Tag Archives: standards

Improving Patient Care and Reducing Costs in Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Filed under Boundaryless Information Flow™, Data management, Enterprise Architecture, Enterprise Transformation, Healthcare, Professional Development, Standards

How the Open Trusted Technology Provider Standard (O-TTPS) and Accreditation Will Help Lower Cyber Risk

By Andras Szakal, Vice President and Chief Technology Officer, IBM U.S. Federal

Changing business dynamics and enabling technologies

In 2008, IBM introduced the concept of a “Smarter Planet.” The Smarter Planet initiative focused, in part, on the evolution of globalization against the backdrop of changing business dynamics and enabling technologies. A key concept was the need for infrastructure to be tightly integrated, interconnected, and intelligent, thereby facilitating collaboration between people, government and businesses in order to meet the world’s growing appetite for data and automation. Since then, many industries and businesses have adopted this approach, including the ICT (information and communications technology) industries that support the global technology manufacturing supply chain.

Intelligent and interconnected critical systems

This transformation has infused technology into virtually all aspects of our lives, and involves, for example, government systems, the electric grid and healthcare. Most of these technological solutions are made up of hundreds or even thousands of components that are sourced from the growing global technology supply chain.
Intelligent and interconnected critical systems

In the global technology economy, no one technology vendor or integrator is able to always provide a single source solution. It is no longer cost competitive to design all of the electronic components, printed circuit boards, card assemblies, or other sub-assemblies in-house. Adapting to the changing market place and landscape by balancing response time and cost efficiency, in an expedient manner, drives a more wide-spread use of OEM (original equipment manufacturer) products.

As a result, most technology providers procure from a myriad of global component suppliers, who very often require similarly complex supply chains to source their components. Every enterprise has a supplier network, and each of their suppliers has a supply chain network, and these sub-tier suppliers have their own supply chain networks. The resultant technology supply chain is manifested into a network of integrated suppliers.

Increasingly, the critical systems of the planet — telecommunications, banking, energy and others — depend on and benefit from the intelligence and interconnectedness enabled by existing and emerging technologies. As evidence, one need only look to the increase in enterprise mobile applications and BYOD strategies to support corporate and government employees.

Cybersecurity by design: Addressing risk in a sustainable way across the ecosystem

Whether these systems are trusted by the societies they serve depends in part on whether the technologies incorporated into them are fit for the purpose they are intended to serve. Fit for purpose is manifested in two essential ways:

- Does the product meet essential functional requirements?
– Has the product or component been produced by trustworthy provider?

Of course, the leaders or owners of these systems have to do their part to achieve security and safety: e.g., to install, use and maintain technology appropriately, and to pay attention to people and process aspects such as insider threats. Cybersecurity considerations must be addressed in a sustainable way from the get-go, by design, and across the whole ecosystem — not after the fact, or in just one sector or another, or in reaction to crisis.

Assuring the quality and integrity of mission-critical technology

In addressing the broader cybersecurity challenge, however, buyers of mission-critical technology naturally seek reassurance as to the quality and integrity of the products they procure. In our view, the fundamentals of the institutional response to that need are similar to those that have worked in prior eras and in other industries — like food.

The very process of manufacturing technology is not immune to cyber-attack. The primary purpose of attacking the supply chain typically is motivated by monetary gain. The primary goals of a technology supply chain attack are intended to inflict massive economic damage in an effort to gain global economic advantage or as a way to seeding targets with malware that provides unfettered access for attackers.

It is for this reason that the global technology manufacturing industry must establish practices that mitigate this risk by increasing the cost barriers of launching such attacks and increasing the likelihood of being caught before the effects of such an attack are irreversible. As these threats evolve, the global ICT industry must deploy enhanced security through advanced automated cyber intelligence analysis. As critical infrastructure becomes more automated, integrated and essential to critical to functions, the technology supply chain that surrounds it must be considered a principle theme of the overall global security and risk mitigation strategy.

