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Dana Gardner: Welcome to the next BriefingsDirect
enterprise architecture (EA) thought leadership panel discussion. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator as we
examine how a global standards body is working to improve how the healthcare
industry functions.
We’ll now
learn how The Open Group
Healthcare Forum (HCF) is advancing best practices and methods for better
leveraging IT in healthcare ecosystems. And we’ll examine the forum’s Health Enterprise
Reference Architecture (HERA) initiative and its role in standardizing IT
architectures. The goal is to foster better boundaryless interoperability within
and between healthcare public and private sector organizations.
With that,
please join me now in welcoming our panel of experts: Oliver Kipf, The Open Group
Healthcare Forum Chairman and Business Process and Solution Architect at Philips, based in Germany. Welcome,
Oliver.
 |
Kipf |
Oliver Kipf: Hi, thanks a lot.
Gardner: We’re also here with Dr. Jason Lee, Director
of the Healthcare Forum at The Open Group, in Boston. Hello, Dr. Lee.
Dr. Jason Lee: Hi, Dana! Thank you.
Gardner: We’re also here with Gail Kalbfleisch, Director
of the Federal
Health Architecture at the US Department of
Health and Human Services in Washington, D.C. Welcome, Gail.
Gail Kalbfleisch: Thank you.
Teamwork is good for
your health
Gardner: For those who might not be that
familiar with the Healthcare Forum and The Open Group in general, tell us about
why the Healthcare Forum exists, what its mission is, and what you hope to achieve
through your work.
 |
Lee |
Lee: The
Healthcare Forum exists because there is a huge need to architect the
healthcare enterprise, which is approaching 20 percent of the gross domestic
product (GDP)
of the economy in the US, and approaching that level in other developing
countries in Europe.
There is a general feeling that
enterprise architecture is somewhat behind in this industry, relative to other
industries. There are important gaps to fill that will help those stakeholders
in healthcare -- whether they are in hospitals or healthcare delivery systems
or innovation hubs in organizations of different sorts, such as consulting
firms. They can better leverage IT to achieve business goals, through the use of
best practices, lessons learned, and the accumulated wisdom of the various Forum
members over many years of work. We want them to understand the value of our
work so they can use it to address their needs.
Our mission,
simply, is to help make healthcare information available when and where it’s
needed and to accomplish that goal through architecting the healthcare
enterprise. That’s what we hope to achieve.
Gardner: As the chairman of the HCF, could you
explain what a forum is, Oliver? What does it consist of, how many
organizations are involved?
Kipf: The HCF is made up of its members and
I am really proud of this team. We are very passionate about healthcare. We are
in the technology business, so we are more than just the governing bodies; we
also have participation from the provider community. That makes the Forum true
to the nature of The Open Group, in that we are global in nature, we are vendor-neutral,
and we are business-oriented. We go from strategy to execution, and we want to
bridge from business to technology. We take the foundation of The Open Group, and
then we apply this to the HCF.
As we have
many health standards out there, we really want to leverage [experience] from our
30 members to make standards work by providing the right type of tools,
frameworks, and approaches. We partner a lot in the industry.
The
healthcare industry is really a crowded place and there are many standard
development organizations. There are many players. It’s quite vital as a forum
that we reach out, collaborate, and engage with others to reach where we want
to be.
Gardner: Gail, why is the role of the enterprise
architecture function an important ingredient to help bring this together?
What’s important about EA when we think about the healthcare industry?
 |
Kalbfleisch |
Kalbfleisch: From
an EA perspective, I don’t really think that it matters whether you are talking
about the healthcare industry or the finance industry or the personnel industry
or the gas and electric industry. If you look at any of those, the organizations
or the companies that tend to be highly functioning, they have not just
architecture -- because everyone has architecture for what they do. But that
architecture is documented and it’s available for use by decision-makers, and by
developers across the system so that each part can work well together.
We know
that within the healthcare industry it is exceedingly complicated, and it’s a
mixture of a lot of different things. It’s not just your body and your doctor,
it’s also your insurance, your payers, research, academia -- and putting all of
those together.
