Enterprise -> Technology
By: Dana Gardner, Principal Analyst, Interarbor Solutions
Published: 16th July 2014
Copyright Interarbor Solutions © 2014
An expected deluge of data and information about patients, providers, outcomes, and needed efficiencies is pushing the healthcare industry to rapid change. But more than dealing with just the volume of data is required. Interoperability, security and the ability to adapt rapidly to the lessons in the data are all essential.
The means of enabling Boundaryless Information Flow, Open Platform 3.0 adaptation, and security for the healthcare industry are then, not surprisingly, headline topics for The Open Group’s upcoming event, Enabling Boundaryless Information Flow on July 21 and 22 in Boston.
And Boston is a hotbed of innovation and adaption for how technology, enterprise architecture, and open standards can improve the communication and collaboration among healthcare ecosystem players.
In preparation for the conference, BriefingsDirect had the opportunity to interview Jason Lee, the new Healthcare and Security Forums Director at The Open Group. The discussion is moderated by me, Dana Gardner, Principal Analyst at Interarbor Solutions.
Here are some excerpts:
Gardner: Let’s start by talking about the relationship between Boundaryless Information Flow, which is a major theme of the conference, and healthcare. Healthcare perhaps is the killer application for Boundaryless Information Flow.
Lee: Interesting, I haven’t heard it referred to that way, but healthcare is 17 percent of the US economy. It's upwards of $3 trillion. The costs of healthcare are a problem, not just in the United States, but all over the world, and there are a great number of inefficiencies in the way we practice healthcare.
We don’t necessarily intend to be inefficient, but there are so many places and people involved in healthcare, it's very difficult to get them to speak the same language. It's almost as if you're in a large house with lots of different rooms, and every room you walk into they speak a different language. To get information to flow from one room to the other requires some active efforts, and that’s what we're undertaking here at The Open Group.
Gardner: What is it about the current collaboration approaches that don’t work? Obviously, healthcare has been around for a long time and there have been different players involved. What are the hurdles? What prevents a nice, seamless, easy flow and collaboration in information that creates better outcomes? What’s the holdup?
Lee: There are many ways to answer that question, because there are many barriers. Perhaps the simplest is the transformation of healthcare from a paper-based industry to a digital industry. Everyone has walked into a medical office, looked behind the people at the front desk, and seen file upon file and row upon row of folders, information that’s kept in a written format.
When there's been movement toward digitizing that information, not everyone has used the same system. It's almost like trains running on different gauge track. Obviously if the track going east to west is a different gauge than going north to south, then trains aren’t going to be able to travel on those same tracks. In the same way, healthcare information does not flow easily from one office to another or from one provider to another.
Gardner: So not only do we have disparate strategies for collecting and communicating health data, but we're also seeing much larger amounts of data coming from a variety of new and different places. Some of them now even involve sensors inside of patients themselves or devices that people will wear. So is the data deluge, the volume, also an issue here?
Lee: Certainly. I heard recently that an integrated health plan, which has multiple hospitals involved, contains more elements of data than the Library of Congress. As information is collected at multiple points in time, over a relatively short period of time, you really do have a data deluge. Figuring out how to find your way through all the data and look at the most relevant [information] for the patient is a great challenge.
Gardner: I suppose the bad news is that there is this deluge of data, but it’s also good news, because more data means more opportunity for analysis, a better ability to predict and determine best practices, and also provide overall lower costs with better patient care.
So it seems like the stakes are rather high here to get this right, to not just crumble under a volume or an avalanche of data, but to master it, because it's perhaps the future. The solution is somewhere in there, too.
Lee: No question about it. At The Open Group, our focus is on solutions. We, like others, put a great deal of effort into describing the problems, but figuring out how to bring IT technologies to bear on business problems, how to encourage different parts of organizations to speak to one another and across organizations to speak the same language, and to operate using common standards and language. That’s really what we're all about.
