Category Archives: Healthcare

Improving Patient Care and Reducing Costs in Healthcare – Join The Open Group Tweet Jam on Wednesday, April 23

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

On Wednesday, April 23 at 9:00 am PT/12:00 pm ET/5:00 pm GMT, The Open Group Healthcare Forum will host a tweet jam to discuss the issues around healthcare and improving patient care while reducing costs. Many healthcare payer and provider organizations today are facing numerous “must do” priorities, including EHR implementation, transitioning to ICD-10, and meeting enhanced HIPAA security requirements.

This tweet jam will focus on opportunities that healthcare organizations have available to improve patient care and reduce costs associated with capturing, maintaining, and sharing patient information. It will also explore how using Enterprise Architectural approaches that have proven effective in other industries will apply to the healthcare sector and dramatically improve both costs and patient care.

In addition to the need for implementing integrated digital health records that can be shared across health organizations to maximize care for both patients who don’t want to repeat themselves and the doctors providing their care, we’ll explore what other solutions exist to enhance information flow. For example, did you know that a new social network for M.D.s has even emerged to connect and communicate across teams, hospitals and entire health systems? The new network, called Doximity, boasts that 40 percent of U.S. doctors have signed on. Not only are doctors using social media, they’re using software specifically designed for the iPad that roughly 68 percent of doctors are carrying around. One hospital even calculated its return on investment of utilizing a an iPad in just nine days!

We’ll be talking about how many healthcare thought leaders are looking at technology and its influence on online collaboration, patient telemonitoring and information flow.

We welcome The Open Group members and interested participants from all backgrounds to join the discussion and interact with our panel of thought-leaders including Jim Hietala, Vice President of Security; David Lounsbury, CTO; and Dr. Chris Harding, Forum Director of Open Platform 3.0™ Forum. To access the discussion, please follow the hashtag #ogchat during the allotted discussion time.

Interested in joining The Open Group Healthcare Forum? Register your interest, here.

What Is a Tweet Jam?

The Open Group tweet jam, approximately 45 minutes in length, is a “discussion” hosted on Twitter. The purpose of the tweet jam is to share knowledge and answer questions on relevant and thought-provoking issues. Each tweet jam is led by a moderator and a dedicated group of experts to keep the discussion flowing. The public (or anyone using Twitter interested in the topic) is encouraged to join the discussion.

Participation Guidance

Whether you’re a newbie or veteran Twitter user, here are a few tips to keep in mind:

Have your first #ogchat tweet be a self-introduction: name, affiliation, occupation.

Start all other tweets with the question number you’re responding to and add the #ogchat hashtag.

Sample: Q1 What barriers exist for collaboration among providers in healthcare, and what can be done to improve things? #ogchat

Please refrain from product or service promotions. The goal of a tweet jam is to encourage an exchange of knowledge and stimulate discussion.

While this is a professional get-together, we don’t have to be stiff! Informality will not be an issue.

A tweet jam is akin to a public forum, panel discussion or Town Hall meeting – let’s be focused and thoughtful.

If you have any questions prior to the event or would like to join as a participant, please contact Rob Checkal (@robcheckal or rob.checkal@hotwirepr.com). We anticipate a lively chat and hope you will be able to join!

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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Filed under Boundaryless Information Flow™, Enterprise Architecture, Healthcare, Tweet Jam

The Financial Incentive for Health Information Exchanges

By Jim Hietala, VP, Security, The Open Group

Health IT professionals have always known that interoperability would be one of the most important aspects of the Affordable Care Act (ACA). Now doctors have financial incentive to be proactive in taking part in the process of exchange information between computer systems.

According to a recent article in MedPage Today, doctors are now “clamoring” for access to patient information ahead of the deadlines for the government’s “meaningful use” program. Doctors and hospitals will get hit with fines for not knowing about patients’ health histories, for patient readmissions and unnecessary retesting. “Meaningful use” refers to provisions in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use electronic health records in a meaningful way that significantly improves clinical care.
Doctors who accept Medicare will find themselves penalized for not adopting or successfully demonstrating meaningful use of a certified electronic health record (EHR) technology by 2015. Health professionals’ Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year for certain categories.  If less than 75% of Eligible Professionals (EPs) have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5% (95% of Medicare covered amount).

With the stick, there’s also a carrot. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

According to HealthIT.Gov, interoperability is essential for applications that interact with users (such as e-prescribing), systems that communicate with each other (such as messaging standards) information processes and management (such as health information exchange) how consumer devices integrate with other systems and applications (such as tablet, smart phones and PCs).

The good news is that more and more hospitals and doctors are participating in data exchanges and sharing patient information. On January 30th, the eHealth Exchange, formerly the Nationwide Health Information Network, and operated by Healtheway, reported a surge in network participation numbers and increases in secure online transactions among members.

According to the news release, membership in the eHealth Exchange is currently pegged at 41 participants who together represent some 800 hospitals, 6,000 mid-to-large medical groups, 800 dialysis centers and 850 retail pharmacies nationwide. Some of the earliest members to sign on with the exchange were the Veterans Health Administration, Department of Defense, Kaiser Permanente, the Social Security Administration and Dignity Health.

While the progress in health information exchanges is good, there is still much work to do in defining standards, so that the right information is available at the right time and place to enable better patient care. Devices are emerging that can capture continuous information on our health status. The information captured by these devices can enable better outcomes, but only if the information is made readily available to medical professionals.

The Open Group recently formed The Open Group Healthcare Forum, which focuses on bringing  Boundaryless Information Flow™ to the healthcare industry enabling data to flow more easily throughout the complete healthcare ecosystem.  By leveraging the discipline and principles of Enterprise Architecture, including TOGAF®, an Open Group standard, the forum aims to develop standardized vocabulary and messaging that will result in higher quality outcomes, streamlined business practices and innovation within the industry.

62940-hietalaJim Hietala, CISSP, GSEC, is the Vice President, Security for The Open Group, where he manages all IT security, risk management and healthcare programs and standards activities. He participates in the SANS Analyst/Expert program and has also published numerous articles on information security, risk management, and compliance topics in publications including The ISSA Journal, Bank Accounting & Finance, Risk Factor, SC Magazine, and others.

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Filed under Boundaryless Information Flow™, Enterprise Architecture, Healthcare, Professional Development, Standards, TOGAF®, Uncategorized

Q&A with Allen Brown, President and CEO of The Open Group

By The Open Group

Last month, The Open Group hosted its San Francisco 2014 conference themed “Toward Boundaryless Information Flow™.” Boundaryless Information Flow has been the pillar of The Open Group’s mission since 2002 when it was adopted as the organization’s vision for Enterprise Architecture. We sat down at the conference with The Open Group President and CEO Allen Brown to discuss the industry’s progress toward that goal and the industries that could most benefit from it now as well as The Open Group’s new Dependability through Assuredness™ Standard and what the organization’s Forums are working on in 2014.

The Open Group adopted Boundaryless Information Flow as its vision in 2002, and the theme of the San Francisco Conference has been “Towards Boundaryless Information Flow.” Where do you think the industry is at this point in progressing toward that goal?

Well, it’s progressing reasonably well but the challenge is, of course, when we established that vision back in 2002, life was a little less complex, a little bit less fast moving, a little bit less fast-paced. Although organizations are improving the way that they act in a boundaryless manner – and of course that changes by industry – some industries still have big silos and stovepipes, they still have big boundaries. But generally speaking we are moving and everyone understands the need for information to flow in a boundaryless manner, for people to be able to access and integrate information and to provide it to the teams that they need.

One of the keynotes on Day One focused on the opportunities within the healthcare industry and The Open Group recently started a Healthcare Forum. Do you see Healthcare industry as a test case for Boundaryless Information Flow and why?

Healthcare is one of the verticals that we’ve focused on. And it is not so much a test case, but it is an area that absolutely seems to need information to flow in a boundaryless manner so that everyone involved – from the patient through the administrator through the medical teams – have all got access to the right information at the right time. We know that in many situations there are shifts of medical teams, and from one medical team to another they don’t have access to the same information. Information isn’t easily shared between medical doctors, hospitals and payers. What we’re trying to do is to focus on the needs of the patient and improve the information flow so that you get better outcomes for the patient.

Are there other industries where this vision might be enabled sooner rather than later?

I think that we’re already making significant progress in what we call the Exploration, Mining and Minerals industry. Our EMMM™ Forum has produced an industry-wide model that is being adopted throughout that industry. We’re also looking at whether we can have an influence in the airline industry, automotive industry, manufacturing industry. There are many, many others, government and retail included.

The plenary on Day Two of the conference focused on The Open Group’s Dependability through Assuredness standard, which was released last August. Why is The Open Group looking at dependability and why is it important?

Dependability is ultimately what you need from any system. You need to be able to rely on that system to perform when needed. Systems are becoming more complex, they’re becoming bigger. We’re not just thinking about the things that arrive on the desktop, we’re thinking about systems like the barriers at subway stations or Tube stations, we’re looking at systems that operate any number of complex activities. And they bring an awful lot of things together that you have to rely upon.

Now in all of these systems, what we’re trying to do is to minimize the amount of downtime because downtime can result in financial loss or at worst human life, and we’re trying to focus on that. What is interesting about the Dependability through Assuredness Standard is that it brings together so many other aspects of what The Open Group is working on. Obviously the architecture is at the core, so it’s critical that there’s an architecture. It’s critical that we understand the requirements of that system. It’s also critical that we understand the risks, so that fits in with the work of the Security Forum, and the work that they’ve done on Risk Analysis, Dependency Modeling, and out of the dependency modeling we can get the use cases so that we can understand where the vulnerabilities are, what action has to be taken if we identify a vulnerability or what action needs to be taken in the event of a failure of the system. If we do that and assign accountability to people for who will do what by when, in the event of an anomaly being detected or a failure happening, we can actually minimize that downtime or remove it completely.

Now the other great thing about this is it’s not only a focus on the architecture for the actual system development, and as the system changes over time, requirements change, legislation changes that might affect it, external changes, that all goes into that system, but also there’s another circle within that system that deals with failure and analyzes it and makes sure it doesn’t happen again. But there have been so many evidences of failure recently. In the banks for example in the UK, a bank recently was unable to process debit cards or credit cards for customers for about three or four hours. And that was probably caused by the work done on a routine basis over a weekend. But if Dependability through Assuredness had been in place, that could have been averted, it could have saved an awfully lot of difficulty for an awful lot of people.