A global, agile, and scalable approach to supply chain security

Certainly, the manner in which technologies are invented, produced, and sold requires a global, agile, and scalable approach to supply chain assurance and is essential to achieve the desired results. Any technology supply chain security standard that hopes to be widely adopted must be flexible and country-agnostic. The very nature of the global supply chain (massively segmented and diverse) requires an approach that provides practicable guidance but avoids being overtly prescriptive. Such an approach would require the aggregation of industry practices that have been proven beneficial and effective at mitigating risk.

The OTTF (The Open Group Trusted Technology Forum) is an increasingly recognized and promising industry initiative to establish best practices to mitigate the risk of technology supply chain attack. Facilitated by The Open Group, a recognized international standards and certification body, the OTTF is working with governments and industry worldwide to create vendor-neutral open standards and best practices that can be implemented by anyone. Current membership includes a list of the most well-known technology vendors, integrators, and technology assessment laboratories.

The benefits of O-TTPS for governments and enterprises

IBM is currently a member of the OTTF and has been honored to hold the Chair for the last three years.  Governments and enterprises alike will benefit from the work of the OTTF. Technology purchasers can use the Open Trusted Technology Provider™ Standard (O-TTPS) and Framework best-practice recommendations to guide their strategies.

A wide range of technology vendors can use O-TTPS approaches to build security and integrity into their end-to-end supply chains. The first version of the O-TTPS is focused on mitigating the risk of maliciously tainted and counterfeit technology components or products. Note that a maliciously tainted product is one that has been produced by the provider and acquired through reputable channels but which has been tampered maliciously. A counterfeit product is produced other than by or for the provider, or is supplied by a non-reputable channel, and is represented as legitimate. The OTTF is currently working on a program that will accredit technology providers who conform to the O-TTPS. IBM expects to complete pilot testing of the program by 2014.

IBM has actively supported the formation of the OTTF and the development of the O-TTPS for several reasons. These include but are not limited to the following:

- The Forum was established within a trusted and respected international standards body – The Open Group.
– The Forum was founded, in part, through active participation by governments in a true public-private partnership in which government members actively participate.
– The OTTF membership includes some of the most mature and trusted commercial technology manufactures and vendors because a primary objective of the OTTF was harmonization with other standards groups such as ISO (International Organization for Standardization) and Common Criteria.

The O-TTPS defines a framework of organizational guidelines and best practices that enhance the security and integrity of COTS ICT. The first version of the O-TTPS is focused on mitigating certain risks of maliciously tainted and counterfeit products within the technology development / engineering lifecycle. These best practices are equally applicable for systems integrators; however, the standard is intended to primarily address the point of view of the technology manufacturer.

O-TTPS requirements

The O-TTPS requirements are divided into three categories:

1. Development / Engineering Process and Method
2. Secure Engineering Practices
3. Supply Chain Security Practices

The O-TTPS is intended to establish a normalized set of criteria against which a technology provider, component supplier, or integrator can be assessed. The standard is divided into categories that define best practices for engineering development practices, secure engineering, and supply chain security and integrity intended to mitigate the risk of maliciously tainted and counterfeit components.

The accreditation program

As part of the process for developing the accreditation criteria and policy, the OTTF established a pilot accreditation program. The purpose of the pilot was to take a handful of companies through the accreditation process and remediate any potential process or interpretation issues. IBM participated in the OTTP-S accreditation pilot to accredit a very significant segment of the software product portfolio; the Application Infrastructure Middleware Division (AIM) which includes the flagship WebSphere product line. The AIM pilot started in mid-2013 and completed in the first week of 2014 and was formally recognized as accredited in the fist week of February 2014.