If we don’t have EA, people new to the system -- or people
who were deeply embedded into their parts of the system -- can’t see how that
system all works together usefully. For example, there are a lot of different
standards organizations. If we don’t see how all of that works together -- where
everybody else is working, and how to make it fit together – then we’re going
to have a hard time getting to interoperability quickly and efficiently.
It's important that we get to individual solution building blocks to attain a more integrated approach.
Kipf: If you think of the healthcare
industry, we’ve been very good at developing individual solutions to specific
problems. There’s a lot of innovation and a lot of technology that we use. But
there is an inherent risk of producing silos among the many stakeholders who,
ultimately, work for the good of the patient. It's important that we get to individual
solution building blocks to attain a more integrated approach based on
architecture building blocks, and based on common frameworks, tools and
approaches.
Gardner: Healthcare is a very complex environment
and IT is very fast-paced. Can you give us an update on what the Healthcare
Forum has been doing, given the difficulty of managing such complexity?
Bird’s-eye view mapping
Lee: The Healthcare Forum began with a
series of white papers, initially focusing on an information model that has a
long history in the federal government. We used enterprise architecture to
evaluate the Federal Health Information Model (FHIM).
People began listening and we started to
talk to people outside of The Open Group, and outside of the normal channels of
The Open Group. We talked to different types of architects, such as information
architects, solution architects, engineers, and initially settled on the
problem that is essential to The Open Group -- and that is the problem of boundaryless
information flow.
It can be difficult to achieve boundaryless information flow to enable information to travel digitally, securely and quickly.
We need to
get beyond the silos that Oliver mentioned and that Gail alluded to. As I
mentioned in my opening comments, this is a huge industry, and Gail illustrated
it by naming some of the stakeholders within the health, healthcare and
wellness enterprises. If you think of your hospital, it can be difficult to
achieve boundaryless information flow to enable your information to travel
digitally, securely, quickly, and in a way that’s valid, reliable and
understandable by those who send it and by those who receive it. But if that is possible, it’s all to the
betterment of the patient.
Initially, in
our focus on what healthcare folks call interoperability -- what we refer to as
boundaryless information flow -- we came to realize through discussions with
stakeholders in the public sector, as well as the private sector and globally,
that understanding how the different pieces are linked together is critical.
Anybody who works in an organization or belongs to a church, school or family
understands that sometimes getting the right message communicated from point A
to point B can be difficult.
To address
that issue, the HCF members have decided to create a Health Enterprise Reference
Architecture (HERA) that is essentially a framework and a map at the highest
level. It helps people see that what they do relates to what others do,
regardless of their position in their company. You want to deliver value to
those people, to help them understand how their work is interconnected, and how
IT can help them achieve their goals.
Gardner: Oliver, who should be aware of and
explore engaging with the HCF?
Kipf: The members of The Open Group
themselves, many of them are players in the field of healthcare, and so they are
the natural candidates to really engage with. In that healthcare ecosystem we
have providers, payers, governing bodies, pharmaceuticals, and IT companies.
Those who
deeply need planning, management and architecting -- to make big thinking a reality
out there -- those decision-makers are the prime candidates for engagement in
the Healthcare Forum. They can benefit from the kinds of products we produce,
the reference architecture, and the white papers that we offer. In a nutshell,
it’s the members, and it’s the healthcare industry, and the healthcare ecosystem
that we are targeting.
Gardner: Gail, perhaps you could address the
reference architecture initiative? Why do you see that as important? Who do you
think should be aware of it and contribute to it?
Shared reference
points
Kalbfleisch: Reference architecture is one of
those building block pieces that should be used. You can call it a template. You
can have words that other people can relate to, maybe easier than the
architecture-speak.
If you take
that template, you can make it available to other people so that we can all be
designing our processes and systems with a common understanding of our information
exchange -- so that it crosses boundaries easily and securely. If we are all running
on the same template, that’s going to enable us to identify how to start, what
has to be included, and what standards we are going to use.
