By Oliver Matthias Kipf, Software Lead EU MDR Program, Philips
In this article, I’ll share guiding principles for a reference architecture for the Healthcare industry. The main beneficiaries of this reference architecture are patients, health professionals, and Healthcare organizations. Its main users are planners, managers, and Enterprise Architects. A second article will focus on key design ideas for such a reference architecture, followed by a third article to describe its essential capabilities.
Healthcare – A Changing Landscape
The quality of life increases substantially if we keep a healthy mind and body. Healthcare systems play an important role to fulfill our individual healthcare needs and that of the larger population. Across the globe, Healthcare faces a multitude of challenges:
- Ageing populations and rise of chronic diseases
- New discoveries in medical science
- New technologies and tightened regulations
Though we have seen the introduction of advanced Healthcare technologies, many times they focus on specific conditions and treatments but fail to improve the overall experience from a patient perspective.
Take for example critical data, like test reports, many times delivered the old way through paper-based and handwritten documents. A July 2006 report from the National Academies of Science’s Institute of Medicine (IOM) concluded that handwritten prescriptions killed more than 7,000 Americans annually. A shocking statistic and only the tip of the iceberg of 1.5 million preventable medication mistakes.
That leaves us patients with questions, such as …why can’t my care provider integrate with the app I use to manage my health condition when I suffer from a chronic disease, or …how come, it seems, my online retailer knows more about my state of health than my doctor?
The Healthcare Landscape
Throughout the articles, I use a simplified Healthcare landscape, based on the World Health Organization’s six building blocks of health systems. At the center of this conceptual model is the person seeking health, surrounded by the health system building blocks (health worker, information, governance, etc.). An outer ring contains organizations, such as hospitals, day care facilities (care providers), manufacturers of medical devices, or producers of pharmaceutical products.
Healthcare Landscape
How to Take the Healthcare to the Next Level
The good news is that information technology can solve problems of fragmentation, through smart process management, and the exchange of standardized information, to name a few.
A Blueprint for the Healthcare Industry
The aim must be to help organizations provide health services with better outcomes, at lower cost, and improved patient and staff experience. We need a toolbox that is flexible, adaptable to individual needs, and that can serve a network of partners that team up to deliver care.
The Patient Perspective
As a patient with a chronic disease, I monitor my health condition daily. I manage my medication with the help of my devices and adjust my lifestyle accordingly. My care providers should work with me to manage my disease.
The Health Professional Perspective
As a Healthcare professional, I need to team up to coordinate delivery of care. I create, use, and share information with other care providers within a given episode of care, and across different treatment periods.
The Architect and Planner Perspective
As a user of the reference architecture, I need an easy-to-use toolbox that is readily available and helps me in my daily work. It needs to align with the regulations of our industry.
The Six Guiding Principles
Healthcare is a people business where health professionals provide personalized services to patients based on trust. A reference architecture should encourage delivery of care across a patient’s health continuum. It should contain an architecture development method and provide a blueprint for the architecture of a single enterprise and its partner network.
The following principles define the general properties for a reference architecture for health. They are tightly interwoven, and every principle builds upon the previous one.
Principle 1: Focus on the Person
| Focus on the Person |
| Design health services and related processes around the patient, and not the disease. Keep in mind the health professional who provides the service and the patient who receives the service |
Principle 2: Service Orientation
| Service Orientation |
| Design the enterprise and your partner network along the health services and supporting services you provide |
Principle 3: Team Delivery
| Team Delivery |
| Coordinate care delivery across your partner network; the care you provide for a specific problem, condition, or illness during a specific period; and the care the patient receives across different care episodes |
Principle 4: Quality in Every Step
| Quality in Every Step |
| Make quality and regulatory compliance an integral part of your work. Define the quality structure of your partner network, and drive for processes to achieve desired results. Manage risks and apply change control |
Principle 5: From Strategy to Execution
| From Strategy to Execution |
| Plan where you want to be and how to get there. Build, deliver, and operate capabilities accordingly |
Principle 6: Lifetime Evolution
| Lifetime Evolution |
| Environments change, new demands emerge. Services or processes require adjustments, assets last only a limited period and need maintenance – Continuously improve to get better |
We can apply the six guiding principles to multiple elements and areas of the Healthcare landscape, as shown in the following diagram:
Healthcare Landscape & Principles
About the Author
Oliver Matthias Kipf is a Process and Solution Architect and certified Master Architect; He provides thought leadership, innovation, and architecture expertise in Healthcare. You can contact him at oliver_kipf@hotmail.com
References
European Commission, 2019: Defining Value in “Value-Based Healthcare” Report of the expert panel on effective ways of investing in Health (EXPH); 2019
European Union, 2017: Regulation (EU) 2017/745 on medical devices; https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32017R0745
European Standard NEN-EN 15224:2017: Quality Management Systems – EN ISO 9001 2015 for Healthcare
Institute of Medicine, 2007: Preventing Medication Errors. Washington, DC: The National Academies Press. https://doi.org/10.17226/11623.
ISO International Standard, 2016: ISO 13485. Third edition 2016-03-01
IEC ISO, 2015: IEC 62304 Medical device software – Software lifecycle processes. Edition 1.1 2015-06
OECD, 2011: A System of Health Accounts; http://www.oecd.org/els/health-systems/a-system-of-health-accounts-2011-9789264270985-en.htm
The Open Group: Welcome to the Archimate® 3.1 Specification, a Standard of The Open Group: https://pubs.opengroup.org/architecture/archimate3-doc/
US National Library of Medicine: National Institutes of Health – Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651704/
World Health Organization and the Organisation for Economic Co-operation and Development, 2019: Price setting and price regulation in health care – Lessons for advancing Universal Health Coverage
World Health Organization: National Health Planning Tools – Health System Building Blocks; https://extranet.who.int/nhptool/BuildingBlock.aspx
World Health Organization: Framework on integrated people-centred health services; https://www.who.int/servicedeliverysafety/areas/people-centred-care/en/
World Health Organization: Health Systems Strengthening Glossary: https://www.who.int/healthsystems/hss_glossary/en/index5.html
Acknowledgements
The author likes to thank his colleagues at Philips and the team of The Open Group Healthcare Forum for their inspiration; and above all, his family for their great support.
http://www.opengroup.org @theopengroup
Simple, easy to understand and well articulated. Kudos to Oliver
Wonderful, thank you! Glad you enjoyed it. Take care, The Open Group
Great article Oliver, looking forward for the rest of the series. Of course I am very much aligned to your views here.
I would like to dig a bit deeper on factor 3 – Team Delivery -, every actor with the ability to have (positive) impact in the health of a given individual, and population at large, show aim to build its services/products and manage related data not only in connection with its partners, but the full health ecosystem, which will include a myriad of systems and players, including the patient him/herself, as you well indicate in your reference architecture widely embraced.
This calls, and reinforces, the need for a general architecture and framework able to integrate these products, services, actors, systems, businesses, organizations, regulations, … into a coherent set of capabilities that can cooperate with each other over time and space.
Just as a side note, there is one new technology that is challenging the current set of structures in a very interesting manner, in several ways pressuring the health ecosystem in the directions of your article, that is AI applied to the health space. Data integration, health roles, technology understanding, regulatory frameworks, are all challenged. In order to achieve a safe, widespread, value-driven delivery of AI capabilities in the health ecosystem, we must strive to operate within a solid health reference architecture that integrates the ecosystem. May be worth an article in itself.
Thank you very much for your thorough feedback. Glad you enjoyed the blog! Take care, The Open Group