How does the Dependability through Assuredness Standard also move the industry toward Boundaryless Information Flow?

It’s part of it. It’s critical that with big systems the information has to flow. But this is not so much the information but how a system is going to work in a dependable manner.

Business Architecture was another featured topic in the San Francisco plenary. What role can business architecture play in enterprise transformation vis a vis the Enterprise Architecture as a whole?

A lot of people in the industry are talking about Business Architecture right now and trying to focus on that as a separate discipline. We see it as a fundamental part of Enterprise Architecture. And, in fact, there are three legs to Enterprise Architecture, there’s Business Architecture, there’s the need for business analysts, which are critical to supplying the information, and then there are the solutions, and other architects, data, applications architects and so on that are needed. So those three legs are needed.

We find that there are two or three different types of Business Architect. Those that are using the analysis to understand what the business is doing in order that they can inform the solutions architects and other architects for the development of solutions. There are those that are more integrated with the business that can understand what is going on and provide input into how that might be improved through technology. And there are those that can actually go another step and talk about here we have the advances and the technology and here are the opportunities for advancing our competitiveness and organization.

What are some of the other key initiatives that The Open Group’s forum and work groups will be working on in 2014?

That kind question is like if you’ve got an award, you’ve got to thank your friends, so apologies to anyone that I leave out. Let me start alphabetically with the Architecture Forum. The Architecture Forum obviously is working on the evolution of TOGAF®, they’re also working with the harmonization of TOGAF with Archimate® and they have a number of projects within that, of course Business Architecture is on one of the projects going on in the Architecture space. The Archimate Forum are pushing ahead with Archimate—they’ve got two interesting activities going on at the moment, one is called ArchiMetals, which is going to be a sister publication to the ArchiSurance case study, where the ArchiSurance provides the example of Archimate is used in the insurance industry, ArchiMetals is going to be used in a manufacturing context, so there will be a whitepaper on that and there will be examples and artifacts that we can use. They’re also working on in Archimate a standard for interoperability for modeling tools. There are four tools that are accredited and certified by The Open Group right now and we’re looking for that interoperability to help organizations that have multiple tools as many of them do.

Going down the alphabet, there’s DirecNet. Not many people know about DirecNet, but Direcnet™ is work that we do around the U.S. Navy. They’re working on standards for long range, high bandwidth mobile networking. We can go to the FACE™ Consortium, the Future Airborne Capability Environment. The FACE Consortium are working on their next version of their standard, they’re working toward accreditation, a certification program and the uptake of that through procurement is absolutely amazing, we’re thrilled about that.

Healthcare we’ve talked about. The Open Group Trusted Technology Forum, where they’re working on how we can trust the supply chain in developed systems, they’ve released the Open Trusted Technology Provider™ Standard (O-TTPS) Accreditation Program, that was launched this week, and we already have one accredited vendor and two certified test labs, assessment labs. That is really exciting because now we’ve got a way of helping any organization that has large complex systems that are developed through a global supply chain to make sure that they can trust their supply chain. And that is going to be invaluable to many industries but also to the safety of citizens and the infrastructure of many countries. So the other part of the O-TTPS is that standard we are planning to move toward ISO standardization shortly.

The next one moving down the list would be Open Platform 3.0™. This is really exciting part of Boundaryless Information Flow, it really is. This is talking about the convergence of SOA, Cloud, Social, Mobile, Internet of Things, Big Data, and bringing all of that together, this convergence, this bringing together of all of those activities is really something that is critical right now, and we need to focus on. In the different areas, some of our Cloud computing standards have already gone to ISO and have been adopted by ISO. We’re working right now on the next products that are going to move through. We have a governance standard in process and an ecosystem standard has recently been published. In the area of Big Data there’s a whitepaper that’s 25 percent completed, there’s also a lot of work on the definition of what Open Platform 3.0 is, so this week the members have been working on trying to define Open Platform 3.0. One of the really interesting activities that’s gone on, the members of the Open Platform 3.0 Forum have produced something like 22 different use cases and they’re really good. They’re concise and they’re precise and the cover a number of different industries, including healthcare and others, and the next stage is to look at those and work on the ROI of those, the monetization, the value from those use cases, and that’s really exciting, I’m looking forward to peeping at that from time to time.

The Real Time and Embedded Systems Forum (RTES) is next. Real-Time is where we incubated the Dependability through Assuredness Framework and that was where that happened and is continuing to develop and that’s really good. The core focus of the RTES Forum is high assurance system, and they’re doing some work with ISO on that and a lot of other areas with multicore and, of course, they have a number of EC projects that we’re partnering with other partners in the EC around RTES.

The Security Forum, as I mentioned earlier, they’ve done a lot of work on risk and dependability. So they’ve not only their standards for the Risk Taxonomy and Risk Analysis, but they’ve now also developed the Open FAIR Certification for People, which is based on those two standards of Risk Analysis and Risk Taxonomy. And we’re already starting to see people being trained and being certified under that Open FAIR Certification Program that the Security Forum developed.

A lot of other activities are going on. Like I said, I probably left a lot of things out, but I hope that gives you a flavor of what’s going on in The Open Group right now.

The Open Group will be hosting a summit in Amsterdam May 12-14, 2014. What can we look forward to at that conference?

In Amsterdam we have a summit – that’s going to bring together a lot of things, it’s going to be a bigger conference that we had here. We’ve got a lot of activity in all of our activities; we’re going to bring together top-level speakers, so we’re looking forward to some interesting work during that week.

 

 

 

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Filed under Enterprise Architecture, Cybersecurity, TOGAF®, ArchiMate®, FACE™, Standards, Business Architecture, EMMMv™, Conference, O-TTF, Healthcare, RISK Management, Boundaryless Information Flow™

Q&A with Jim Hietala on Security and Healthcare

By The Open Group

We recently spoke with Jim Hietala, Vice President, Security for The Open Group, at the 2014 San Francisco conference to discuss upcoming activities in The Open Group’s Security and Healthcare Forums.

Jim, can you tell us what the Security Forum’s priorities are going to be for 2014 and what we can expect to see from the Forum?

In terms of our priorities for 2014, we’re continuing to do work in Security Architecture and Information Security Management. In the area of Security Architecture, the big project that we’re doing is adding security to TOGAF®, so we’re working on the next version of the TOGAF standard and specification and there’s an active project involving folks from the Architecture Forum and the Security Forum to integrate security into and stripe it through TOGAF. So, on the Security Architecture side, that’s the priority. On the Information Security Management side, we’re continuing to do work in the area of Risk Management. We introduced a certification late last year, the OpenFAIR certification, and we’ll continue to do work in the area of Risk Management and Risk Analysis. We’re looking to add a second level to the certification program, and we’re doing some other work around the Risk Analysis standards that we’ve introduced.

The theme of this conference was “Towards Boundaryless Information Flow™” and many of the tracks focused on convergence, and the convergence of things Big Data, mobile, Cloud, also known as Open Platform 3.0. How are those things affecting the realm of security right now?

I think they’re just beginning to. Cloud—obviously the security issues around Cloud have been here as long as Cloud has been over the past four or five years. But if you look at things like the Internet of Things and some of the other things that comprise Open Platform 3.0, the security impacts are really just starting to be felt and considered. So I think information security professionals are really just starting to wrap their hands around, what are those new security risks that come with those technologies, and, more importantly, what do we need to do about them? What do we need to do to mitigate risk around something like the Internet of Things, for example?

What kind of security threats do you think companies need to be most worried about over the next couple of years?

There’s a plethora of things out there right now that organizations need to be concerned about. Certainly advanced persistent threat, the idea that maybe nation states are trying to attack other nations, is a big deal. It’s a very real threat, and it’s something that we have to think about – looking at the risks we’re facing, exactly what is that adversary and what are they capable of? I think profit-motivated criminals continue to be on everyone’s mind with all the credit card hacks that have just come out. We have to be concerned about cyber criminals who are profit motivated and who are very skilled and determined and obviously there’s a lot at stake there. All of those are very real things in the security world and things we have to defend against.

The Security track at the San Francisco conference focused primarily on risk management. How can companies better approach and manage risk?

As I mentioned, we did a lot of work over the last few years in the area of Risk Management and the FAIR Standard that we introduced breaks down risk into what’s the frequency of bad things happening and what’s the impact if they do happen? So I would suggest that taking that sort of approach, using something like taking the Risk Taxonomy Standard that we’ve introduced and the Risk Analysis Standard, and really looking at what are the critical assets to protect, who’s likely to attack them, what’s the probably frequency of attacks that we’ll see? And then looking at the impact side, what’s the consequence if somebody successfully attacks them? That’s really the key—breaking it down, looking at it that way and then taking the right mitigation steps to reduce risk on those assets that are really important.

You’ve recently become involved in The Open Group’s new Healthcare Forum. Why a healthcare vertical forum for The Open Group?

In the area of healthcare, what we see is that there’s just a highly fragmented aspect to the ecosystem. You’ve got healthcare information that’s captured in various places, and the information doesn’t necessarily flow from provider to payer to other providers. In looking at industry verticals, the healthcare industry seemed like an area that really needed a lot of approaches that we bring from The Open Group—TOGAF and Enterprise Architecture approaches that we have.

If you take it up to a higher level, it really needs the Boundaryless Information Flow that we talk about in The Open Group. We need to get to the point where our information as patients is readily available in a secure manner to the people who need to give us care, as well as to us because in a lot of cases the information exists as islands in the healthcare industry. In looking at healthcare it just seemed like a natural place where, in our economies – and it’s really a global problem – a lot of money is spent on healthcare and there’s a lot of opportunities for improvement, both in the economics but in the patient care that’s delivered to individuals through the healthcare system. It just seemed like a great area for us to focus on.

As the new Healthcare Forum kicks off this year, what are the priorities for the Forum?

The Healthcare Forum has just published a whitepaper summarizing the workshop findings for the workshop that we held in Philadelphia last summer. We’re also working on a treatise, which will outline our views about the healthcare ecosystem and where standards and architecture work is most needing to be done. We expect to have that whitepaper produced over the next couple of months. Beyond that, we see a lot of opportunities for doing architecture and standards work in the healthcare sector, and our membership is going to determine which of those areas to focus on, which projects to initiate first.

For more on the The Open Group Security Forum, please visit http://www.opengroup.org/subjectareas/security. For more on the The Open Group Healthcare Forum, see http://www.opengroup.org/getinvolved/industryverticals/healthcare.

