of the U.S. Department of Health and Human Services) as its latest key member.

FHA Director Gail Kalbfleisch commented on the announcement, “We look forward to this membership opportunity with the Healthcare Forum, and becoming a part of the synergy that comes from collaborating with other members.”

Allen Brown, President & CEO of The Open Group also welcomed the news, “We are delighted to welcome the ONC to The Open Group Healthcare Forum following the evaluation of the FHIM by our members. The efficient and effective flow of secure healthcare information through healthcare systems is a critical goal of all who are engaged in that industry and is core to the vision of The Open Group which is Boundaryless Information Flow™, achieved through global interoperability in a secure, reliable and timely manner“.

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The Open Group London 2014 Preview: A Conversation with RTI’s Stan Schneider about the Internet of Things and Healthcare

By The Open Group

RTI is a Silicon Valley-based messaging and communications company focused on helping to bring the Industrial Internet of Things (IoT) to fruition. Recently named “The Most Influential Industrial Internet of Things Company” by Appinions and published in Forbes, RTI’s EMEA Manager Bettina Swynnerton will be discussing the impact that the IoT and connected medical devices will have on hospital environments and the Healthcare industry at The Open Group London October 20-23. We spoke to RTI CEO Stan Schneider in advance of the event about the Industrial IoT and the areas where he sees Healthcare being impacted the most by connected devices.

Earlier this year, industry research firm Gartner declared the Internet of Things (IoT) to be the most hyped technology around, having reached the pinnacle of the firm’s famed “Hype Cycle.”

Despite the hype around consumer IoT applications—from FitBits to Nest thermostats to fashionably placed “wearables” that may begin to appear in everything from jewelry to handbags to kids’ backpacks—Stan Schneider, CEO of IoT communications platform company RTI, says that 90 percent of what we’re hearing about the IoT is not where the real value will lie. Most of media coverage and hype is about the “Consumer” IoT like Google glasses or sensors in refrigerators that tell you when the milk’s gone bad. However, most of the real value of the IoT will take place in what GE has coined as the “Industrial Internet”—applications working behind the scenes to keep industrial systems operating more efficiently, says Schneider.

“In reality, 90 percent of the real value of the IoT will be in industrial applications such as energy systems, manufacturing advances, transportation or medical systems,” Schneider says.

However, the reality today is that the IoT is quite new. As Schneider points out, most companies are still trying to figure out what their IoT strategy should be. There isn’t that much active building of real systems at this point.

Most companies, at the moment, are just trying to figure out what the Internet of Things is. I can do a webinar on ‘What is the Internet of Things?’ or ‘What is the Industrial Internet of Things?’ and get hundreds and hundreds of people showing up, most of whom don’t have any idea. That’s where most companies are. But there are several leading companies that very much have strategies, and there are a few that are even executing their strategies, ” he said. According to Schneider, these companies include GE, which he says has a 700+ person team currently dedicated to building their Industrial IoT platform, as well as companies such as Siemens and Audi, which already have some applications working.

For its part, RTI is actively involved in trying to help define how the Industrial Internet will work and how companies can take disparate devices and make them work with one another. “We’re a nuts-and-bolts, make-it-work type of company,” Schneider notes. As such, openness and standards are critical not only to RTI’s work but to the success of the Industrial IoT in general, says Schneider. RTI is currently involved in as many as 15 different industry standards initiatives.

IoT Drivers in Healthcare

Although RTI is involved in IoT initiatives in many industries, from manufacturing to the military, Healthcare is one of the company’s main areas of focus. For instance, RTI is working with GE Healthcare on the software for its CAT scanner machines. GE chose RTI’s DDS (data distribution service) product because it will let GE standardize on a single communications platform across product lines.

Schneider says there are three big drivers that are changing the medical landscape when it comes to connectivity: the evolution of standalone systems to distributed systems, the connection of devices to improve patient outcome and the replacement of dedicated wiring with networks.

The first driver is that medical devices that have been standalone devices for years are now being built on new distributed architectures. This gives practitioners and patients easier access to the technology they need.

For example, RTI customer BK Medical, a medical device manufacturer based in Denmark, is in the process of changing their ultrasound product architecture. They are moving from a single-user physical system to a wirelessly connected distributed design. Images will now be generated in and distributed by the Cloud, thus saving significant hardware costs while making the systems more accessible.

According to Schneider, ultrasound machine architecture hasn’t really changed in the last 30 or 40 years. Today’s ultrasound machines are still wheeled in on a cart. That cart contains a wired transducer, image processing hardware or software and a monitor. If someone wants to keep an image—for example images of fetuses in utero—they get carry out physical media. Years ago it was a Polaroid picture, today the images are saved to CDs and handed to the patient.

In contrast, BK’s new systems will be completely distributed, Schneider says. Doctors will be able to carry a transducer that looks more like a cellphone with them throughout the hospital. A wireless connection will upload the imaging data into the cloud for image calculation. With a distributed scenario, only one image processing system may be needed for a hospital or clinic. It can even be kept in the cloud off-site. Both patients and caregivers can access images on any display, wherever they are. This kind of architecture makes the systems much cheaper and far more efficient, Schneider says. The days of the wheeled-in cart are numbered.