IBM is currently leveraging the value of the O-TTPS and working to accredit additional development organizations. Some of the lessons learned during the IBM AIM initial O-TTPS accreditation include:

- Conducting a pre-assessment against the O-TTPS should be conducted by an organization before formally entering accreditation. This allows for remediation of any gaps and reduces potential assessment costs and project schedule.
– Starting with a segment of your development portfolio that has a mature secure engineering practices and processes. This helps an organization address accreditation requirements and facilitates interactions with the 3rd party lab.
– Using your first successful O-TTPS accreditation to create templates that will help drive data gathering and validate practices to establish a repeatable process as your organization undertakes additional accreditations.

andras-szakalAndras Szakal, VP and CTO, IBM U.S. Federal, is responsible for IBM’s industry solution technology strategy in support of the U.S. Federal customer. Andras was appointed IBM Distinguished Engineer and Director of IBM’s Federal Software Architecture team in 2005. He is an Open Group Distinguished Certified IT Architect, IBM Certified SOA Solution Designer and a Certified Secure Software Lifecycle Professional (CSSLP).  Andras holds undergraduate degrees in Biology and Computer Science and a Masters Degree in Computer Science from James Madison University. He has been a driving force behind IBM’s adoption of government IT standards as a member of the IBM Software Group Government Standards Strategy Team and the IBM Corporate Security Executive Board focused on secure development and cybersecurity. Andras represents the IBM Software Group on the Board of Directors of The Open Group and currently holds the Chair of the IT Architect Profession Certification Standard (ITAC). More recently, he was appointed chair of The Open Group Trusted Technology Forum and leads the development of The Open Trusted Technology Provider Framework.

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Filed under Accreditations, Cybersecurity, government, O-TTF, O-TTPS, OTTF, RISK Management, Standards, supply chain, Supply chain risk

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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Accrediting the Global Supply Chain: A Conversation with O-TTPS Recognized Assessors Fiona Pattinson and Erin Connor

By The Open Group 

At the recent San Francisco 2014 conference, The Open Group Trusted Technology Forum (OTTF) announced the launch of the Open Trusted Technology Provider™ Standard (O-TTPS) Accreditation Program.

The program is one the first accreditation programs worldwide aimed at assuring the integrity of commercial off-the-shelf (COTS) information and communication technology (ICT) products and the security of their supply chains.

In three short years since OTTF launched, the forum has grown to include more than 25 member companies dedicated to safeguarding the global supply chain against the increasing sophistication of cybersecurity attacks through standards. Accreditation is yet another step in the process of protecting global technology supply chains from maliciously tainted and counterfeit products.

As part of the program, third-party assessor companies will be employed to assess organizations applying for accreditation, with The Open Group serving as the vendor-neutral Accreditation Authority that operates the program.  Prior to the launch, the forum conducted a pilot program with a number of member companies. It was announced at the conference that IBM is the first company to becoming accredited, earning accreditation for its Application, Infrastructure and Middleware (AIM), software business division for its product integrity and supply chain practices.

We recently spoke with OTTF members Fiona Pattinson, director of strategy and business development at Atsec Information Security, and Erin Connor, director at EWA-Canada, at the San Francisco conference to learn more about the assessment process and the new program.

The O-TTPS focus is on securing the technology supply chain. What would you say are the biggest threats facing the supply chain today?

Fiona Pattinson (FP): I think in the three years since the forum began certainly all the members have discussed the various threats quite a lot. It was one of things we discussed as an important topic early on, and I don’t know if it’s the ‘biggest threat,’ but certainly the most important threats that we needed to address initially were those of counterfeit and maliciously tainted products. We came to that through both discussion with all the industry experts in the forum and also through research into some of the requirements from government, so that’s exactly how we knew which threats [to start with].

Erin Connor (EC):  And the forum benefits from having both sides of the acquisition process, both acquirers, and the suppliers and vendors. So they get both perspectives.

How would you define maliciously tainted and counterfeit products?

FP:  They are very carefully defined in the standard—we needed to do that because people’s understanding of that can vary so much.

EC: And actually the concept of ‘maliciously’ tainted was incorporated close to the end of the development process for the standard at the request of members on the acquisition side of the process.

[Note: The standard precisely defines maliciously tainted and counterfeit products as follows:

"The two major threats that acquirers face today in their COTS ICT procurements, as addressed in this Standard, are defined as:

1. Maliciously tainted product – the product is produced by the provider and is acquired

through a provider’s authorized channel, but has been tampered with maliciously.