62940-hietalaJim Hietala, CISSP, GSEC, is the Vice President, Security for The Open Group, where he manages all IT security, risk management and healthcare programs and standards activities. He participates in the SANS Analyst/Expert program and has also published numerous articles on information security, risk management, and compliance topics in publications including The ISSA Journal, Bank Accounting & Finance, Risk Factor, SC Magazine, and others.

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Filed under Cloud/SOA, Conference, Data management, Healthcare, Information security, Open FAIR Certification, Open Platform 3.0, RISK Management, TOGAF®, Uncategorized

Facing the Challenges of the Healthcare Industry – An Interview with Eric Stephens of The Open Group Healthcare Forum

By The Open Group

The Open Group launched its new Healthcare Forum at the Philadelphia conference in July 2013. The forum’s focus is on bringing Boundaryless Information Flow™ to the healthcare industry to enable data to flow more easily throughout the complete healthcare ecosystem through a standardized vocabulary and messaging. Leveraging the discipline and principles of Enterprise Architecture, including TOGAF®, the forum aims to develop standards that will result in higher quality outcomes, streamlined business practices and innovation within the industry.

At the recent San Francisco 2014 conference, Eric Stephens, Enterprise Architect at Oracle, delivered a keynote address entitled, “Enabling the Opportunity to Achieve Boundaryless Information Flow” along with Larry Schmidt, HP Fellow at Hewlett-Packard. A veteran of the healthcare industry, Stephens was Senior Director of Enterprise Architects Excellus for BlueCross BlueShield prior to joining Oracle and he is an active member of the Healthcare Forum.

We sat down after the keynote to speak with Stephens about the challenges of healthcare, how standards can help realign the industry and the goals of the forum. The opinions expressed here are Stephens’ own, not of his employer.

What are some of the challenges currently facing the healthcare industry?

There are a number of challenges, and I think when we look at it as a U.S.-centric problem, there’s a disproportionate amount of spending that’s taking place in the U.S. For example, if you look at GDP or percentage of GDP expenditures, we’re looking at now probably 18 percent of GDP [in the U.S.], and other developed countries are spending a full 5 percent less than that of their GDP, and in some cases they’re getting better outcomes outside the U.S.

The mere fact that there’s the existence of what we call “medical tourism, where if I need a hip replacement, I can get it done for a fraction of the cost in another country, same or better quality care and have a vacation—a rehab vacation—at the same time and bring along a spouse or significant other, means there’s a real wide range of disparity there. 

There’s also a lack of transparency. Having worked at an insurance company, I can tell you that with the advent of high deductible plans, there’s a need for additional cost information. When I go on Amazon or go to a local furniture store, I know what the cost is going to be for what I’m about to purchase. In the healthcare system, we don’t get that. With high deductible plans, if I’m going to be responsible for a portion or a larger portion of the fee, I want to know what it is. And what happens is, the incentives to drive costs down force the patient to be a consumer. The consumer now asks the tough questions. If my daughter’s going in for a tonsillectomy, show me a bill of materials that shows me what’s going to be done – if you are charging me $20/pill for Tylenol, I’ll bring my own. Increased transparency is what will in turn drive down the overall costs.

I think there’s one more thing, and this gets into the legal side of things. There is an exorbitant amount of legislation and regulation around what needs to be done. And because every time something goes sideways, there’s going to be a lawsuit, doctors will prescribe an extra test, and extra X-ray for a patient whether they need it or not.

The healthcare system is designed around a vicious cycle of diagnose-treat-release. It’s not incentivized to focus on prevention and management. Oregon is promoting these coordinated care organizations (CCOs) that would be this intermediary that works with all medical professionals – whether it was physical, mental, dental, even social worker – to coordinate episodes of care for patients. This drives down inappropriate utilization – for example, using an ER as a primary care facility and drives the medical system towards prevention and management of health. 

Your keynote with Larry Schmidt of HP focused a lot on cultural changes that need to take place within the healthcare industry – what are some of the changes necessary for the healthcare industry to put standards into place?

I would say culturally, it goes back to those incentives, and it goes back to introducing this idea of patient-centricity. And for the medical community, to really start recognizing that these individuals are consumers and increased choice is being introduced, just like you see in other industries. There are disruptive business models. As a for instance, medical tourism is a disruptive business model for United States-based healthcare. The idea of pharmacies introducing clinical medicine for routine care, such as what you see at a CVS, Wal-Mart or Walgreens. I can get a flu shot, I can get a well-check visit, I can get a vaccine – routine stuff that doesn’t warrant a full-blown medical professional. It’s applying the right amount of medical care to a particular situation.

Why haven’t existing standards been adopted more broadly within the industry? What will help providers be more likely to adopt standards?

I think the standards adoption is about “what’s in it for me, the WIIFM idea. It’s demonstrating to providers that utilizing standards is going to help them get out of the medical administration business and focus on their core business, the same way that any other business would want to standardize its information through integration, processes and components. It reduces your overall maintenance costs going forward and arguably you don’t need a team of billing folks sitting in an doctor’s office because you have standardized exchanges of information.

Why haven’t they been adopted? It’s still a question in my mind. Why would a doctor not want to do that is perhaps a question we’re going to need to explore as part of the Healthcare Forum.

Is it doctors that need to adopt the standards or technologies or combination of different constituents within the ecosystem?

I think it’s a combination. We hear a lot about the Affordable Care Act (ACA) and the health exchanges. What we don’t hear about is the legislation to drive toward standardization to increase interoperability. So unfortunately it would seem the financial incentives or things we’ve tried before haven’t worked, and we may simply have to resort to legislation or at least legislative incentives to make it happen because part of the funding does cover information exchanges so you can move health information between providers and other actors in the healthcare system.

You’re advocating putting the individual at the center of the healthcare ecosystem. What changes need to take place within the industry in order to do this?

I think it’s education, a lot of education that has to take place. I think that individuals via the incentive model around high deductible plans will force some of that but it’s taking responsibility and understanding the individual role in healthcare. It’s also a cultural/societal phenomenon.

I’m kind of speculating here, and going way beyond what enterprise architecture or what IT would deliver, but this is a philosophical thing around if I have an ailment, chances are there’s a pill to fix it. Look at the commercials, every ailment say hypertension, it’s easy, you just dial the medication correctly and you don’t worry as much about diet and exercise. These sorts of things – our over-reliance on medication. I’m certainly not going to knock the medications that are needed for folks that absolutely need them – but I think we can become too dependent on pharmacological solutions for our health problems.   

What responsibility will individuals then have for their healthcare? Will that also require a cultural and behavioral shift for the individual?

The individual has to start managing his or her own health. We manage our careers and families proactively. Now we need to focus on our health and not just float through the system. It may come to financial incentives for certain “individual KPIs such as blood pressure, sugar levels, or BMI. Advances in medical technology may facilitate more personal management of one’s health.

One of the Healthcare Forum’s goals is to help establish Boundaryless Information Flow within the Healthcare industry you’ve said that understanding the healthcare ecosystem will be a key component for that what does that ecosystem encompass and why is it important to know that first?

Very simply we’re talking about the member/patient/consumer, then we get into the payers, the providers, and we have to take into account government agencies and other non-medical agents, but they all have to work in concert and information needs to flow between those organizations in a very standardized way so that decisions can be made in a very timely fashion.

It can’t be bottled up, it’s got to be provided to the right provider at the right time, otherwise, best case, it’s going to cost more to manage all the actors in the system. Worst case, somebody dies or there is a “never event due to misinformation or lack of information during the course of care. The idea of Boundaryless Information Flow gives us the opportunity to standardize, have easily accessible information – and by the way secured – it can really aide in that decision-making process going forward. It’s no different than Wal-Mart knowing what kind of merchandise sells well before and after a hurricane (i.e., beer and toaster pastries, BTW). It’s the same kind of real-time information that’s made available to a Google car so it can steer its way down the road. It’s that kind of viscosity needed to make the right decisions at the right time.

Healthcare is a highly regulated industry, how can Boundarylesss Information Flow and data collection on individuals be achieved and still protect patient privacy?

We can talk about standards and the flow and the technical side. We need to focus on the security and privacy side.  And there’s going to be a legislative side because we’re going to touch on real fundamental data governance issue – who owns the patient record? Each actor in the system thinks they own the patient record. If we’re going to require more personal accountability for healthcare, then shouldn’t the consumer have more ownership? 

We also need to address privacy disclosure regulations to avoid catastrophic data leaks of protected health information (PHI). We need bright IT talent to pull off the integration we are talking about here. We also need folks who are well versed in the privacy laws and regulations. I’ve seen project teams of 200 have up to eight folks just focusing on the security and privacy considerations. We can argue about headcount later but my point is the same – one needs some focused resources around this topic.

What will standards bring to the healthcare industry that is missing now?

I think the standards, and more specifically the harmonization of the standards, is going to bring increased maintainability of solutions, I think it’s going to bring increased interoperability, I think it’s going to bring increased opportunities too. We see mobile computing or even DropBox, that has API hooks into all sorts of tools, and it’s well integrated – so I can integrate and I can move files between devices, I can move files between apps because they have hooks it’s easy to work with. So it’s building these communities of developers, apps and technical capabilities that makes it easy to move the personal health record for example, back and forth between providers and it’s not a cataclysmic event to integrate a new version of electronic health records (EHR) or to integrate the next version of an EHR. This idea of standardization but also some flexibility that goes into it.

Are you looking just at the U.S. or how do you make a standard that can go across borders and be international?

It is a concern, much of my thinking and much of what I’ve conveyed today is U.S.-centric, based on our problems, but many of these interoperability problems are international. We’re going to need to address it; I couldn’t tell you what the sequence is right now. There are other considerations, for example, single vs. multi-payer—that came up in the keynote. We tend to think that if we stay focused on the consumer/patient we’re going to get it for all constituencies. It will take time to go international with a standard, but it wouldn’t be the first time. We have a host of technical standards for the Internet (e.g., TCP/IP, HTTP). The industry has been able to instill these standards across geographies and vendors. Admittedly, the harmonization of health care-related standards will be more difficult. However, as our world shrinks with globalization an international lens will need to be applied to this challenge. 

Eric StephensEric Stephens (@EricStephens) is a member of Oracle’s executive advisory community where he focuses on advancing clients’ business initiatives leveraging the practice of Business and Enterprise Architecture. Prior to joining Oracle he was Senior Director of Enterprise Architecture at Excellus BlueCross BlueShield leading the organization with architecture design, innovation, and technology adoption capabilities within the healthcare industry.