The second IoT driver in Healthcare is connecting medical devices together to improve patient outcomes. Most hospital devices today are completely independent and standalone. So, if a patient is hooked up to multiple monitors, the only thing that really “connects” those devices today is a piece of paper at the end of a hospital bed that shows how each should be functioning. Nurses are supposed to check these devices on an hourly basis to make sure they’re working correctly and the patient is ok.

Schneider says this approach is error-ridden. First, the nurse may be too busy to do a good job checking the devices. Worse, any number of things can set off alarms whether there’s something wrong with the patient or not. As anyone who has ever visited a friend or relative in the hospital attest to, alarms are going off constantly, making it difficult to determine when someone is really in distress. In fact, one of the biggest problems in hospital settings today, Schneider says, is a phenomenon known as “alarm fatigue.” Single devices simply can’t reliably tell if there’s some minor glitch in data or if the patient is in real trouble. Thus, 80% of all device alarms in hospitals are turned off. Meaningless alarms fatigue personnel, so they either ignore or turn off the alarms…and people can die.

To deal with this problem, new technologies are being created that will connect devices together on a network. Multiple devices can then work in tandem to really figure out when something is wrong. If the machines are networked, alarms can be set to go off only when multiple distress indicators are indicated rather than just one. For example, if oxygen levels drop on both an oxygen monitor on someone’s finger and on a respiration monitor, the alarm is much more likely a real patient problem than if only one source shows a problem. Schneider says the algorithms to fix these problems are reasonably well understood; the barrier is the lack of networking to tie all of these machines together.

The third area of change in the industrial medical Internet is the transition to networked systems from dedicated wired designs. Surgical operating rooms offer a good example. Today’s operating room is a maze of wires connecting screens, computers, and video. Videos, for instance, come from dynamic x-ray imaging systems, from ultrasound navigation probes and from tiny cameras embedded in surgical instruments. Today, these systems are connected via HDMI or other specialized cables. These cables are hard to reconfigure. Worse, they’re difficult to sterilize, Schneider says. Thus, the surgical theater is hard to configure, clean and maintain.

In the future, the mesh of special wires can be replaced by a single, high-speed networking bus. Networks make the systems easier to configure and integrate, easier to use and accessible remotely. A single, easy-to-sterilize optical network cable can replace hundreds of wires. As wireless gets faster, even that cable can be removed.

“By changing these systems from a mesh of TV-cables to a networked data bus, you really change the way the whole system is integrated,” he said. “It’s much more flexible, maintainable and sharable outside the room. Surgical systems will be fundamentally changed by the Industrial IoT.”

IoT Challenges for Healthcare

Schneider says there are numerous challenges facing the integration of the IoT into existing Healthcare systems—from technical challenges to standards and, of course, security and privacy. But one of the biggest challenges facing the industry, he believes, is plain old fear. In particular, Schneider says, there is a lot of fear within the industry of choosing the wrong path and, in effect, “walking off a cliff” if they choose the wrong direction. Getting beyond that fear and taking risks, he says, will be necessary to move the industry forward, he says.

In a practical sense, the other thing currently holding back integration is the sheer number of connected devices currently being used in medicine, he says. Manufacturers each have their own systems and obviously have a vested interest in keeping their equipment in hospitals, so many have been reluctant to develop or become standards-compliant and push interoperability forward, Schneider says.

This is, of course, not just a Healthcare issue. “We see it in every single industry we’re in. It’s a real problem,” he said.

Legacy systems are also a problematic area. “You can’t just go into a Kaiser Permanente and rip out $2 billion worth of equipment,” he says. Integrating new systems with existing technology is a process of incremental change that takes time and vested leadership, says Schneider.

Cloud Integration a Driver

Although many of these technologies are not yet very mature, Schneider believes that the fundamental industry driver is Cloud integration. In Schneider’s view, the Industrial Internet is ultimately a systems problem. As with the ultrasound machine example from BK Medical, it’s not that an existing ultrasound machine doesn’t work just fine today, Schneider says, it’s that it could work better.

“Look what you can do if you connect it to the Cloud—you can distribute it, you can make it cheaper, you can make it better, you can make it faster, you can make it more available, you can connect it to the patient at home. It’s a huge system problem. The real overwhelming striking value of the Industrial Internet really happens when you’re not just talking about the hospital but you’re talking about the Cloud and hooking up with practitioners, patients, hospitals, home care and health records. You have to be able to integrate the whole thing together to get that ultimate value. While there are many point cases that are compelling all by themselves, realizing the vision requires getting the whole system running. A truly connected system is a ways out, but it’s exciting.”

Open Standards

Schneider also says that openness is absolutely critical for these systems to ultimately work. Just as agreeing on a standard for the HTTP running on the Internet Protocol (IP) drove the Web, a new device-appropriate protocol will be necessary for the Internet of Things to work. Consensus will be necessary, he says, so that systems can talk to each other and connectivity will work. The Industrial Internet will push that out to the Cloud and beyond, he says.