A reference architecture is one of those very important
pieces that not only forms a list of how we want to do things, and what we
agreed to, but it also makes it so that every organization doesn’t have to
start from scratch. It can be reused and improved upon as we go through the
work. If someone improves the architecture, that can come back into the
reference architecture.
Who should know about it? Decision makers, developers, medical device innovators, people who are looking to improve the way information flows within any health sector.
Who should
know about it? Decision makers, developers, medical device innovators, people
who are looking to improve the way information flows within any health sector
-- whether it’s Oliver in Europe, whether it’s someone over in California,
Australia, it really doesn't matter. Anyone who wants to make interoperability
better should know about it.
My focus is
on decision-makers, policymakers, process developers, and other people who look
at it from a device-design perspective. One of the things that has been
discussed within the HCF’s reference architecture work is the need to make sure
that it’s all at a high-enough level, where we can agree on what it looks like.
Yet it also must go down deeply enough so that people can apply it to what they
are doing -- whether it’s designing a piece of software or designing a medical
device.
Gardner: Jason, The Open Group has been
involved with standards and reference architectures for decades, with such
recent initiatives as the IT4IT
approach, as well as the longstanding TOGAF
reference architecture. How does the HERA relate to some of these other
architectural initiatives?
Building on a strong
foundation
Lee: The HERA starts by using the
essential components and insights that are built into the TOGAF ArchitecturalDevelopment Model (ADM) and builds from there. It also uses the ArchiMate
language, but we have never felt restricted to using only those existing Open
Group models that have been around for some time and are currently being
developed further.
We are a
big organization in terms of our approach, our forum, and so we want to draw from
the best there is in order to fill in the gaps. Over the last few decades, an
incredible amount of talent has joined The Open Group to develop architectural
models and standards that apply across multiple industries, including
healthcare. We reuse and build from this important work.
In
addition, as we have dug deeper into the healthcare industry, we have found other
issues – gaps -- that need filling. There are related topics that would benefit.
To do that, we have been working hard to establish relationships with other
organizations in the healthcare space, to bring them in, and to collaborate. We
have done this with the Health Level Seven
Organization (HL7), which is one of the best-known standards organizations
in the world.
We are also
doing this now with an organization called Healthcare
Services Platform Consortium (HSPC), which involves academic, government
and hospital organizations, as well as people who are focused on developing
standards around terminology.
IT’s getting better
all the time
Kipf: If you think about reference architecture
in a specific domain, such as in the healthcare industry, you look at your
customers and the enterprises -- those really concerned with the delivery of
health services. You need to ask yourself the question: What are their needs?
And the
need in this industry is a focus on the person and on the service. It’s also
highly regulatory, so being compliant is a big thing. Quality is a big thing. The
idea of lifetime evolution -- that you become better and better all the time --
that is very important, very intrinsic to the healthcare industry.
When we are
looking into the customers out there that we believe that the HERA could be of
value, it’s the small- to mid-sized and the large enterprises that you have to
think of, and it’s really across the globe. That’s why we believe that the HERA
is something that is tuned into the needs of our industry.
And as
Jason mentioned, we build on open standards and we leverage them where we can. ArchiMate
is one of the big ones -- not only the business language, but also a lot of the
concepts are based on ArchiMate. But we need to include other standards as
well, obviously those from the healthcare industry, and we need to deviate from
specific standards where this is of value to our industry.
Gardner: Oliver, in order to get this
standard to be something that's used, that’s very practical, people look to
results. So if you were to take advantage of such reference architectures as
HERA, what should you expect to get back? If you do it right, what are the
payoffs?
Capacity for change
and collaboration
Kipf: It should enable you to do a better
job, to become more efficient, and to make better use of technology. Those are
the kinds of benefits that you see realized. It’s not only that you have a
place where you can model all the elements of your enterprise, where you can
put and manage your processes and your services, but it’s also in the way you are
architecting your enterprise.
The HERA gives you the tools to get where you want to be, to define where you want to be -- and also how to get there.
It gives you the ability to change. From a transformation
management perspective, we know that many healthcare systems have great
challenges and there is this need to change. The HERA gives you the tools to
get where you want to be, to define where you want to be -- and also how to get
there. This is where we believe it provides a lot of benefits.