 

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What I learnt at The Open Group Bangalore Conference last weekend

By Sreekanth Iyer, Executive IT Architect, IBM

It was quite a lot of learning on a Saturday attending The Open Group conference at Bangalore. Actually it was a two day program this year. I could not make it on Friday because of other work commitments. I heard from the people who attended that it was a great session on Friday. At least I knew about a fellow IBMer Jithesh Kozhipurath’s presentation on Friday. I’d the chance to look at that excellent material on applying TOGAF® practices for integrated IT Operations Enterprise Architecture which was his experience sharing of the lab infra optimization work that he was leading.

I started bit late on Saturday, thinking it was happening at the Leela Palace which was near to my home (Ah.. that was in 2008) Realized late that it was at the Philips Innovation Campus at Manyata. But managed to reach just on time before the start of the sessions.

The day started with an Architecture as a Service discussion. The presentation was short but there were lot of interesting questions and interactions post the session.  I was curious know more about the “self-service” aspect on that topic.

Then we had Jason Uppal of ClinicialMessage Inc. on stage (see picture below) , who gave a wonderful presentation on the human touch to the architecture and how to leverage EA to make disruptive changes without disrupting the working systems.

Jason bangaloreLots of take-aways from the session. Importantly the typical reasons why certain Architectures can fail… caused many a times we have a solution already in our mind and we are trying to fit that into the requirement. And most of these times if we look at the Requirements artifact we will be see that the problems are not rightly captured. Couldn’t agree more with the good practices that he discussed.

Starting with  “Identifying the Problem Right” – I thought that is definitely the first and important step in Architecture.  Then Jason talked about significance of communicating and engaging people and stakeholders in the architecture — point that he drove home with a good example from the health care industry. He talked about the criticality of communicating and engaging the stakeholders — engagement of course improves quality. Building the right levers in the architecture and solving the whole problem were some of the other key points that I noted down. More importantly the key message was as Architects, we have to go beyond drawing the lines and boxes to deliver the change, may be look to deliver things that can create an impact in 30 days balancing the short term and long term goals.

I got the stage for couple of minutes to update on the AEA Bangalore Chapter activities. My request to the attendees was to leverage the chapter for their own professional development – using that as a platform to share expertise, get answers to queries, connect with other professionals of similar interest and build the network. Hopefully will see more participation in the Bangalore chapter events this year.

On the security track, had multiple interesting sessions. Began with Jim Hietala of The Open Group discussing the Risk Management Framework. I’ve been attending a course on the subject. But this one provided a lot of insight on the taxonomy (O-RT) and the analysis part – more of taking a quantitative approach than a qualitative approach. Though the example was based on risks with regard to laptop thefts, there is no reason we can’t apply the principles to real issues like quantifying the threats for moving workloads to cloud. (that’s another to-do added to my list).

Then it was my session on the Best practices for moving workloads to cloud for Indian Banks. Talked about the progress so far with the whitepaper. The attendees were limited as there was Jason’s EA workshop happening in parallel. But those who attended were really interested in the subject. We did have a good discussion on the benefits, challenges and regulations with regard to the Indian Banking workloads and their movement to cloud.  We discussed few interesting case studies. There are areas that need more content and I’ve requested the people who attended the session to participate in the workgroup. We are looking at getting a first draft done in the next 30 days.

Finally, also sat in the presentation by Ajit A. Matthew on the security implementation at Intel. Everywhere the message is clear. You need to implement context based security and security intelligence to enable the new age innovation but at the same time protect your core assets.

It was a Saturday well spent. Added had some opportunities to connect with few new folks and understand their security challenges with cloud.  Looking to keep the dialog going and have an AEA Bangalore chapter event sometime during Q1. In that direction, I took the first step to write this up and share with my network.

Event Details:
The Open Group Bangalore, India
January 24-25, 2014

Sreekanth IyerSreekanth Iyer is an Executive IT Architect in IBM Security Systems CTO office and works on developing IBM’s Cloud Security Technical Strategy. He is an Open Group Certified Distinguished Architect and is a core member of the Bangalore Chapter of the Association of Enterprise Architects. He has over 18 years’ industry experience and has led several client solutions across multiple industries. His key areas of work include Information Security, Cloud Computing, SOA, Event Processing, and Business Process management. He has authored several technical articles, blogs and is a core contributor to multiple Open Group as well as IBM publications. He works out of the IBM India Software Lab Bangalore and you can follow him on Twitter @sreek.

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The Open Group London – Day Two Highlights

By Loren K. Baynes, Director, Global Marketing Communications

We eagerly jumped into the second day of our Business Transformation conference in London on Tuesday October 22nd!  The setting is the magnificent Central Hall Westminster.

Steve Nunn, COO of The Open Group and CEO of Association of Enterprise Architects (AEA), started off the morning introducing our plenary based on Healthcare Transformation.  Steve noted that the numbers in healthcare spend are huge and bringing Enterprise Architecture (EA) to healthcare will help with efficiencies.

The well-renowned Dr. Peter Sudbury, Healthcare Specialist with HP Enterprise Services, discussed the healthcare crisis (dollars, demand, demographics), the new healthcare paradigm, barriers to change and innovation. Dr. Sudbury also commented on the real drivers of healthcare costs: healthcare inflation is higher intrinsically; innovation increases cost; productivity improvements lag other industries.

IMG_sudburyDr. Peter Sudbury

Dr. Sudbury, Larry Schmidt (Chief Technologist, HP) and Roar Engen (Head of Enterprise Architecture, Helse Sør-Øst RHF, Norway) participated in the Healthcare Transformation Panel, moderated by Steve Nunn.  The group discussed opportunities for improvement by applying EA in healthcare.  They mentioned that physicians, hospitals, drug manufacturers, nutritionists, etc. should all be working together and using Boundaryless Information Flow™ to ensure data is smoothly shared across all entities.  It was also stated that TOGAF® is beneficial for efficiencies.

Following the panel, Dr. Mario Tokoro (Founder & Executive Advisor of Sony Computer Science Laboratories, Inc. Japanese Science & Technology Agency, DEOS Project Leader) reviewed the Dependability through Assuredness™ standard, a standard of The Open Group.

The conference also offered many sessions in Finance/Commerce, Government and Tutorials/Workshops.

Margaret Ford, Consult Hyperion, UK and Henk Jonkers of BIZZdesign, Netherlands discussed “From Enterprise Architecture to Cyber Security Risk Assessment”.  The key takeaways were: complex cyber security risks require systematic, model-based risk assessment; attack navigators can provide this by linking ArchiMate® to the Risk Taxonomy.

“Applying Service-Oriented Architecture within a Business Technology Environment in the Finance Sector” was presented by Gerard Peters, Managing Consultant, Capgemini, The Netherlands. This case study is part of a white paper on Service-Oriented Architecture for Business Technology (SOA4BT).

You can view all of the plenary and many of the track presentations at livestream.com.  And for those who attended, full conference proceedings will be available.

The night culminated with a spectacular experience on the London Eye, the largest Ferris wheel in Europe located on the River Thames.

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Gaining Dependability Across All Business Activities Requires Standard of Standards to Tame Dynamic Complexity, Says The Open Group CEO

By Dana Gardner, Interarbor Solutions

Listen to the recorded podcast here

Hello, and welcome to a special BriefingsDirect Thought Leadership

Interview series, coming to you in conjunction with The Open Group Conference on July 15, in Philadelphia.

88104-aaadanaI’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator throughout these discussions on enterprise transformation in the finance, government, and healthcare sector.

We’re here now with the President and CEO of The Open Group, Allen Brown, to explore the increasingly essential role of standards, in an undependable, unpredictable world. [Disclosure: The Open Group is a sponsor of BriefingsDirect podcasts.]

Welcome back, Allen.

Allen Brown: It’s good to be here, Dana. abrown

Gardner: What are the environmental variables that many companies are facing now as they try to improve their businesses and assess the level of risk and difficulty? It seems like so many moving targets.

 Brown: Absolutely. There are a lot of moving targets. We’re looking at a situation where organizations are having to put in increasingly complex systems. They’re expected to make them highly available, highly safe, highly secure, and to do so faster and cheaper. That’s kind of tough.

Gardner: One of the ways that organizations have been working towards a solution is to have a standardized approach, perhaps some methodologies, because if all the different elements of their business approach this in a different way, we don’t get too far too quickly, and it can actually be more expensive.

Perhaps you could paint for us the vision of an organization like The Open Group in terms of helping organizations standardize and be a little bit more thoughtful and proactive towards these changed elements?

Brown: With the vision of The Open Group, the headline is “Boundaryless Information Flow.” That was established back in 2002, at a time when organizations were breakingdown the stovepipes or the silos within and between organizations and getting people to work together across functioning. They found, having done that, or having made some progress towards that, that the applications and systems were built for those silos. So how can we provide integrated information for all those people?

As we have moved forward, those boundaryless systems have become bigger

and much more complex. Now, boundarylessness and complexity are giving everyone different types of challenges. Many of the forums or consortia that make up The Open Group are all tackling it from their own perspective, and it’s all coming together very well.

We have got something like the Future Airborne Capability Environment (FACE) Consortium, which is a managed consortium of The Open Group focused on federal aviation. In the federal aviation world they’re dealing with issues like weapons systems.

New weapons

Over time, building similar weapons is going to be more expensive, inflation happens. But the changing nature of warfare is such that you’ve then got a situation where you’ve got to produce new weapons. You have to produce them quickly and you have to produce them inexpensively.

So how can we have standards that make for more plug and play? How can the avionics within a cockpit of whatever airborne vehicle be more interchangeable, so that they can be adapted more quickly and do things faster and at lower cost.

After all, cost is a major pressure on government departments right now.

We’ve also got the challenges of the supply chain. Because of the pressure on costs, it’s critical that large, complex systems are developed using a global supply chain. It’s impossible to do it all domestically at a cost. Given that, countries around the world, including the US and China, are all concerned about what they’re putting into their complex systems that may have tainted or malicious code or counterfeit products.

The Open Group Trusted Technology Forum (OTTF) provides a standard that ensures that, at each stage along the supply chain, we know that what’s going into the products is clean, the process is clean, and what goes to the next link in the chain is clean. And we’re working on an accreditation program all along the way.

We’re also in a world, which when we mention security, everyone is concerned about being attacked, whether it’s cybersecurity or other areas of security, and we’ve got to concern ourselves with all of those as we go along the way.