2. Counterfeit product – the product is produced other than by, or for, the provider, or is

supplied to the provider by other than a provider’s authorized channel and is presented as being legitimate even though it is not."]

The OTTF announced the Accreditation Program for the OTTP Standard at the recent San Francisco conference. Tell us about the standard and how the accreditation program will help ensure conformance to it?

EC: The program is intended to provide organizations with a way to accredit their lifecycle processes for their product development so they can prevent counterfeit or maliciously tainted components from getting into the products they are selling to an end user or into somebody else’s supply chain. It was determined that a third-party type of assessment program would be used. For the organizations, they will know that we Assessors have gone through a qualification process with The Open Group and that we have in place all that’s required on the management side to properly do an assessment. From the consumer side, they have confidence the assessment has been completed by an independent third-party, so they know we aren’t beholden to the organizations to give them a passing grade when perhaps they don’t deserve it. And then of course The Open Group is in position to oversee the whole process and award the final accreditation based on the recommendation we provide.  The Open Group will also be the arbiter of the process between the assessors and organizations if necessary. 

FP:  So The Open Group’s accreditation authority is validating the results of the assessors.

EC: It’s a model that is employed in many, many other product or process assessment and evaluation programs where the actual accreditation authority steps back and have third parties do the assessment.

FP: It is important that the assessor companies are working to the same standard so that there’s no advantage in taking one assessor over the other in terms of the quality of the assessments that are produced.

How does the accreditation program work?

FP: Well, it’s brand new so we don’t know if it is perfect yet, but having said that, we have worked over several months on defining the process, and we have drawn from The Open Group’s existing accreditation programs, as well as from the forum experts who have worked in the accreditation field for many years. We have been performing pilot accreditations in order to check out how the process works. So it is already tested.

How does it actually work? Well, first of all an organization will feel the need to become accredited and at that point will apply to The Open Group to get the accreditation underway. Once their scope of accreditation – which may be as small as one product or theoretically as large as a whole global company – and once the application is reviewed and approved by The Open Group, then they engage an assessor.

There is a way of sampling a large scope to identify the process variations in a larger scope using something we term ‘selective representative products.’ It’s basically a way of logically sampling a big scope so that we capture the process variations within the scope and make sure that the assessment is kept to a reasonable size for the organization undergoing the assessment, but it also gives good assurance to the consumers that it is a representative sample. The assessment is performed by the Recognized Assessor company, and a final report is written and provided to The Open Group for their validation. If everything is in order, then the company will be accredited and their scope of conformance will be added to the accreditation register and trademarked.

EC: So the customers of that organization can go and check the registration for exactly what products are covered by the scope.

FP: Yes, the register is public and anybody can check. So if IBM says WebSphere is accredited, you can go and check that claim on The Open Group web site.

How long does the process take or does it vary?

EC: It will vary depending on how large the scope to be accredited is in terms of the size of the representative set and the documentation evidence. It really does depend on what the variations in the processes are among the product lines as to how long it takes the assessor to go through the evidence and then to produce the report. The other side of the coin is how long it takes the organization to produce the evidence. It may well be that they might not have it totally there at the outset and will have to create some of it.

FP: As Erin said, it varies by the complexity and the variation of the processes and hence the number of selected representative products. There are other factors that can influence the duration. There are three parties influencing that: The applicant Organization, The Open Group’s Accreditation Authority and the Recognized Assessor.

For example, we found that the initial work by the Organization and the Accreditation Authority in checking the scope and the initial documentation can take a few weeks for a complex scope, of course for the pilots we were all new at doing that. In this early part of the project it is vital to get the scope both clearly defined and approved since it is key to a successful accreditation.

It is important that an Organization assigns adequate resources to help keep this to the shortest time possible, both during the initial scope discussions, and during the assessment. If the Organization can provide all the documentation before they get started, then the assessors are not waiting for that and the duration of the assessment can be kept as short as possible.

Of course the resources assigned by the Recognized Assessor also influences how long an assessment takes. A variable for the assessors is how much documentation do they have to read and review? It might be small or it might be a mountain.