Gardner: Gail, similar question, for those
organizations, both public and private sector, that do this well, that embrace HERA,
what should they hope to get in return?
Kalbfleisch: I completely agree with what Oliver said.
To add, one of the benefits that you get from using EA is a chance to have a
perspective from outside your own narrow silos. The HERA should be able to help
a person see other areas that they have to take into consideration, that maybe
they wouldn’t have before.
Another
value is to engage with other people who are doing similar work, who may have
either learned lessons, or are doing similar things at the same time. So that's
one of the ways I see the effectiveness and of doing our jobs better, quicker,
and faster.
Also, it
can help us identify where we have gaps and where we need to focus our efforts.
We can focus our limited resources in much better ways on specific issues -- where
we can accomplish what we are looking to -- and to gain that boundaryless
information flow.
Reaching your goals
We show them how they can follow a roadmap to accomplish their self-defined goals more effectively.
Lee: Essentially,
the HERA will provide a framework that enables companies to leverage IT to
achieve their goals. The wonderful thing about it is that we are not telling
organizations what their goals should be. We show them how they can follow a
roadmap to accomplish their self-defined goals more effectively. Often this
involves communicating the big picture, as Gail said, to those who are in
siloed positions within their organizations.
There is an
old saying: “What you see depends on where you sit.” The HERA helps
stakeholders gain this perspective by helping key players understand the
relationships, for example, between business processes and engineering. So
whether a stakeholder’s interest is increasing patient satisfaction, reducing
error, improving quality, and having better patient outcomes and gaining more
reimbursement where reimbursement is tied to outcomes -- using the product and
the architecture that we are developing helps all of these goals.
Gardner: Jason, for those who are intrigued
by what you are doing with HERA, tell us about its trajectory, its evolution, and
how that journey unfolds. Who can they learn more or get involved?
Lee: We have only been working on the
HERA per se for the last year, although its underpinnings go back 20 years or
more. Its trajectory is not to a single point, but to an evolutionary process.
We will be producing products, white papers, as well as products that others
can use in a modular fashion to leverage what they already use within their
legacy systems.
We
encourage anyone out there, particularly in the health system delivery space,
to join us. That can be done by contacting me at j.lee@opengroup.org and at www.opengroup.org/healthcare.
It’s an
incredible time, a very opportune time, for key players to be involved because
we are making very important decisions that lay the foundation for the HERA. We
collaborate with key players, and we lay down the tracks from which we will
build increasing levels of complexity.
But we
start at the top, using non-architectural language to be able to talk to
decision-makers, whether they are in the public sector or private sector. So we
invite any of these organizations to join us.
Learn from others’
mistakes
Kalbfleisch: My first foray into working with The
Open Group was long before I was in the health IT sector. I was with the US Air
Force and we were doing very non-health architectural work in conjunction with
The Open Group.
The
interesting part to me is in ensuring boundaryless information flow in a manner
that is consistent with the information flowing where it needs to go and who
has access to it. How does it get from place to place across distinct mission
areas, or distinct business areas where the information is not used the same
way or stored in the same way? Such dissonance between those business areas is
not a problem that is isolated just to healthcare; it’s across all business
areas.
We don't have to make the same mistakes. We can take what people have learned and extend it much further.
That was exciting.
I was able to take awareness of The Open Group from a previous life, so to speak,
and engage with them to get involved in the Healthcare Forum from my current
position.
A lot of
the technical problems that we have in exchanging information, regardless of
what industry you are in, have been addressed by other people, and have already
been worked on. By leveraging the way organizations have already worked on it for
20 years, we can leverage that work within the healthcare industry. We don't
have to make the same mistakes that were made before. We can take what people
have learned and extend it much further. We can do that best by working
together in areas like The Open Group HCF.
Kipf: On that evolutionary approach, I
also see this as a long-term journey. Yes, there will be releases when we have
a specification, and there will guidelines. But it's important that this is an
engagement, and we have ongoing collaboration with customers in the future,
even after it is released. The coming together of a team is what really makes a
great reference architecture, a team that places the architecture at a high
level.