Our Security Forum is looking at how we build those things out. The big thing about large, complex systems is that they’re large and complex. If something goes wrong, how can you fix it in a prescribed time scale? How can you establish what went wrong quickly and how can you address it quickly?

If you’ve got large, complex systems that fail, it can mean human life, as it did with the BP oil disaster at Deepwater Horizon or with Space Shuttle Challenger. Or it could be financial. In many organizations, when something goes wrong, you end up giving away service.

An example that we might use is at a railway station where, if the barriers don’t work, the only solution may be to open them up and give free access. That could be expensive. And you can use that analogy for many other industries, but how can we avoid that human or financial cost in any of those things?

A couple of years after the Space Shuttle Challenger disaster, a number of criteria were laid down for making sure you had dependable systems, you could assess risk, and you could know that you would mitigate against it.

What The Open Group members are doing is looking at how you can get dependability and assuredness through different systems. Our Security Forum has done a couple of standards that have got a real bearing on this. One is called Dependency Modeling, and you can model out all of the dependencies that you have in any system.

Simple analogy

A very simple analogy is that if you are going on a road trip in a car, you’ve got to have a competent driver, have enough gas in the tank, know where you’re going, have a map, all of those things.

What can go wrong? You can assess the risks. You may run out of gas or you may not know where you’re going, but you can mitigate those risks, and you can also assign accountability. If the gas gauge is going down, it’s the driver’s accountability to check the gauge and make sure that more gas is put in.

We’re trying to get that same sort of thinking through to these large complex systems. What you’re looking at doing, as you develop or evolve large, complex systems, is to build in this accountability and build in understanding of the dependencies, understanding of the assurance cases that you need, and having these ways of identifying anomalies early, preventing anything from failing. If it does fail, you want to minimize the stoppage and, at the same time, minimize the cost and the impact, and more importantly, making sure that that failure never happens again in that system.

The Security Forum has done the Dependency Modeling standard. They have also provided us with the Risk Taxonomy. That’s a separate standard that helps us analyze risk and go through all of the different areas of risk.

Now, the Real-time & Embedded Systems Forum has produced the Dependability through Assuredness, a standard of The Open Group, that brings all of these things together. We’ve had a wonderful international endeavor on this, bringing a lot of work from Japan, working with the folks in the US and other parts of the world. It’s been a unique activity.

Dependability through Assuredness depends upon having two interlocked cycles. The first is a Change Management Cycle that says that, as you look at requirements, you build out the dependencies, you build out the assurance cases for those dependencies, and you update the architecture. Everything has to start with architecture now.

You build in accountability, and accountability, importantly, has to be accepted. You can’t just dictate that someone is accountable. You have to have a negotiation. Then, through ordinary operation, you assess whether there are anomalies that can be detected and fix those anomalies by new requirements that lead to new dependabilities, new assurance cases, new architecture and so on.

The other cycle that’s critical in this, though, is the Failure Response Cycle. If there is a perceived failure or an actual failure, there is understanding of the cause, prevention of it ever happening again, and repair. That goes through the Change Accommodation Cycle as well, to make sure that we update the requirements, the assurance cases, the dependability, the architecture, and the accountability.

So the plan is that with a dependable system through that assuredness, we can manage these large, complex systems much more easily.

Gardner: Allen, many of The Open Group activities have been focused at the enterprise architect or business architect levels. Also with these risk and security issues, you’re focusing at chief information security officers or governance, risk, and compliance (GRC), officials or administrators. It sounds as if the Dependability through Assuredness standard shoots a little higher. Is this something a board-level mentality or leadership should be thinking about, and is this something that reports to them?

Board-level issue

Brown: In an organization, risk is a board-level issue, security has become a board-level issue, and so has organization design and architecture. They’re all up at that level. It’s a matter of the fiscal responsibility of the board to make sure that the organization is sustainable, and to make sure that they’ve taken the right actions to protect their organization in the future, in the event of an attack or a failure in their activities.

The risks to an organization are financial and reputation, and those risks can be very real. So, yes, they should be up there. Interestingly, when we’re looking at areas like business architecture, sometimes that might be part of the IT function, but very often now we’re seeing as reporting through the business lines. Even in governments around the world, the business architects are very often reporting up to business heads.

Gardner: Here in Philadelphia, you’re focused on some industry verticals, finance, government, health. We had a very interesting presentation this morning by Dr. David Nash, who is the Dean of the Jefferson School of Population Health, and he had some very interesting insights about what’s going on in the United States vis-à-vis public policy and healthcare.

One of the things that jumped out at me was, at the end of his presentation, he was saying how important it was to have behavior modification as an element of not only individuals taking better care of themselves, but also how hospitals, providers, and even payers relate across those boundaries of their organization.

That brings me back to this notion that these standards are very powerful and useful, but without getting people to change, they don’t have the impact that they should. So is there an element that you’ve learned and that perhaps we can borrow from Dr. Nash in terms of applying methods that actually provoke change, rather than react to change?

Brown: Yes, change is a challenge for many people. Getting people to change is like taking a horse to water, but will it drink? We’ve got to find methods of doing that.

One of the things about The Open Group standards is that they’re pragmatic and practical standards. We’ve seen’ in many of our standards’ that where they apply to product or service, there is a procurement pull through. So the FACE Consortium, for example, a $30 billion procurement means that this is real and true.

In the case of healthcare, Dr. Nash was talking about the need for boundaryless information sharing across the organizations. This is a major change and it’s a change to the culture of the organizations that are involved. It’s also a change to the consumer, the patient, and the patient advocates.

All of those will change over time. Some of that will be social change, where the change is expected and it’s a social norm. Some of that change will change as people and generations develop. The younger generations are more comfortable with authority that they perceive with the healthcare professionals, and also of modifying the behavior of the professionals.

The great thing about the healthcare service very often is that we have professionals who want to do a number of things. They want to improve the lives of their patients, and they also want to be able to do more with less.

Already a need

There’s already a need. If you want to make any change, you have to create a need, but in healthcare, there is already a pent-up need that people see that they want to change. We can provide them with the tools and the standards that enable it to do that, and standards are critically important, because you are using the same language across everyone.

It’s much easier for people to apply the same standards if they are using the same language, and you get a multiplier effect on the rate of change that you can achieve by using those standards. But I believe that there is this pent-up demand. The need for change is there. If we can provide them with the appropriate usable standards, they will benefit more rapidly.

Gardner: Of course, measuring the progress with the standards approach helps as well. We can determine where we are along the path as either improvements are happening or not happening. It gives you a common way of measuring.

The other thing that was fascinating to me with Dr. Nash’s discussion was that he was almost imploring the IT people in the crowd to come to the rescue. He’s looking for a cavalry and he’d really seemed to feel that IT, the data, the applications, the sharing, the collaboration, and what can happen across various networks, all need to be brought into this.

How do we bring these worlds together? There is this policy, healthcare and population statisticians are doing great academic work, and then there is the whole IT world. Is this something that The Open Group can do — bridge these large, seemingly unrelated worlds?

Brown: At the moment, we have the capability of providing the tools for them to do that and the processes for them to do that. Healthcare is a very complex world with the administrators and the healthcare professionals. You have different grades of those in different places. Each department and each organization has its different culture, and bringing them together is a significant challenge.

In some of that processes, certainly, you start with understanding what it is you’re trying to address. You start with what are the pain points, what are the challenges, what are the blockages, and how can we overcome those blockages? It’s a way of bringing people together in workshops. TOGAF, a standard of The Open Group, has the business scenario method, bringing people together, building business scenarios, and understanding what people’s pain points are.

As long as we can then follow through with the solutions and not disappoint people, there is the opportunity for doing that. The reality is that you have to do that in small areas at a time. We’re not going to take the entire population of the United States and get everyone in the workshop and work altogether.

But you can start in pockets and then generate evangelists, proof points, and successful case studies. The work will then start emanating out to all other areas.

Gardner: It seems too that, with a heightened focus on vertical industries, there are lessons that could be learned in one vertical industry and perhaps applied to another. That also came out in some of the discussions around big data here at the conference.

The financial industry recognized the crucial role that data plays, made investments, and brought the constituencies of domain expertise in finance with the IT domain expertise in data and analysis, and came up with some very impressive results.

Do you see that what has been the case in something like finance is now making its way to healthcare? Is this an enterprise or business architect role that opens up more opportunity for those individuals as business and/or enterprise architects in healthcare? Why don’t we see more enterprise architects in healthcare?

Good folks

Brown: I don’t know. We haven’t run the numbers to see how many there are. There are some very competent enterprise architects within the healthcare industry around the world. We’ve got some good folks there.

The focus of The Open Group for the last couple of decades or so has always been on horizontal standards, standards that are applicable to any industry. Our focus is always about pragmatic standards that can be implemented and touched and felt by end-user consumer organizations.

Now, we’re seeing how we can make those even more pragmatic and relevant by addressing the verticals, but we’re not going to lose the horizontal focus. We’ll be looking at what lessons can be learned and what we can build on. Big data is a great example of the fact that the same kind of approach of gathering the data from different sources, whatever that is, and for mixing it up and being able to analyze it, can be applied anywhere.

The challenge with that, of course, is being able to capture it, store it, analyze it, and make some sense of it. You need the resources, the storage, and the capability of actually doing that. It’s not just a case of, “I’ll go and get some big data today.”

I do believe that there are lessons learned that we can move from one industry to another. I also believe that, since some geographic areas and some countries are ahead of others, there’s also a cascading of knowledge and capability around the world in a given time scale as well.

Gardner: Well great. I’m afraid we’ll have to leave it there. We’ve been talking about the increasingly essential role of standards in a complex world, where risk and dependability become even more essential. We have seen how The Open Group is evolving to meet these challenges through many of its activities and through many of the discussions here at the conference.

Please join me now in thanking our guest, Allen Brown, President and CEO of The Open Group. Thank you.

Brown: Thanks for taking the time to talk to us, Dana.

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The Open Group Philadelphia – Day Two Highlights

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

philly 2.jpgDay 2 at The Open Group conference in the City of Brotherly Love, as Philadelphia is also known, was another busy and remarkable day.

The plenary started with a fascinating presentation, “Managing the Health of the Nation” by David Nash, MD, MBA, Dean of Jefferson School of Population Health.  Healthcare is the number one industry in the city of Philadelphia, with the highest number of patients in beds in the top 10 US cities. The key theme of his thought-provoking speech was “boundaryless information sharing” (sound familiar?), which will enable a healthcare system that is “safe, effective, patient-centered, timely, equitable, efficient”.