The Open Group’s final review and oversight of the assessment takes some time and is influenced by resource availability within that organization. If they have any questions it may take a little while to resolve.

What kind of safeguards does the accreditation program put in place for enforcing the standard?

FP: It is a voluntary standard—there’s no requirement to comply. Currently some of the U.S. government organizations are recommending it. For example, NASA in their SEWP contract and some of the draft NIST documents on Supply Chain refer to it, too.

EC: In terms of actual oversight, we review what their processes are as assessors, and the report and our recommendations are based on that review. The accreditation expires after three years so before the three years is up, the organization should actually get the process underway to obtain a re-accreditation.  They would have to go through the process again but there will be a few more efficiencies because they’ve done it before. They may also wish to expand the scope to include the other product lines and portions of the company. There aren’t any periodic ‘spot checks’ after accreditation to make sure they’re still following the accredited processes, but part of what we look at during the assessment is that they have controls in place to ensure they continue doing the things they are supposed to be doing in terms of securing their supply chain.

FP:  And then the key part is the agreement the organizations signs with The Open Group includes the fact the organization warrant and represent that they remain in conformance with the standard throughout the accreditation period. So there is that assurance too, which builds on the more formal assessment checks.

What are the next steps for The Open Group Trusted Technology Forum?  What will you be working on this year now that the accreditation program has started?

FP: Reviewing the lessons we learned through the pilot!

EC: And reviewing comments from members on the standard now that it’s publicly available and working on version 1.1 to make any corrections or minor modifications. While that’s going on, we’re also looking ahead to version 2 to make more substantial changes, if necessary. The standard is definitely going to be evolving for a couple of years and then it will reach a steady state, which is the normal evolution for a standard.

For more details on the O-TTPS accreditation program, to apply for accreditation, or to learn more about becoming an O-TTPS Recognized Assessor visit the O-TTPS Accreditation page.

For more information on The Open Group Trusted Technology Forum please visit the OTTF Home Page.

The O-TTPS standard and the O-TTPS Accreditation Policy they are freely available from the Trusted Technology Section in The Open Group Bookstore.

For information on joining the OTTF membership please contact Mike Hickey – m.hickey@opengroup.org

Fiona Pattinson Fiona Pattinson is responsible for developing new and existing atsec service offerings.  Under the auspices of The Open Group’s OTTF, alongside many expert industry colleagues, Fiona has helped develop The Open Group’s O-TTPS, including developing the accreditation program for supply chain security.  In the past, Fiona has led service developments which have included establishing atsec’s US Common Criteria laboratory, the CMVP cryptographic module testing laboratory, the GSA FIPS 201 TP laboratory, TWIC reader compliance testing, NPIVP, SCAP, PCI, biometrics testing and penetration testing. Fiona has responsibility for understanding a broad range of information security topics and the application of security in a wide variety of technology areas from low-level design to the enterprise level.

ErinConnorErin Connor is the Director at EWA-Canada responsible for EWA-Canada’s Information Technology Security Evaluation & Testing Facility, which includes a Common Criteria Test Lab, a Cryptographic & Security Test Lab (FIPS 140 and SCAP), a Payment Assurance Test Lab (device testing for PCI PTS POI & HSM, Australian Payment Clearing Association and Visa mPOS) and an O-TTPS Assessor lab Recognized by the Open Group.  Erin participated with other expert members of the Open Group Trusted Technology Forum (OTTF) in the development of The Open Group Trusted Technology Provider Standard for supply chain security and its accompanying Accreditation Program.  Erin joined EWA-Canada in 1994 and his initial activities in the IT Security and Infrastructure Assurance field included working on the team fielding a large scale Public Key Infrastructure system, Year 2000 remediation and studies of wireless device vulnerabilities.  Since 2000, Erin has been working on evaluations of a wide variety of products including hardware security modules, enterprise security management products, firewalls, mobile device and management products, as well as system and network vulnerability management products.  He was also the only representative of an evaluation lab in the Biometric Evaluation Methodology Working Group, which developed a proposed methodology for the evaluation of biometric technologies under the Common Criteria.