“One of my favorite quotes is from IBM, he says – IBM said, ‘it’s not a new Internet, it’s a new Web.’” By that, they mean that the industry needs new, machine-centric protocols to run over the same Internet hardware and base IP protocol, Schneider said.

Schneider believes that this new web will eventually evolve to become the new architecture for most companies. However, for now, particularly in hospitals, it’s the “things” that need to be integrated into systems and overall architectures.

One example where this level of connectivity will make a huge difference, he says, is in predictive maintenance. Once a system can “sense” or predict that a machine may fail or if a part needs to be replaced, there will be a huge economic impact and cost savings. For instance, he said Siemens uses acoustic sensors to monitor the state of its wind generators. By placing sensors next to the bearings in the machine, they can literally “listen” for squeaky wheels and thus figure out whether a turbine may soon need repair. These analytics let them know when the bearing must be replaced before the turbine shuts down. Of course, the infrastructure will need to connect all of these “things” to the each other and the cloud first. So, there will need to be a lot of system level changes in architectures.

Standards, of course, will be key to getting these architectures to work together. Schneider believes standards development for the IoT will need to be tackled from both horizontal and vertical standpoint. Both generic communication standards and industry specific standards like how to integrate an operating room must evolve.

“We are a firm believer in open standards as a way to build consensus and make things actually work. It’s absolutely critical,” he said.

stan_schneiderStan Schneider is CEO at Real-Time Innovations (RTI), the Industrial Internet of Things communications platform company. RTI is the largest embedded middleware vendor and has an extensive footprint in all areas of the Industrial Internet, including Energy, Medical, Automotive, Transportation, Defense, and Industrial Control.  Stan has published over 50 papers in both academic and industry press. He speaks at events and conferences widely on topics ranging from networked medical devices for patient safety, the future of connected cars, the role of the DDS standard in the IoT, the evolution of power systems, and understanding the various IoT protocols.  Before RTI, Stan managed a large Stanford robotics laboratory, led an embedded communications software team and built data acquisition systems for automotive impact testing.  Stan completed his PhD in Electrical Engineering and Computer Science at Stanford University, and holds a BS and MS from the University of Michigan. He is a graduate of Stanford’s Advanced Management College.

 

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IT Trends Empowering Your Business is Focus of The Open Group London 2014

By The Open Group

The Open Group, the vendor-neutral IT consortium, is hosting an event in London October 20th-23rd at the Central Hall, Westminster. The theme of this year’s event is on how new IT trends are empowering improvements in business and facilitating enterprise transformation.

Objectives of this year’s event:

  • Show the need for Boundaryless Information Flow™, which would result in more interoperable, real-time business processes throughout all business ecosystems
  • Examine the use of developing technology such as Big Data and advanced data analytics in the financial services sector: to minimize risk, provide more customer-centric products and identify new market opportunities
  • Provide a high-level view of the Healthcare ecosystem that identifies entities and stakeholders which must collaborate to enable the vision of Boundaryless Information Flow
  • Detail how the growth of “The Internet of Things” with online currencies and mobile-enabled transactions has changed the face of financial services, and poses new threats and opportunities
  • Outline some of the technological imperatives for Healthcare providers, with the use of The Open Group Open Platform 3.0™ tools to enable products and services to work together and deploy emerging technologies freely and in combination
  • Describe how to develop better interoperability and communication across organizational boundaries and pursue global standards for Enterprise Architecture for all industries

Key speakers at the event include:

  • Allen Brown, President & CEO, The Open Group
  • Magnus Lindkvist, Futurologist
  • Hans van Kesteren, VP & CIO Global Functions, Shell International, The Netherlands
  • Daniel Benton, Global Managing Director, IT Strategy, Accenture

Registration for The Open Group London 2014 is open and available to members and non-members. Please register here.

Join the conversation via Twitter – @theopengroup #ogLON

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Case Study – ArchiMate®, An Open Group Standard: Public Research Centre Henri Tudor and Centre Hospitalier de Luxembourg

By The Open Group

The Public Research Centre Henri Tudor is an institute of applied research aimed at reinforcing the innovation capacity at organizations and companies and providing support for national policies and international recognition of Luxembourg’s scientific community. Its activities include applied and experimental research; doctoral research; the development of tools, methods, labels, certifications and standards; technological assistance; consulting and watch services; and knowledge and competency transfer. Its main technological domains are advanced materials, environmental, Healthcare, information and communication technologies as well as business organization and management. The Centre utilizes its competencies across a number of industries including Healthcare, industrial manufacturing, mobile, transportation and financial services among others.

In 2012, the Centre Hospitalier de Luxembourg allowed Tudor to experiment with an access rights management system modeled using ArchiMate®, an Open Group standard. This model was tested by CRP Tudor to confirm the approach used by the hospital’s management to grant employees, nurses and doctors permission to access patient records.