Following Dr. Nash’s presentation was the Healthcare Transformation Panel moderated by Allen Brown, CEO of The Open Group.  Participants were:  Gina Uppal (Fulbright-Killam Fellow, American University Program), Mike Lambert (Open Group Fellow, Architecting the Enterprise), Rosemary Kennedy (Associate Professor, Thomas Jefferson University), Blaine Warkentine, MD, MPH and Fran Charney (Pennsylvania Patient Safety Authority). The group brought different sets of experiences within the healthcare system and provided reaction to Dr. Nash’s speech.  All agree on the need for fundamental change and that technology will be key.

The conference featured a spotlight on The Open Group’s newest forum, Open Platform 3.0™ by Dr. Chris Harding, Director of Interoperability.  Open Platform 3.0 was formed to advance The Open Group vision of Boundaryless Information Flow™ to help enterprises in the use of Cloud, Social, Mobile Computing and Big Data.  For more info; http://www.opengroup.org/getinvolved/forums/platform3.0

The Open Group flourishes because of people interaction and collaboration.  The accolades continued with several members being recognized for their outstanding contributions to The Open Group Trusted Technology Forum (OTTF) and the Service-Oriented Architecture (SOA) and Cloud Computing Work Groups.  To learn more about our Forums and Work Groups and how to get involved, please visit http://www.opengroup.org/getinvolved

Presentations and workshops were also held in the Healthcare, Finance and Government vertical industries. Presenters included Larry Schmidt (Chief Technologist, HP), Rajamanicka Ponmudi (IT Architect, IBM) and Robert Weisman (CEO, Build the Vision, Inc.).

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The Open Group Philadelphia – Day One Highlights

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

PhillyOn Monday, July 15th, we kicked off our conference in Philadelphia. As Allen Brown, CEO of The Open Group, commented in his opening remarks, Philadelphia is the birthplace of American democracy.  This is the first time The Open Group has hosted a conference in this historical city.

Today’s plenary sessions featured keynote speakers covering topics ranging from an announcement of a new Open Group standard, appointment of a new Fellow, Enterprise Architecture and Transformation, Big Data and spotlights on The Open Group forums, Real-time Embedded Systems and Open Trusted Technology, as well as a new initiative on Healthcare.

Allen Brown noted that The Open Group has 432 member organizations with headquarters in 32 countries and over 40,000 individual members in 126 countries.

The Open Group Vision is Boundaryless Information Flow™ achieved through global interoperability in a secure, reliable and timely manner.  But as stated by Allen, “Boundaryless does not mean there are no boundaries.  It means that boundaries are permeable to enable business”

Allen also presented an overview of the new “Dependability Through Assuredness™ Standard.  The Open Group Real-time Embedded Systems Forum is the home of this standard. More news to come!

Allen introduced Dr. Mario Tokoro, (CEO of Sony Computer Systems Laboratories) who began this project in 2006. Dr. Tokoro stated, “Thank you from the bottom of my heart for understanding the need for this standard.”

Eric Sweden, MSIH MBA, Program Director, Enterprise Architecture & Governance\National Association of State CIOs (NASCIO) offered a presentation entitled “State of the States – NASCIO on Enterprise Architecture: An Emphasis on Cross-Jurisdictional Collaboration across States”.  Eric noted “Enterprise Architecture is a blueprint for better government.” Furthermore, “Cybersecurity is a top priority for government”.

Dr. Michael Cavaretta, Technical Lead and Data Scientist with Ford Motor Company discussed “The Impact of Big Data on the Enterprise”.  The five keys, according to Dr. Cavaretta, are “perform, analyze, assess, track and monitor”.  Please see the following transcript from a Big Data analytics podcast, hosted by The Open Group, Dr. Cavaretta participated in earlier this year. http://blog.opengroup.org/2013/01/28/the-open-group-conference-plenary-speaker-sees-big-data-analytics-as-a-way-to-bolster-quality-manufacturing-and-business-processes/

The final presentation during Monday morning’s plenary was “Enabling Transformation Through Architecture” by Lori Summers (Director of Technology) and Amit Mayabhate (Business Architect Manager) with Fannie Mae Multifamily.

Lori stated that their organization had adopted Business Architecture and today they have an integrated team who will complete the transformation, realize value delivery and achieve their goals.

Amit noted “Traceability from the business to architecture principles was key to our design.”

In addition to the many interesting and engaging presentations, several awards were presented.  Joe Bergmann, Director, Real-time and Embedded Systems Forum, The Open Group, was appointed Fellow by Allen Brown in recognition of Joe’s major achievements over the past 20+ years with The Open Group.

Other special recognition recipients include members from Oracle, IBM, HP and Red Hat.

In addition to the plenary session, we hosted meetings on Finance, Government and Healthcare industry verticals. Today is only Day One of The Open Group conference in Philadelphia. Please stay tuned for more exciting conference highlights over the next couple days.

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Filed under ArchiMate®, Business Architecture, Conference, Cybersecurity, Data management, Enterprise Architecture, Enterprise Transformation, Healthcare, O-TTF, Security Architecture, Standards, TOGAF®

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

By Dana Gardner, Interarbor Solutions

Listen to the recorded podcast here

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

Gardner

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

We’re here now with a panel of experts to explore how new IT trends are empowering improvements, specifically in the area of healthcare. We’ll learn how healthcare industry organizations are seeking large-scale transformation and what are some of the paths they’re taking to realize that.

We’ll see how improved cross-organizational collaboration and such trends as big data and cloud computing are helping to make healthcare more responsive and efficient.

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

Jason Uppal: Thank you, Dana.

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

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

Larry Schmidt: Thank you.

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

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

Gardner: Let’s take a look at this very interesting and dynamic healthcare sector, Jim. What, in particular, is so special about healthcare and why do things like enterprise architecture and allowing for better interoperability and communication across organizational boundaries seem to be so relevant here?

Hietala: There’s general acknowledgement in the industry that, inside of healthcare and inside the healthcare ecosystem, information either doesn’t flow well or it only flows at a great cost in terms of custom integration projects and things like that.

Fertile ground

From The Open Group’s perspective, it seems that the healthcare industry and the ecosystem really is fertile ground for bringing to bear some of the enterprise architecture concepts that we work with at The Open Group in order to improve, not only how information flows, but ultimately, how patient care occurs.

Gardner: Larry Schmidt, similar question to you. What are some of the unique challenges that are facing the healthcare community as they try to improve on responsiveness, efficiency, and greater capabilities?

Schmidt: There are several things that have not really kept up with what technology is able to do today.

For example, the whole concept of personal observation comes into play in what we would call “value chains” that exist right now between a patient and a doctor. We look at things like mobile technologies and want to be able to leverage that to provide additional observation of an individual, so that the doctor can make a more complete diagnosis of some sickness or possibly some medication that a person is on.

We want to be able to see that observation in real life, as opposed to having to take that in at the office, which typically winds up happening. I don’t know about everybody else, but every time I go see my doctor, oftentimes I get what’s called white coat syndrome. My blood pressure will go up. But that’s not giving the doctor an accurate reading from the standpoint of providing great observations.

Technology has advanced to the point where we can do that in real time using mobile and other technologies, yet the communication flow, that information flow, doesn’t exist today, or is at best, not easily communicated between doctor and patient.

There are plenty of places that additional collaboration and communication can improve the whole healthcare delivery model.

If you look at the ecosystem, as Jim offered, there are plenty of places that additional collaboration and communication can improve the whole healthcare delivery model.

That’s what we’re about. We want to be able to find the places where the technology has advanced, where standards don’t exist today, and just fuel the idea of building common communication methods between those stakeholders and entities, allowing us to then further the flow of good information across the healthcare delivery model.

Gardner: Jason Uppal, let’s think about what, in addition to technology, architecture, and methodologies can bring to bear here? Is there also a lag in terms of process thinking in healthcare, as well as perhaps technology adoption?

Uppal: I’m going to refer to a presentation that I watched from a very well-known surgeon from Harvard, Dr. Atul Gawande. His point was is that, in the last 50 years, the medical industry has made great strides in identifying diseases, drugs, procedures, and therapies, but one thing that he was alluding to was that medicine forgot the cost, that everything is cost.

At what price?

Today, in his view, we can cure a lot of diseases and lot of issues, but at what price? Can anybody actually afford it?

Uppal

His view is that if healthcare is going to change and improve, it has to be outside of the medical industry. The tools that we have are better today, like collaborative tools that are available for us to use, and those are the ones that he was recommending that we need to explore further.

That is where enterprise architecture is a powerful methodology to use and say, “Let’s take a look at it from a holistic point of view of all the stakeholders. See what their information needs are. Get that information to them in real time and let them make the right decisions.”

Therefore, there is no reason for the health information to be stuck in organizations. It could go with where the patient and providers are, and let them make the best decision, based on the best practices that are available to them, as opposed to having siloed information.

So enterprise-architecture methods are most suited for developing a very collaborative environment. Dr. Gawande was pointing out that, if healthcare is going to improve, it has to think about it not as medicine, but as healthcare delivery.

There are definitely complexities that occur based on the different insurance models and how healthcare is delivered across and between countries.

Gardner: And it seems that not only are there challenges in terms of technology adoption and even operating more like an efficient business in some ways. We also have very different climates from country to country, jurisdiction to jurisdiction. There are regulations, compliance, and so forth.

Going back to you, Larry, how important of an issue is that? How complex does it get because we have such different approaches to healthcare and insurance from country to country?

Schmidt: There are definitely complexities that occur based on the different insurance models and how healthcare is delivered across and between countries, but some of the basic and fundamental activities in the past that happened as a result of delivering healthcare are consistent across countries.

As Jason has offered, enterprise architecture can provide us the means to explore what the art of the possible might be today. It could allow us the opportunity to see how innovation can occur if we enable better communication flow between the stakeholders that exist with any healthcare delivery model in order to give us the opportunity to improve the overall population.

After all, that’s what this is all about. We want to be able to enable a collaborative model throughout the stakeholders to improve the overall health of the population. I think that’s pretty consistent across any country that we might work in.

Ongoing work

Gardner: Jim Hietala, maybe you could help us better understand what’s going on within The Open Group and, even more specifically, at the conference in Philadelphia. There is the Population Health Working Group and there is work towards a vision of enabling the boundaryless information flow between the stakeholders. Any other information and detail you could offer would be great.[Registration to the conference remains open. Follow the conference on Twitter at #ogPHL.]