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How to Build a Smarter City – Join The Open Group Tweet Jam on February 26

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

On Wednesday, February 26, The Open Group will host a Tweet Jam examining smart cities and how Real-time and Embedded Systems can seamlessly integrate inputs from various agencies and locations. That collective data allows local governments to better adapt to change by implementing an analytics-based approach to measure:

  • Economic activity
  • Mobility patterns
  • Resource consumption
  • Waste management and sustainability measures
  • Inclement weather
  • And much more!

These metrics allow smart cities to do much more than just coordinate responses to traffic jams, they are forecasting and coordinating safety measures in advance of physical disasters and inclement weather; calculating where offices and shops can be laid out most efficiently; and how all the parts of urban life should be fitted together including energy, sustainability and infrastructural repairs and planning and development.

Smart cities are already very much a reality in the Middle East and in Korea and those have become a model for developers in China, and for redevelopment in Europe. Market research firm, IDC Government Insights projects that 2014 is the year cities around the world start getting smart. It predicts a $265 billion spend by cities worldwide this year alone to implement new technology and integrate agency data. Part of the reason for that spend is likely spurred by the fact that more than half the world’s population currently lives in urban areas. With urbanization rates rapidly increasing, Brookings Institution estimates that number could swell up to 75 percent of the global populace by 2050.

While the awe-inspiring smart city of Rio de Janeiro is proving to be an interesting smart city model for cities across the world, are smart cities always the best option for informing city decisions?  Could the beauty of a self-regulating open grid allow people to decide how best to use spaces in the city?

Please join us on Wednesday, February 26 at 9:00 am PT/12:00 pm ET/5:00 pm GMT for a tweet jam, that will discuss the issues around smart cities.  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  David Lounsbury, CTO and Chris Harding, Director of Interoperability from The Open Group. To access the discussion, please follow the #ogchat hashtag during the allotted discussion time.

What Is a Tweet Jam?

A tweet jam is a one-hour “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: “A1: There are already a number of cities implementing tech to get smarter. #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!

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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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The Open Group San Francisco 2014 – Day Two Highlights

By Loren K. Baynes, Director, Global Marketing Communications

Day two, February 4th, of The Open Group San Francisco conference kicked off with a welcome and opening remarks from Steve Nunn, COO of The Open Group and CEO of the Association of Enterprise Architects.

Nunn introduced Allen Brown, President and CEO of The Open Group, who provided highlights from The Open Group’s last quarter.  As of Q4 2013, The Open Group had 45,000 individual members in 134 countries hailing from 449 member companies in 38 countries worldwide. Ten new member companies have already joined The Open Group in 2014, and 24 members joined in the last quarter of 2013, with the first member company joining from Vietnam. In addition, 6,500 individuals attended events sponsored by The Open Group in Q4 2013 worldwide.

Updates on The Open Group’s ongoing work were provided including updates on the FACE™ Consortium, DirectNet® Waveform Standard, Architecture Forum, Archimate® Forum, Open Platform 3.0™ Forum and Security Forum.

Of note was the ongoing development of TOGAF® and introduction of a three-volume work including individual volumes outlining the TOGAF framework, guidance and tools and techniques for the standard, as well as collaborative work that allows the Archimate modeling language to be used for risk management in enterprise architectures.

In addition, Open Platform 3.0 Forum has already put together 22 business use cases outlining ROI and business value for various uses related to technology convergence. The Cloud Work Group’s Cloud Reference Architecture has also been submitted to ISO for international standards certification, and the Security Forum has introduced certification programs for OpenFAIR risk management certification for individuals.

The morning plenary centered on The Open Group’s Dependability through Assuredness™ (O-DA) Framework, which was released last August.