Background

The Centre Hospitalier de Luxembourg is a public hospital that focuses on severe pathologies, medical and surgical emergencies and palliative care. The hospital also has an academic research arm. The hospital employs a staff of approximately 2,000, including physicians and specialized employees, medical specialists, nurses and administrative staff. On average the hospital performs more than 450,000 outpatient services, 30,000 inpatient services and more than 60,000 adult and pediatric emergency services, respectively, per year.

Unlike many hospitals throughout the world, the Centre Hospitalier de Luxembourg is open and accessible 24 hours a day, seven days a week. Accessing patient records is required at the hospital at any time, no matter the time of day or weekend. In addition, the Grand Duchy of Luxembourg has a system where medical emergencies are allocated to one hospital each weekend across each of the country’s three regions. In other words, every two weeks, one hospital within a given region is responsible for all of the incoming medical emergencies on its assigned weekend, affecting patient volume and activity.

Access rights management

As organizations have become not only increasingly global but also increasingly digital, access rights management has become a critical component of keeping institutional information secure so that it does not fall into the wrong hands. Managing access to internal information is a critical component of every company’s security strategy, but it is particularly important for organizations that deal with sensitive information about consumers, or in the case of the Centre Hospitalier de Luxembourg, patients.

Modeling an access rights management system was important for the hospital for a number of reasons. First, European privacy laws dictate that only the people who require information regarding patient medical files should be allowed access to those files. Although privacy laws may restrict access to patient records, a rights management system must be flexible enough to grant access to the correct individuals when necessary.

In the case of a hospital such as the Centre Hospitalier de Luxembourg, access to information may be critical for the life of the patient. For instance, if a patient was admitted to the emergency room, the emergency room physician will be able to better treat the patient if he or she can access the patient’s records, even if they are not the patient’s primary care physician. Admitting personnel may also need access to records at the time of admittance. Therefore, a successful access rights management system must combine a balance between restricting information and providing flexible access as necessary, giving the right access at the right time without placing an administrative burden on the doctors or staff.

The project

Prior to the experiment in which the Public Research Centre Henri Tudor tested this access rights management model, the Centre Hospitalier de Luxembourg had not experienced any problems in regard to its information sharing system. However, its access rights were still being managed by a primarily paper-based system. As part of the scope of the project, the hospital was also looking to become compliant with existing privacy laws. Developing an access rights management model was intended to close the gap within the hospital between restricting access to patient information overall and providing new rights, as necessary, to employees that would allow them to do their work without endangering patient lives. From a technical perspective, the access rights management system also needed not only to work in conjunction with existing applications, such as the ERP system, used within the hospital but also support rights management at the business layer.

Most current access rights managements systems provide information access to individuals based on a combination of the functional requirements necessary for employees to do their jobs and governance rights, which provide the protections that will keep the organization and its information safe and secure. What many existing models have failed to take into account is that most access control models and rights engineering methods don’t adequately represent both sides of this equation. As such, determining the correct level of access for different employees within organizations can be difficult.

Modeling access rights management

Within the Centre Hospitalier de Luxembourg, employee access rights were defined based on individual job responsibilities and job descriptions. To best determine how to grant access rights across an hospital, the Public Research Centre Henri Tudor needed to create a system that could take these responsibilities into account, rather than just rely on functional or governance requirements.

To create an access rights management model that would work with the hospital’s existing processes and ERP software, the Public Research Centre Henri Tudor first needed to come up with a way to model responsibility requirements instead of just functional or governance requirements. According to Christophe Feltus, Research Engineer at the Public Research Centre, defining a new approach based on actor or employee responsibilities was the first step in creating a new model for the hospital.

Although existing architecture modeling languages provide views for many different types of stakeholders within organizations—from executives to IT and project managers—no modeling language had previously been used to develop a view dedicated to access rights management, Feltus says. As such, that view needed to be created and modeled anew for this project.

To develop this new view, the Public Research Centre needed to find an architecture modeling language that was flexible enough to accommodate such an extension. After evaluating three separate modeling languages, they chose ArchiMate®, an Open Group Standard and open and independent modeling language, to help them visualize the relationships among the hospital’s various employees in an unambiguous way.

Much like architectural drawings are used in building architecture to describe the various aspects of construction and building use, ArchiMate provides a common language for describing how to construct business processes, organizational structures, information flows, IT systems and technical infrastructures. By providing a common language and visual representation of systems, ArchiMate helps stakeholders within organizations design, assess and communicate how decisions and changes within business domains will affect the organization.

According to Feltus, Archimate provided a well-formalized language for the Public Research Centre to portray the architecture needed to model the access rights management system they wanted to propose for Centre Hospitalier. Because ArchiMate is a flexible and open language, it also provided an extension mechanism that could accommodate the responsibility modeling language (ReMMo) that the engineering team had developed for the hospital.

In addition to providing the tools and extensions necessary for the engineering team to properly model the hospital’s access rights system, the Public Research Centre also chose ArchiMate because it is an open and vendor-neutral modeling language. As a publically funded institution, it was important that the Public Research Centre avoided using vendor-specific tools that would lock them in to a potentially costly cycle of constant version upgrades.