Hietala: On Tuesday of the conference, we have a healthcare focus day. The keynote that morning will be given by Dr. David Nash, Dean of the Jefferson School of Population Health. He’ll give what’s sure to be a pretty interesting presentation, followed by a reactors’ panel, where we’ve invited folks from different stakeholder constituencies.

Hietala

We are going to have clinicians there. We’re going to have some IT folks and some actual patients to give their reaction to Dr. Nash’s presentation. We think that will be an interesting and entertaining panel discussion.

The balance of the day, in terms of the healthcare content, we have a workshop. Larry Schmidt is giving one of the presentations there, and Jason and myself and some other folks from our working group are involved in helping to facilitate and carry out the workshop.

The goal of it is to look into healthcare challenges, desired outcomes, the extended healthcare enterprise, and the extended healthcare IT enterprise and really gather those pain points that are out there around things like interoperability to surface those and develop a work program coming out of this.

We want to be able to enable a collaborative model throughout the stakeholders to improve the overall health of the population.

So we expect it to be an interesting day if you are in the healthcare IT field or just the healthcare field generally, it would definitely be a day well spent to check it out.

Gardner: Larry, you’re going to be talking on Tuesday. Without giving too much away, maybe you can help us understand the emphasis that you’re taking, the area that you’re going to be exploring.

Schmidt: I’ve titled the presentation “Remixing Healthcare through Enterprise Architecture.” Jason offered some thoughts as to why we want to leverage enterprise architecture to discipline healthcare. My thoughts are that we want to be able to make sure we understand how the collaborative model would work in healthcare, taking into consideration all the constituents and stakeholders that exist within the complete ecosystem of healthcare.

This is not just collaboration across the doctors, patients, and maybe the payers in a healthcare delivery model. This could be out as far as the drug companies and being able to get drug companies to a point where they can reorder their raw materials to produce new drugs in the case of an epidemic that might be occurring.

Real-time model

It would be a real-time model that allows us the opportunity to understand what’s truly happening, both to an individual from a healthcare standpoint, as well as to a country or a region within a country and so on from healthcare. This remixing of enterprise architecture is the introduction to that concept of leveraging enterprise architecture into this collaborative model.

Then, I would like to talk about some of the technologies that I’ve had the opportunity to explore around what is available today in technology. I believe we need to have some type of standardized messaging or collaboration models to allow us to further facilitate the ability of that technology to provide the value of healthcare delivery or betterment of healthcare to individuals. I’ll talk about that a little bit within my presentation and give some good examples.

It’s really interesting. I just traveled from my company’s home base back to my home base and I thought about something like a body scanner that you get into in the airport. I know we’re in the process of eliminating some of those scanners now within the security model from the airports, but could that possibly be something that becomes an element within healthcare delivery? Every time your body is scanned, there’s a possibility you can gather information about that, and allow that to become a part of your electronic medical record.

There is a lot of information available today that could be used in helping our population to be healthier.

Hopefully, that was forward thinking, but that kind of thinking is going to play into the art of the possible, with what we are going to be doing, both in this presentation and talking about that as part of the workshop.

Gardner: Larry, we’ve been having some other discussions with The Open Group around what they call Open Platform 3.0™, which is the confluence of big data, mobile, cloud computing, and social.

One of the big issues today is this avalanche of data, the Internet of things, but also the Internet of people. It seems that the more work that’s done to bring Open Platform 3.0 benefits to bear on business decisions, it could very well be impactful for centers and other data that comes from patients, regardless of where they are, to a medical establishment, regardless of where it is.

So do you think we’re really on the cusp of a significant shift in how medicine is actually conducted?

Schmidt: I absolutely believe that. There is a lot of information available today that could be used in helping our population to be healthier. And it really isn’t only the challenge of the communication model that we’ve been speaking about so far. It’s also understanding the information that’s available to us to take that and make that into knowledge to be applied in order to help improve the health of the population.

As we explore this from an as-is model in enterprise architecture to something that we believe we can first enable through a great collaboration model, through standardized messaging and things like that, I believe we’re going to get into even deeper detail around how information can truly provide empowered decisions to physicians and individuals around their healthcare.

So it will carry forward into the big data and analytics challenges that we have talked about and currently are talking about with The Open Group.

Healthcare framework

Gardner: Jason Uppal, we’ve also seen how in other business sectors, industries have faced transformation and have needed to rely on something like enterprise architecture and a framework like TOGAF® in order to manage that process and make it something that’s standardized, understood, and repeatable.

It seems to me that healthcare can certainly use that, given the pace of change, but that the impact on healthcare could be quite a bit larger in terms of actual dollars. This is such a large part of the economy that even small incremental improvements can have dramatic effects when it comes to dollars and cents.

So is there a benefit to bringing enterprise architect to healthcare that is larger and greater than other sectors because of these economics and issues of scale?

Uppal: That’s a great way to think about this thing. In other industries, applying enterprise architecture to do banking and insurance may be easily measured in terms of dollars and cents, but healthcare is a fundamentally different economy and industry.

It’s not about dollars and cents. It’s about people’s lives, and loved ones who are sick, who could very easily be treated, if they’re caught in time and the right people are around the table at the right time. So this is more about human cost than dollars and cents. Dollars and cents are critical, but human cost is the larger play here.

Whatever systems and methods are developed, they have to work for everybody in the world.

Secondly, when we think about applying enterprise architecture to healthcare, we’re not talking about just the U.S. population. We’re talking about global population here. So whatever systems and methods are developed, they have to work for everybody in the world. If the U.S. economy can afford an expensive healthcare delivery, what about the countries that don’t have the same kind of resources? Whatever methods and delivery mechanisms you develop have to work for everybody globally.

That’s one of the things that a methodology like TOGAF brings out and says to look at it from every stakeholder’s point of view, and unless you have dealt with every stakeholder’s concerns, you don’t have an architecture, you have a system that’s designed for that specific set of audience.

The cost is not this 18 percent of the gross domestic product in the U.S. that is representing healthcare. It’s the human cost, which is many multitudes of that. That’s is one of the areas where we could really start to think about how do we affect that part of the economy, not the 18 percent of it, but the larger part of the economy, to improve the health of the population, not only in the North America, but globally.

If that’s the case, then what really will be the impact on our greater world economy is improving population health, and population health is probably becoming our biggest problem in our economy.

We’ll be testing these methods at a greater international level, as opposed to just at an organization and industry level. This is a much larger challenge. A methodology like TOGAF is a proven and it could be stressed and tested to that level. This is a great opportunity for us to apply our tools and science to a problem that is larger than just dollars. It’s about humans.

All “experts”

Gardner: Jim Hietala, in some ways, we’re all experts on healthcare. When we’re sick, we go for help and interact with a variety of different services to maintain our health and to improve our lifestyle. But in being experts, I guess that also means we are witnesses to some of the downside of an unconnected ecosystem of healthcare providers and payers.

One of the things I’ve noticed in that vein is that I have to deal with different organizations that don’t seem to communicate well. If there’s no central process organizer, it’s really up to me as the patient to pull the lines together between the different services — tests, clinical observations, diagnosis, back for results from tests, sharing the information, and so forth.

Have you done any studies or have anecdotal information about how that boundaryless information flow would be still relevant, even having more of a centralized repository that all the players could draw on, sort of a collaboration team resource of some sort? I know that’s worked in other industries. Is this not a perfect opportunity for that boundarylessness to be managed?

Hietala: I would say it is. We all have experiences with going to see a primary physician, maybe getting sent to a specialist, getting some tests done, and the boundaryless information that’s flowing tends to be on paper delivered by us as patients in all the cases.

So the opportunity to improve that situation is pretty obvious to anybody who’s been in the healthcare system as a patient. I think it’s a great place to be doing work. There’s a lot of money flowing to try and address this problem, at least here in the U.S. with the HITECH Act and some of the government spending around trying to improve healthcare.

We’ll be testing these methods at a greater international level, as opposed to just at an organization and industry level.

You’ve got healthcare information exchanges that are starting to develop, and you have got lots of pain points for organizations in terms of trying to share information and not having standards that enable them to do it. It seems like an area that’s really a great opportunity area to bring lots of improvement.

Gardner: Let’s look for some examples of where this has been attempted and what the success brings about. I’ll throw this out to anyone on the panel. Do you have any examples that you can point to, either named organizations or anecdotal use case scenarios, of a better organization, an architectural approach, leveraging IT efficiently and effectively, allowing data to flow, putting in processes that are repeatable, centralized, organized, and understood. How does that work out?

Uppal: I’ll give you an example. One of the things that happens when a patient is admitted to hospital and in hospital is that they get what’s called a high-voltage care. There is staff around them 24×7. There are lots of people around, and every specialty that you can think of is available to them. So the patient, in about two or three days, starts to feel much better.

When that patient gets discharged, they get discharged to home most of the time. They go from very high-voltage care to next to no care. This is one of the areas where in one of the organizations we work with is able to discharge the patient and, instead of discharging them to the primary care doc, who may not receive any records from the hospital for several days, they get discharged to into a virtual team. So if the patient is at home, the virtual team is available to them through their mobile phone 24×7.

Connect with provider

If, at 3 o’clock in the morning, the patient doesn’t feel right, instead of having to call an ambulance to go to hospital once again and get readmitted, they have a chance to connect with their care provider at that time and say, “This is what the issue is. What do you want me to do next? Is this normal for the medication that I am on, or this is something abnormal that is happening?”

When that information is available to that care provider who may not necessarily have been part of the care team when the patient was in the hospital, that quick readily available information is key for keeping that person at home, as opposed to being readmitted to the hospital.

We all know that the cost of being in a hospital is 10 times more than it is being at home. But there’s also inconvenience and human suffering associated with being in a hospital, as opposed to being at home.

Those are some of the examples that we have, but they are very limited, because our current health ecosystem is a very organization specific, not  patient and provider specific. This is the area there is a huge room for opportunities for healthcare delivery, thinking about health information, not in the context of the organization where the patient is, as opposed to in a cloud, where it’s an association between the patient and provider and health information that’s there.

Extending that model will bring infinite value to not only reducing the cost, but improving the cost and quality of care.

In the past, we used to have emails that were within our four walls. All of a sudden, with Gmail and Yahoo Mail, we have email available to us anywhere. A similar thing could be happening for the healthcare record. This could be somewhere in the cloud’s eco setting, where it’s securely protected and used by only people who have granted access to it.