Speaking first about the framework was Dr. Mario Tokoro, Founder and Executive Advisor for Sony Computer Science Laboratories. Dr. Tokoro gave an overview of the Dependable Embedded OS project (DEOS), a large national project in Japan originally intended to strengthen the country’s embedded systems. After considerable research, the project leaders discovered they needed to consider whether large, open systems could be dependable when it came to business continuity, accountability and ensuring consistency throughout the systems’ lifecycle. Because the boundaries of large open systems are ever-changing, the project leaders knew they must put together dependability requirements that could accommodate constant change, allow for continuous service and provide continuous accountability for the systems based on consensus. As a result, they put together a framework to address both the change accommodation cycle and failure response cycles for large systems – this framework was donated to The Open Group’s Real-Time Embedded Systems Forum and released as the O-DA standard.

Dr. Tokoro’s presentation was followed by a panel discussion on the O-DA standard. Moderated by Dave Lounsbury, VP and CTO of The Open Group, the panel included Dr. Tokoro; Jack Fujieda, Founder and CEO ReGIS, Inc.; T.J. Virdi, Senior Enterprise IT Architect at Boeing; and Bill Brierly, Partner and Senior Consultant, Conexiam. The panel discussed the importance of openness for systems, iterating the conference theme of boundaries and the realities of having standards that can ensure openness and dependability at the same time. They also discussed how the O-DA standard provides end-to-end requirements for system architectures that also account for accommodating changes within the system and accountability for it.

Lounsbury concluded the track by iterating that assuring systems’ dependability is not only fundamental to The Open Group mission of Boundaryless Information Flow™ and interoperability but also in preventing large system failures.

Tuesday’s late morning sessions were split into two tracks, with one track continuing the Dependability through Assuredness theme hosted by Joe Bergmann, Forum Chair of The Open Group’s Real-Time and Embedded Systems Forum. In this track, Fujieda and Brierly furthered the discussion of O-DA outlining the philosophy and vision of the standard, as well as providing a roadmap for the standard.

In the morning Business Innovation & Transformation track, Alan Hakimi, Consulting Executive, Microsoft presented “Zen and the Art of Enterprise Architecture: The Dynamics of Transformation in a Complex World.” Hakimi emphasized that transformation needs to focus on a holistic view of an organization’s ecosystem and motivations, economics, culture and existing systems to help foster real change. Based on Buddhist philosophy, he presented an eightfold path to transformation that can allow enterprise architects to approach transformation and discuss it with other architects and business constituents in a way that is meaningful to them and allows for complexity and balance.

This was followed by “Building the Knowledge-Based Enterprise,” a session given by Bob Weisman, Head Management Consultant for Build the Vision.

Tuesday’s afternoon sessions centered on a number of topics including Business Innovation and Transformation, Risk Management, Archimate, TOGAF tutorials and case studies and Professional Development.

In the Archimate track, Vadim Polyakov of Inovalon, Inc., presented “Implementing an EA Practice in an Agile Enterprise” a case study centered on how his company integrated its enterprise architecture with the principles of agile development and how they customized the Archimate framework as part of the process.

The Risk Management track featured William Estrem, President, Metaplexity Associates, and Jim May of Windsor Software discussing how the Open FAIR Standard can be used in conjunction with TOGAF 9.1 to enhance risk management in organizations in their session, “Integrating Open FAIR Risk Analysis into the Enterprise Architecture Capability.” Jack Jones, President of CXOWARE, also discussed the best ways for “Communicating the Value Proposition” for cohesive enterprise architectures to business managers using risk management scenarios.

The plenary sessions and many of the track sessions from today’s tracks can be viewed on The Open Group’s Livestream channel at http://new.livestream.com/opengroup.

The day culminated with dinner and a Lion Dance performance in honor of Chinese New Year performed by Leung’s White Crane Lion & Dragon Dance School of San Francisco.

We would like to express our gratitude for the support by our following sponsors:  BIZZDesign, Corso, Good e-Learning, I-Server and Metaplexity Associates.

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O-DA standard panel discussion with Dave Lounsbury, Bill Brierly, Dr. Mario Tokoro, Jack Fujieda and TJ Virdi

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Filed under Conference, Enterprise Architecture, Enterprise Transformation, Standards, TOGAF®, Uncategorized