We can also
develop distinct flavors of the specification. We should expect much more
detail. Those implementation architectures then become spin-offs of reference
architectures such as the HERA.
Lee: I can give some concrete examples,
to bookend the kinds of problems that can be addressed using the HERA. At the
micro end, a hospital can use the HERA structure to implement a patient check-in
to the hospital for patients who would like to bypass the usual process and
check themselves in. This has a number of positive value outcomes for the
hospital in terms of staffing and in terms of patient satisfaction and cost
savings.
At the
other extreme, a large hospital system in Philadelphia or Stuttgart or Oslo or
in India finds itself with patients appearing at the emergency room or in the
ambulatory settings unaffiliated with that particular hospital. Rather than have
that patient come as a blank sheet of paper, and redo all the tests that had
been done prior, the HERA will help these healthcare organizations figure out
how to exchange data in a meaningful way. So the information can flow
digitally, securely, and it means the same thing to those who get it as much as
it does to those who receive it, and everything is patient-focused,
patient-centric.
Gardner: Oliver, we have seen with other
Open Group standards and reference architectures, a certification process often
comes to bear that helps people be recognized for being adept and properly
trained. Do you expect to have a certification process with HERA at some point?
Certifiable enterprise
expertise
Kipf: Yes, the more we mature with the
HERA, along with the defined guidelines and the specifications and the HERA
model, the more there will be a need and demand for health enterprise-focused
employees in the marketplace. They can show how consulting services can then
use HERA.
And that's
a perfect place when you think of certification. It helps make sure that the quality
of the workforce is strong, whether it's internal or in the form of a professional
services role. They can comply with the HERA.
Gardner: Clearly, this has applicability to healthcare
payer organizations, provider organizations, government agencies, and the
vendors who supply pharmaceuticals or medical instruments. There are a great
deal of process benefits when done properly, so that enterprise architects
could become certified eventually.
My question
then is how do we take the HERA, with such a potential for being beneficial
across the board, and make it well-known? Jason, how do we get the word out? How
can people who are listening to this or reading this, help with that?
Spread the word,
around the world
Lee: It's a question that has to be considered
every time we meet. I think the answer is straightforward. First, we build a
product [the HERA] that has clear value for stakeholders in the healthcare
system. That’s the internal part.
Second—and often, simultaneously—we
develop a very important marketing/collaboration/socialization
capability. That’s the external part. I've worked in healthcare for more than 30
years, and whether it's public or private sector decision-making, there are
many stakeholders, and everybody's focused on the same few things: improving
value, enhancing quality, expanding access, and providing security.
All companies must plan, build, operate and improve.
We will
continue developing relationships with key players to ensure them that what
they’re doing is key to the HERA. At the broadest level, all companies must plan,
build, operate and improve.
There are immense
opportunities for business development. There are innumerable ways to use the
HERA to help health enterprise systems operate efficiently and effectively. There
are opportunities to demonstrate to key movers and shakers in healthcare system
how what we're doing integrates with what they're doing. This will maximize the
uptake of the HERA and minimize the chances it sits on a shelf after it's been
developed.
Gardner: Oliver, there are also a variety of
regional conferences and events around the world. Some of them are from The Open
Group. How important is it for people to be aware of these events, maybe by
taking part virtually online or in person? Tell us about the face-time opportunities,
if you will, of these events, and how that can foster awareness and improvement
of HERA uptake.
Kipf: We began with the last Open Group
event. I was in Berlin, presenting the HERA. As we see more development, more
maturity, we can then show more. The uptake will be there and we also need to
include things like cyber security, things like risk compliance. So we can bring
in a lot of what we have been doing in various other initiatives within The
Open Group. We can show how it can be a fusion, and make this something that is
really of value.
I am
confident that through face-to-face events, such as The Open Group events, we
can further spread the message.
Lee: And a real shout-out to Gail and Oliver
who have been critical in making introductions and helping to share The Open
Group Healthcare Forum’s work broadly. The most recent example is the 2016 HIMSS conference, a meeting that brings
together more than 40,000 people every year. There is a federal
interoperability showcase there, and we have been able to introduce and discuss
our HERA work there.