“What was very interesting [about ArchiMate] was that it was an open and independent solution. This is very important for us. As a public company, it’s preferable not to use private solutions. This was something very important,” said Feltus.

Feltus notes that using ArchiMate to model the access rights project was also a relatively easy and intuitive process. “It was rather easy,” Feltus said. “The concepts are clear and recommendations are well done, so it was easy to explore the framework.” The most challenging part of the project was selecting which extension mechanism would best portray the design and model they wanted to use.

Results

After developing the access rights model using ArchiMate, the responsibility metamodel was presented to the hospital’s IT staff by the Public Research Centre Henri Tudor. The Public Research Centre team believes that the responsibility model created using ArchiMate allows for better alignment between the hospital’s business processes defined at the business layer with their IT applications being run at the application layer. The team also believes the model could both enhance provisioning of access rights to employees and improve the hospital’s performance. For example, using the proposed responsibility model, the team found that some employees in the reception department had been assigned more permissions than they required in practice. Comparing the research findings with the reality on the ground at the hospital has shown the Public Research Centre team that ArchiMate is an effective tool for modeling and determining both responsibilities and access rights within organizations.

Due to the ease of use and success the Public Research Centre Henri Tudor experienced in using ArchiMate to create the responsibility model and the access rights management system for the hospital, Tudor also intends to continue to use ArchiMate for other public and private research projects as appropriate.

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The Open Group Boston 2014 – Day Two Highlights

By Loren K. Bayes, Director, Global Marketing Communications

Enabling Boundaryless Information Flow™  continued in Boston on Tuesday, July 22Allen Brown, CEO and President of The Open Group welcomed attendees with an overview of the company’s second quarter results.

The Open Group membership is at 459 organizations in 39 countries, including 16 new membership agreements in 2Q 2014.

Membership value is highlighted by the collaboration Open Group members experience. For example, over 4,000 individuals attended Open Group events (physically and virtually whether at member meetings, webinars, podcasts, tweet jams). The Open Group website had more than 1 million page views and over 105,000 publication items were downloaded by members in 80 countries.

Brown also shared highlights from The Open Group Forums which featured status on many upcoming white papers, snapshots, reference models and standards, as well as individiual Forum Roadmaps. The Forums are busy developing and reviewing projects such as the Next Version of TOGAF®, an Open Group standard, an ArchiMate® white paper, The Open Group Healthcare Forum charter and treatise, Standard Mils™ APIs and Open Fair. Many publications are translated into multiple languages including Chinese and Portuguese. Also, a new Forum will be announced in the third quarter at The Open Group London 2014 so stay tuned for that launch news!

Our first keynote of the day was Making Health Addictive by Joseph Kvedar, MD, Partners HealthCare, Center for Connected Health.

Dr. Kvedar described how Healthcare delivery is changing, with mobile technology being a big part. Other factors pushing changes are reimbursement paradigms and caregivers being paid to be more efficient and interested in keeping people healthy and out of hospitals. The goal of Healthcare providers is to integrate care into the day-to-day lives of patients. Healthcare also aims for better technologies and architecture.

Mobile is a game-changer in Healthcare because people are “always on and connected”. Mobile technology allows for in-the-moment messaging, ability to capture health data (GPS, accelerator, etc.) and display information in real time as needed. Bottom-line, smartphones are addictive so they are excellent tools for communication and engagement.

But there is a need to understand and address the implications of automating Healthcare: security, privacy, accountability, economics.

The plenary continued with Proteus Duxbury, CTO, Connect for Health Colorado, who presented From Build to Run at the Colorado Health Insurance Exchange – Achieving Long-term Sustainability through Better Architecture.

Duxbury stated the keys to successes of his organization are the leadership and team’s shared vision, a flexible vendor being agile with rapidly changing regulatory requirements, and COTS solution which provided minimal customization and custom development, resilient architecture and security. Connect for Health experiences many challenges including budget restraints, regulation and operating in a “fish bowl”. Yet, they are on-track with their three-year ‘build to run’ roadmap, stabilizing their foundation and gaining efficiencies.

During the Q&A with Allen Brown following each presentation, both speakers emphasized the need for standards, architecture and data security.

Brown and DuxburyAllen Brown and Proteus Duxbury

During the afternoon, track sessions consisted of Healthcare, Enterprise Architecture (EA) & Business Value, Service-Oriented Architecture (SOA), Security & Risk Management, Professional Development and ArchiMate Tutorials. Chris Armstrong, President, Armstrong Process Group, Inc. discussed Architecture Value Chain and Capability Model. Laura Heritage, Principal Solution Architect / Enterprise API Platform, SOA Software, presented Protecting your APIs from Threats and Hacks.

The evening culminated with a reception at the historic Old South Meeting House, where the Boston Tea Party began in 1773.

photo2

IMG_2814Networking Reception at Old South Meeting House

A special thank you to our sponsors and exhibitors at The Open Group Boston 2014: BiZZdesign, Black Duck, Corso, Good e-Learning, Orbus and AEA.

Join the conversation #ogBOS!