Those are some of the examples where extending that model will bring infinite value to not only reducing the cost, but improving the cost and quality of care.

Schmidt: Jason touched upon the home healthcare scenario and being able to provide touch points at home. Another place that we see evolving right now in the industry is the whole concept of mobile office space. Both countries, as well as rural places within countries that are developed, are actually getting rural hospitals and rural healthcare offices dropped in by helicopter to allow the people who live in those communities to have the opportunity to talk to a doctor via satellite technologies and so on.

The whole concept of a architecture around and being able to deal with an extension of what truly lines up being telemedicine is something that we’re seeing today. It would be wonderful if we could point to things like standards that allow us to be able to facilitate both the communication protocols as well as the information flows in that type of setting.

Many corporations can jump on the bandwagon to help the rural communities get the healthcare information and capabilities that they need via the whole concept of telemedicine.

That’s another area where enterprise architecture has come into play. Now that we see examples of that working in the industry today, I am hoping that as part of this working group, we’ll get to the point where we’re able to facilitate that much better, enabling innovation to occur for multiple companies via some of the architecture or the architecture work we are planning on producing.

Single view

Gardner: It seems that we’ve come a long way on the business side in many industries of getting a single view of the customer, as it’s called, the customer relationship management, big data, spreading the analysis around among different data sources and types. This sounds like a perfect fit for a single view of the patient across their life, across their care spectrum, and then of course involving many different types of organizations. But the government also needs to have a role here.

Jim Hietala, at The Open Group Conference in Philadelphia, you’re focusing on not only healthcare, but finance and government. Regarding the government and some of the agencies that you all have as members on some of your panels, how well do they perceive this need for enterprise architecture level abilities to be brought to this healthcare issue?

Hietala: We’ve seen encouraging signs from folks in government that are encouraging to us in bringing this work to the forefront. There is a recognition that there needs to be better data flowing throughout the extended healthcare IT ecosystem, and I think generally they are supportive of initiatives like this to make that happen.

Gardner: Of course having conferences like this, where you have a cross pollination between vertical industries, will perhaps allow some of the technical people to talk with some of the government people too and also have a conversation with some of the healthcare people. That’s where some of these ideas and some of the collaboration could also be very powerful.

We’ve seen encouraging signs from folks in government that are encouraging to us in bringing this work to the forefront.

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

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

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

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

Uppal: Thank you, Dana.

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

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

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

Hietala: Thank you, Dana.

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

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Driving Boundaryless Information Flow in Healthcare

By E.G. Nadhan, HP

I look forward with great interest to the upcoming Open Group conference on EA & Enterprise Transformation in Finance, Government & Healthcare in Philadelphia in July 2013. In particular, I am interested in the sessions planned on topics related to the Healthcare Industry. This industry is riddled with several challenges of uncontrolled medical costs, legislative pressures, increased plan participation, and improved longevity of individuals. Come to think of it, these challenges are not that different from those faced when defining a comprehensive enterprise architecture. Therefore, can the fundamental principles of Enterprise Architecture be applied towards the resolution of these challenges in the Healthcare industry? The Open Group certainly thinks so.

Enterprise Architecture is a discipline, methodology, and practice for translating business vision and strategy into the fundamental structures and dynamics of an enterprise at various levels of abstraction. As defined by TOGAF®, enterprise architecture needs to be developed through multiple phases. These include Business Architecture, Applications, Information, and Technology Architecture. All this must be in alignment with the overall vision. The TOGAF Architecture Development Method enables a systematic approach to addressing these challenges while simplifying the problem domain.

This approach to the development of Enterprise Architecture can be applied towards the complex problem domain that manifests itself in Healthcare. Thus, it is no surprise that The Open Group is sponsoring the Population Health Working Group, which has a vision to enable “boundary-less information flow” between the stakeholders that participate in healthcare delivery. Checkout the presentation delivered by Larry Schmidt, Chief Technologist, Health and Life Sciences Industries, HP, US at the Open Group conference in Philadelphia.

As a Platinum member of The Open Group, HP has co-chaired the release of multiple standards, including the first technical cloud standard. The Open Group is also leading the definition of the Cloud Governance Framework. Having co-chaired these projects, I look forward to the launch of the Population Health Working Group with great interest.

Given the role of information in today’s landscape, “boundary-less information flow” between the stakeholders that participate in healthcare delivery is vital. At the same time, how about injecting a healthy dose of innovation given that enterprise Architects are best positioned for innovation – a post triggered by Forrester Analyst Brian Hopkins’s thoughts on this topic. The Open Group — with its multifaceted representation from a wide array of enterprises — provides incredible opportunities for innovation in the context of the complex landscape of the healthcare industry. Take a look at the steps taken by HP Labs to innovate and improve patient care one day at a time.

I would strongly encourage you to attend Schmidt’s session, as well as the Healthcare Transformation Panel moderated by Open Group CEO, Allen Brown at this conference.

How about you? What are some of the challenges that you are facing within the Healthcare industry today? Have you applied Enterprise Architecture development methods to problem domains in other industries? Please let me know.

Connect with Nadhan on: Twitter, Facebook, Linkedin and Journey Blog.

A version of this blog post originally appeared on the HP Enterprise Services Blog.

HP Distinguished Technologist and Cloud Advisor, E.G.Nadhan has over 25 years of experience in the IT industry across the complete spectrum of selling, delivering and managing enterprise level solutions for HP customers. He is the founding co-chair for The Open Group SOCCI project and is also the founding co-chair for the Open Group Cloud Computing Governance project. 

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Filed under Business Architecture, Cloud, Cloud/SOA, Conference, Enterprise Architecture, Healthcare, TOGAF®

Healthcare Transformation – Let’s be Provocative

by Jason Uppal, Chief Architect, QRS

Recently, I attended a one-day healthcare transformation event in Toronto. The master of ceremony, a renowned doctor, asked the speakers to be provocative in how to tackle the issues in healthcare and healthcare delivery in a specific way. After about 8 speakers – I must admit I did not hear anything that social media will classify as “remarkable” either in terms of problem definition or the solution direction – all speeches emphasized the importance of better healthcare. I watched one video, Jess’s Story, and I am convinced without discussion that we need a better way to deliver care.

I am an Engineer and not a Medical Doctor. In my profession, we spend 90% of our effort defining the problem and 10% solving it with known solution patterns. In this blog, I would like to define the healthcare delivery problem and offer a potential solution direction.

 First the Basic Facts

Table 1: Healthcare Spending and Quality

Country 1980 [$] 2007 [$] 2010 [$] 2012 [$] Healthcare Quality Ranking
US 1106 6102 8233 8946 6
Canada 3165 4445 5
Germany 3005 4338 1

Note: $ represent per capita spend per year, sources of information are public; references can be made available if required. Healthcare Quality Ranking – lower the number the better

Firstly, the obvious fact is that the US spends more on healthcare per capita and gets less for it.  These facts as well as many other studies lead to the same conclusion.

Problem Definition, Option 1 – Straight-forward reduction of healthcare costs: US healthcare roughly represents 18% of the US GDP. Reduction in spending will result in shrinking the GDP, unless politicians spend the saved money somewhere else. This is not a good option as we all know the impact of austerity measures without altering the underlying process. Or even closer to home, the impact of the recent sequesters on air traffic in major us airports has resulted in terrible delays and has significantly inconvenienced the traveling public.  We learned during the 1980s when “reengineering” was a sexy terms that when we reduced labour by 30%, we simply hoped the remaining souls would figure out how to do work with less.  We all knew what that approach did, fat paycheques for the CEO and senior management and entire industries got wiped out.

Problem Definition, Option 2 – Reduce healthcare costs and issue health  dividends: Let’s target to reduce the base healthcare spending to $4000 per person per year. This will bring spending to the 1980 level with inflation factored. The remaining funds, $4946 per capita ($8946 –$ 4000), be given as a health dividend to the population and providers. This will go to both the population as a tax credit and to providers as an incentive to keep those that they care for healthy. This will not reduce health care spending, have no impact on the GDP, but will certainly improve the health of our biggest producers and consumers in the economy.

There is proof that this model could work to reduce overall cost and improve population health if both the population and providers are incented appropriately. Recently, I had an argument with my General Practitioner’s (GP) secretary who wanted me to come to the office three times for the following:

1)     to receive the results of my blood test,

2)     to have an annual physical check-up,

3)     to remove  couple of annoying skin tags.

Each procedure was no more than 2 to 7 minutes long, they insisted that it have to be three separate appointments. A total of 10 minutes of consult for three procedures with my GP would have cost me an additional 7 hours in my productivity loss (2.0 hours to drive, 0.5 hour wait and 1.0 hour productivity loss due to distractions of the appointments). A reason for this behaviour is that the way physicians are incented; they are able to bill the system more based on the number of visits alone. Not based on what is good for both the patient and provider.

Therefore, I will define the problem this way: reduce the cost of base care to $4000 per capita and incent both the population and provider to stay and keep their customers healthy. Let the innovation begin. There is no shortage of very smart architects, engineers  and very motivated providers who want to live to their oath of “do no harm”.

Call to Action:

  • To help develop next generation healthcare delivery organization – we need the help of healthcare Zuckerbergs, Steve Jobs, Pierre Omidyar, Jeffrey P. Bezos; people who can think outside the box and bypass the current entitled establishment for the better.
  • We are taking first step to define an alternative architecture – join us in Philadelphia on July 16th for a one-day active workshop.
  • Website: http://www.opengroup.org/philadelphia2013
  • Program Outline: http://www.opengroup.org/events/timetable/1548
    • Tuesday: Healthcare Transformation
    • Keynote Speaker: Dr David Nash, Dean of Population Health Jefferson University
    • Reactors Panel: Hear from other experts on what is possible
    • Workshops
      • Be part of organized workshops and learn from your fellow providers and enterprise architects on how to transform healthcare for the next generation
      • This is your trip to the Gemba

uppalJason Uppal, P.Eng. is the Chief Architect at QRS and was the first Master IT Architect certified by The Open Group, by direct review, in October 2005. He is now a Distinguished Chief Architect in the Open CA program. He holds an undergraduate degree in Mechanical Engineering, graduate degree in Economics and a post graduate diploma in Computer Science. Jason’s commitment to Enterprise Architecture Life Cycle (EALC) has led him to focus on training (TOGAF®), education (UOIT) and mentoring services to his clients as well as being the responsible individual for both Architecture and Portfolio & Project Management for a number of major projects.

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Filed under Enterprise Architecture, Healthcare, Open CA