We’ve
collaborated with the Office of the National Coordinator where the Federal
Heath Architecture sits, with the US Veterans Administration, with the US Department
of Defense, and with the Centers for Medicare and Medicaid (CMS). This is all US-centered,
but there are lots of opportunities globally to not just spread the word in
public for domains and public venues, but also to go to those key players who
are moving the industry forward, and in some cases convince them that
enterprise architecture does provide that structure, that template that can
help them achieve their goals.
Future forecast
Gardner: I’m afraid we are almost out of
time. Gail, perhaps a look into the crystal ball. What do you expect and hope
to see in the next few years when it comes to improvements initiatives like
HERA at The Open Group Forum can provide? What do you hope to see in the next
couple of years in terms of improvement?
Kalbfleisch: What I would like to see happen in the
next couple of years as it relates to the HERA, is the ability to have a place
where we can go from anywhere and get a glimpse of the landscape. Right now, it’s
hard to find anywhere where someone in the US can see the great work that
Oliver is doing, or the people in Norway, or the people in Australia are doing.
Reference architecture is great to have, but it has no power until it's used.
It’s really
important that we have opportunities to communicate as large groups, but also
the one-on-one. Yet when we are not able to communicate personally, I would
like to see a resource or a tool where people can go and get the information
they need on the HERA on their own time, or as they have a question. Reference
architecture is great to have, but it has no power until it’s used.
My hope for
the future is for the HERA to be used by decision-makers, developers, and even
patients. So when an organizations such as some hospital wants to develop a new
electronic health record (EHR) system, they have a place to go and get started,
without having to contact Jason or wait for a vendor to come along and tell
them how to solve a problem. That would be my hope for the future.
Lee: You can think of the HERA as a soup
with three key ingredients. First is the involvement and commitment of very
bright people and top-notch organizations. Second, we leverage the deep
experience and products of other forums of The Open Group. Third, we build on
external relationships. Together, these three things will help make the HERA
successful as a certifiable product that people can use to get their work done
and do better.
Gardner: Jason, perhaps you could also
tee-up the next Open Group event in Amsterdam. Can you tell us more about that and
how to get involved?
Lee: We are very excited about our next event in Amsterdam in October. You
can go to www.opengroup.org and look under Events, read about the agendas, and sign
up there. We will have involvement from experts from the US, UK, Germany,
Australia, Norway, and this is just in the Healthcare Forum!
The Open
Group membership will be giving papers, having discussions, moving the ball
forward. It will be a very productive and fun time and we are looking forward
to it.
Again, anyone
who has a question or is interested in joining the Healthcare Forum can please
send me, Jason Lee, an email at j.lee@opengroup.org.
Gardner: I'm afraid we will have to leave it
there. We have been discussing the latest developments in The Open Group Healthcare
Forum, and how it's advancing best practices and methods for better leveraging
IT in healthcare ecosystems. We've learned how the HERA initiative is
standardizing IT architectures and fostering boundaryless interoperability
across the healthcare industry globally.
Please join
me in thanking our panel: Oliver Kipf, The Open Group Healthcare Forum Chairman
and Business Process and Solution Architect at Philips; Dr. Jason Lee, Director
of the Healthcare Forum at The Open Group, and Gail Kalbfleisch, Director of
the Federal Health Architecture at the US Department of Health and Human
Services.
And lastly
a big thanks you to The Open Group for sponsoring this discussion, as well as a
thank you to our audience for joining. I'm Dana Gardner, Principal Analyst at
Interarbor Solutions, your host and moderator.
Thanks
again for listening. Feel free to pass this content on to your cohorts and
others in your community, and do come back next time.
Listen to the podcast. Find it on iTunes. Get the mobile app. Download the transcript. Sponsor: The Open
Group.
Transcript of a discussion on how a global standards body and its ecosystem of partners are working to
improve how the healthcare industry operates. Copyright
The Open Group and Interarbor Solutions, LLC, 2005-2017. All rights reserved.
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