Loren K. BaynesLoren K. Baynes, Director, Global Marketing Communications, joined The Open Group in 2013 and spearheads corporate marketing initiatives, primarily the website, blog and media relations. Loren has over 20 years experience in brand marketing and public relations and, prior to The Open Group, was with The Walt Disney Company for over 10 years. Loren holds a Bachelor of Business Administration from Texas A&M University. She is based in the US.

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The Open Group Boston 2014 – Day One Highlights

By Loren K. Baynes, Director, Global Marketing Communications

The Open Group kicked off Enabling Boundaryless Information Flow™  July 21 at the spectacular setting of the Hyatt Boston Harbor. Allen Brown, CEO and President of The Open Group, welcomed over 150 people from 20 countries, including as far away as Australia, Japan, Saudi Arabia and India.

The first keynote speaker was Marshall Van Alstyne, Professor at Boston University School of Management & Researcher at MIT Center for Digital Business, known as a leading expert in business models. His presentation entitled Platform Shift – How New Open Business Models are Changing the Shape of Industry posed the questions “What does ‘openness’ mean? Why do platforms beat products every time?”.

Van AlstyneMarshall Van Alstyne

According to “InterBrand: 2014 Best Global Brands”, 13 of the top 31 companies are “platform companies”. To be a ‘platform’, a company needs embeddable functions or service and allow 3rd party access. Alystyne noted, “products have features, platforms have communities”. Great standalone products are not sufficient. Positive changes experienced by a platform company include pricing/profitability, supply chains, internal organization, innovation, decreased industry bottlenecks and strategy.

Platforms benefit from broad contributions, as long as there is control of the top several complements. Alstyne commented, “If you believe in the power of community, you need to embrace the platform.”

The next presentation was Open Platform 3.0™ – An Integrated Approach to the Convergence of Technology Platforms, by Dr. Chris Harding, Director for Interoperability, The Open Group. Dr. Harding discussed how society has developed a digital society.

1970 was considered the dawn of an epoch which saw the First RAM chip, IBM introduction of System/370 and a new operating system – UNIX®. Examples of digital progress since that era include driverless cars and Smart Cities (management of traffic, energy, water, communication).

Digital society enablers are digital structural change and corporate social media. The benefits are open innovation, open access, open culture, open government and delivering more business value.

Dr. Harding also noted, standards are essential to innovation and enable markets based on integration. The Open Group Open Platform 3.0™ is using ArchiMate®, an Open Group standard, to analyze the 30+ business use cases produced by the Forum. The development cycle is understanding, analysis, specification, iteration.

Dr. Harding emphasized the importance of Boundaryless Information Flow™, as an enabler of business objectives and efficiency through IT standards in the era of digital technology, and designed for today’s agile enterprise with direct involvement of business users.

Both sessions concluded with an interactive audience Q&A hosted by Allen Brown.

The last session of the morning’s plenary was a panel: The Internet of Things and Interoperability. Dana Gardner, Principal Analyst at Interarbor Solutions, moderated the panel. Participating in the panel were Said Tabet, CTO for Governance, Risk and Compliance Strategy, EMC; Penelope Gordon, Emerging Technology Strategist, 1Plug Corporation; Jean-Francois Barsoum, Senior Managing Consultant, Smarter Cities, Water & Transportation, IBM; and Dave Lounsbury, CTO, The Open Group.

IoT PanelIoT Panel – Gardner, Barsoum, Tabet, Lounsbury, Gordon

The panel explored the practical limits and opportunities of Internet of Things (IoT). The different areas discussed include obstacles to decision-making as big data becomes more prolific, openness, governance and connectivity of things, data and people which pertain to many industries such as smart cities, manufacturing and healthcare.

How do industries, organizations and individuals deal with IoT? This is not necessarily a new problem, but an accelerated one. There are new areas of interoperability but where does the data go and who owns the data? Openness is important and governance is essential.

What needs to change most to see the benefits of the IoT? The panel agreed there needs to be a push for innovation, increased education, move beyond models of humans managing the interface (i.e. machine-to-machine) and determine what data is most important, not always collecting all the data.

A podcast and transcript of the Internet of Things and Interoperability panel will be posted soon.

The afternoon was divided into several tracks: Boundaryless Information Flow™, Open Platform 3.0™ and Enterprise Architecture (EA) & Enterprise Transformation. Best Practices for Enabling Boundaryless Information Flow across the Government was presented by Syed Husain, Consultant Enterprise Architecture, Saudi Arabia E-government Authority. Robert K. Pucci, CTO, Communications Practice, Cognizant Technology Solutions discussed Business Transformation Justification Leveraging Business and Enterprise Architecture.

The evening concluded with a lively networking reception at the hotel.

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Loren K. BaynesLoren K. Baynes, Director, Global Marketing Communications, joined The Open Group in 2013 and spearheads corporate marketing initiatives, primarily the website, blog and media relations. Loren has over 20 years experience in brand marketing and public relations and, prior to The Open Group, was with The Walt Disney Company for over 10 years. Loren holds a Bachelor of Business Administration from Texas A&M University. She is based in the US.

 

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The Open Group Boston 2014 – Q&A with Proteus Duxbury, Connect for Health Colorado

By The Open Group

The U.S. healthcare industry is undergoing a major sea change right now due in part to the Affordable Care Act, as well as the need to digitize legacy systems that have remained largely paper-based in order to better facilitate information exchange.

Proteus Duxbury, the CTO for the state of Colorado’s health insurance exchange, Connect for Health Colorado, has a wide and varied background in healthcare IT ranging from IT consulting and helping to lead a virtual health medicine group to his current position running the supporting technologies operating the Colorado exchange. Duxbury joined Connect for Health Colorado early 2014 as the exchange was going through its first major enrollment period.

We spoke to Duxbury in advance of his keynote on July 22 at The Open Group Boston 2014 conference about the current state of healthcare IT and how Enterprise Architecture will play an integral part in the Connect for Health Colorado exchange moving forward as the organizations transitions from a start-up culture to a maintenance and run mode.

Below is a transcript of that conversation.

What factors went into making the roll-out of Connect for Health Colorado healthcare exchange a success?

There were three things. The first is we have an exceptional leadership team. The CEO, especially, is a fantastic leader and was able to create a strong vision and have her team rally quickly behind it. The executive team was empowered to make decisions quickly and there was a highly dedicated work force and a powerful start-up culture. In addition, there was a uniformly shared passion to see healthcare reform successfully implemented in Colorado.

The second reason for success was the flexibility and commitment of our core vendor—which is CGI—and their ability to effectively manage and be agile with rapidly changing regulatory requirements and rapidly changing needs. These systems had never been built anywhere else before; it really was a green field program of work. There was a shared commitment to achieving success and very strong contracting in place ensuring that we were fully protected throughout the whole process.

The third is our COTS (Commercial Off-The-Shelf) solution that was selected. Early on, we established an architecture principle of deploying out-of-the-box products rather than trying to build from scratch, so there was minimal customization and development effort. Scope control was tight. We implemented the hCentive package, which is one of the leading health insurance exchange software packages. Best-of-breed solutions were implemented around the edges where it was necessary to meet a niche need, but we try to build as much into the single product as we can. We have a highly resilient and available architecture. The technical architecture scales well and has been very robust and resilient through a couple of very busy periods at the end of open enrollment, particularly on March 31st and toward the end of December, as the deadline for enrollment in 2014 plans approached.

Why are you putting together an Enterprise Architecture for the exchange?

We’re extremely busy right now with a number of critical projects. We’re still implementing core functionality but we do have a bit of a breather on the horizon. Going into next year things will get lighter, and now is the time for a clear roadmap to achieve the IT strategic objectives that I have set for the organization.

We are trying to achieve a reduction in our M&O (maintenance and operations) expense because we need to be self-sustaining from a budgetary point of view. Our federal funding will be going away starting 2015 so we need to consolidate architecture and systems and gain additional efficiencies. We need to continue to meet our key SLAs, specifically around availability—we have a very public-facing set of systems. IT needs to be operationalized. We need to move from the existing start-up culture to the management of IT in a CMM (Capability Maturity Model) or ITIL-type fashion. And we also need to continue to grow and hold on to our customer base, as there is always a reasonable amount of churn and competing services in a relatively uncertain marketplace. We need to continue to grow our customer base so we can be self-sustaining. To support this, we need to have a more operationalized, robust and cost-efficient IT architecture, and we need a clear roadmap to get there. If you don’t have a roadmap or design that aligns with business priorities, then those things are difficult to achieve.

Finally, I am building up an IT team. To date, we’ve been highly reliant on contractors and consultants to get us to where we are now. In order to reduce our cost base, we are building out our internal IT team and a number of key management roles. That means we need to have a roadmap and something that we can all steer towards—a shared architecture roadmap.

What benefits do you expect to see from implementing the architecture?

Growing our customer base is a critical goal—we need to stabilize the foundations of our IT solution and use that as a platform for future growth and innovation. It’s hard to grow and innovate if you haven’t got your core IT platform stabilized. By making our IT systems easier to be maintained and updated we hope to see continued reduction in IT M&O. High availability is another benefit I expect to see, as well as closer alignment with business goals and business processes and capabilities.

Are there any particular challenges in setting up an Enterprise Architecture for a statewide health exchange? What are they?

I think there are some unique challenges. The first is budget. We do need to be self-sustaining, and there is not a huge amount of budget available for additional capital investments. There is some, but it has to be very carefully allocated, managed and spent diligently. We do work within a tightly controlled federal set of regulations and constraints and are frequently under the spotlight from auditors and others.

There are CMS (Center for Medicaid Services) regulations that define what we can and cannot do with our technology. We have security regulations that we have to exist within and a lot of IRS requirements that we have to meet and be compliant with. We have a complex set of partners to work with in Colorado and nationally—we have to work with Colorado state agencies such as the Department of Insurance and Medicaid (HCPF), we have to work very closely with a large number—we’ve currently got 17—of carriers. We have CMS and the federal marketplace (Federal Data Services Hub). We have one key vendor—CGI—but we are in a multi-vendor environment and all our projects involve having to manage multiple different organizations towards success.

The final challenge is that we’re very busy still building applications and implementing functionality, so my job is to continue to be focused on successful delivery of two very large projects, while ensuring our longer term architecture planning is completed, which is going to be critical for our long-term sustainability. That’s the classic Enterprise Architecture conundrum. I feel like we’ve got a handle on it pretty well here—because they’re both critical.

What are some of the biggest challenges that you see facing the Healthcare industry right now?

Number one is probably integration—the integration of data especially between different systems. A lot of EMR (electronic medical record) systems are relatively closed to the outside world, and it can be expensive and difficult to open them up. Even though there are some good standards out there like HL7 and EDI (Electronic Data Interchange), everyone seems to be implementing them differently.

Personal healthcare tech (mHealth and Telehealth) is not going to take off until there is more integration. For example, between whatever you’re using to track your smoking, blood pressure, weight, etc., it needs to be integrated seamlessly with your medical records and insurance provider. And until this data can be used for meaningful analytics and care planning, until they solve this integration nightmare, it’s going to be difficult really to make great strides.

Security is the second challenge. There’s a huge proliferation of new technology endpoints and there’s a lot of weak leaks around people, process and technology. The regulators are only really starting to catch up, and they’re one step behind. There’s a lot of personal data out there and it’s not always technology that’s the weak leak. We have that pretty tightly controlled here because we’re highly regulated and are technology is tightly controlled, but on the provider side especially, it’s a huge challenge and every week we see a new data breach.

The third challenge is ROI. There’s a lot of investment being made into personal health technology but because we’re in a private insurance market and a private provider market, until someone has really cracked what the ROI is for these initiatives, whether it’s tied to re-admissions or reimbursements, it’s never going to really become mainstream. And until it becomes part of the fabric of care delivery, real value is not going to be realized and health outcomes not significantly improved.

But models are changing—once the shift to outcome-based reimbursement takes hold, providers will be more incentivized to really invest in these kind of technologies and get them working. But that shift hasn’t really occurred yet, and I’ve yet to see really compelling ROI models for a lot of these new investments. I’m a believer that it really has to be the healthcare provider that drives and facilitates the engagement with patients on these new technologies. Ultimately, I believe, people, left to their own devices, will experiment and play with something for a while, but unless their healthcare provider is engaging them actively on it, it’s not something that they will persist in doing. A lot of the large hospital groups are dipping their toe in the water and seeing what sticks, but I don’t really see any system where these new technologies are becoming part of the norm of healthcare delivery.

Do you feel like there are other places that are seeing more success in this outside of the US?

I know in the UK, they’re having a lot of success with their Telehealth pilots. But their primary objective is to make people healthier, so it’s a lot easier in that environment to have a good idea, show that there’s some case for improving outcomes and get funding. In the US, proving outcomes currently isn’t enough. You have to prove that there’s some revenue to be made or cost to be saved. In some markets, they’ve experienced problems similar to the US and in some markets it’s probably been easier. That doesn’t mean they’ve had an easy time implementing them—the UK has had huge problems with integration and with getting EMR systems deployed and implemented nationally. But a lot of those are classical IT problems of change management, scope control and trying to achieve too much too quickly. The healthcare industry is about 20 years behind other industries. They’re going through all the pain with the EMR rollouts that most manufacturing companies went through with ERP 20 years ago and most banks went through 40 years ago.

How can organizations such as The Open Group and its Healthcare Forum better work with the Healthcare industry to help them achieve better results?

I think firstly bringing a perspective from other industries. Healthcare IT conferences and organizations tend to be largely made up of people who have been in healthcare most of their working lives. The Open Group brings in perspective from other industries. Also reference architectures—there’s a shortage of good reference architectures in the healthcare space and that’s something that is really The Open Group’s strong point. Models that span the entire healthcare ecosystem—including payers, providers, pharma and exchanges, IT process and especially IT architecture process—can be improved in healthcare. Healthcare IT departments aren’t as mature as other industries because the investment has not been there until now. They’re in a relative start-up mode. Enterprise Architecture—if you’re a large healthcare provider and you’re growing rapidly through M&O (like so many are right now), that’s a classic use case for having a structured Enterprise Architecture process.

Within the insurance marketplace movement, things have grown very quickly; it’s been tough work. A handful of the states have been very successful, and I think we’re not unique in that we’re a start-up organization and it’s going to be several years until we mature to fully functional, well measured l IT organization. Architecture rigor and process is key to achieving sustainability and maturity.

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duxbury_0Proteus Duxbury joined Connect for Health Colorado as Chief Technology Officer in February 2014, directing technology strategy and operations. Proteus previously served at Catholic Health Initiatives, where he led all IT activities for Virtual Health Services, a division responsible for deploying Telehealth solutions throughout the US. Prior to that, Proteus served as a Managing Consultant at the PA Consulting Group, leading technology change programs in the US and UK primarily in the healthcare and life science industry. He holds a Bachelor of Science in Information Systems Management from Bournemouth University.

 

 

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