And it is, in a large sense, part of the process of helping to bring healthcare into the 21st Century. A number of industries are a couple of decades ahead of healthcare in the way they use large datasets—big data, some people refer to it as. I'm talking about companies like big department stores and large online retailers. They really have stepped up to the plate and are using that deluge of data in ways that are very beneficial to them—and healthcare can do the same. We're just not quite at the same level of evolution.
Gardner: And to your point, the stakes are so much higher. Retail is, of course, a big deal in the economy, but as you pointed out, healthcare is such a much larger segment. So just making modest improvements in communication, collaboration, or data analysis can reap huge rewards.
Lee: Absolutely true. There is the cost side of things, but there is also the quality side. So there are many ways in which healthcare can improve through standardization and coordinated development, using modern technology that cannot just reduce cost, but improve quality at the same time.
Gardner: I'd like to get into a few of the hotter trends. But before we do, it seems that The Open Group has recognized the importance here by devoting the entire second day of their conference in Boston, that will be on July 22, to healthcare.
Maybe you could provide us a brief overview of what participants, and even those who come in online and view recorded sessions of the conference at http://new.livestream.com/opengroup should expect? What’s going to go on July 22?
Lee: We have a packed day. We're very excited to have Dr. Joe Kvedar, a physician at Partners HealthCare and Founding Director of the Center for Connected Health, as our first plenary speaker. The title of his presentation is “Making Health Additive.”
Dr. Kvedar is a widely respected expert on mobile health, which is currently the Healthcare Forum’s top work priority. As mobile medical devices become ever more available and diversified, they will enable consumers to know more about their own health and wellness.
A great deal of data of potentially useful health data will be generated. How this information can be used—not just by consumers but also by the healthcare establishment that takes care of them as patients—will become a question of increasing importance. It will become an area where standards development and The Open Group can be very helpful.
Our second plenary speaker, Proteus Duxbury, Chief Technology Officer at Connect for Health Colorado, will discuss a major feature of the Affordable Care Act—the health insurance exchanges—which are designed to bring health insurance to tens of millions of people who previous did not have access to it.
He is going to talk about how enterprise architecture—which is really about getting to solutions by helping the IT folks talk to the business folks and vice versa—has helped the State of Colorado develop their health insurance exchange.
After the plenaries, we will break up into three tracks, one of which is healthcare-focused. In this track there will be three presentations, all of which discuss how enterprise architecture and the approach to Boundaryless Information Flow can help healthcare and healthcare decision-makers become more effective and efficient.
One presentation will focus on the transformation of care delivery at the Visiting Nurse Service of New York. Another will address stewarding healthcare transformation using enterprise architecture, focusing on one of our platinum members, Oracle, and a company called Intelligent Medical Objects, and how they're working together in a productive way, bringing IT and healthcare decision-making together.
Then, the final presentation in this track will focus on the development of an enterprise architecture-based solution at an insurance company. The payers, or the insurers—the big companies that are responsible for paying bills and collecting premiums—have a very important role in the healthcare system that extends beyond administration of benefits. Yet, payers are not always recognized for their key responsibilities and capabilities in the area of clinical improvements and cost improvements.
With the increase in payer data brought on in large part by the adoption of a new coding system—the ICD-10—which will come online this year, there will be a huge amount of additional data, including clinical data, that become available. At The Open Group, we consider payers—health insurance companies (some of which are integrated with providers)—as very important stakeholders in the big picture.
In the afternoon, we're going to switch gears a bit and have a speaker talk about the challenges, the barriers, the 'pain points' in introducing new technology into the healthcare systems. The focus will return to remote or mobile medical devices and the predictable but challenging barriers to getting newly generated health information to flow to doctors’ offices and into patients records, electronic health records, and hospitals' data-keeping and data-sharing systems.
We'll have a panel of experts that responds to these pain points, these challenges, and then we'll draw heavily from the audience, who we believe will be very, very helpful, because they bring a great deal of expertise in guiding us in our work. So we're very much looking forward to the afternoon as well.
Gardner: It's really interesting. A couple of these different plenaries and discussions in the afternoon come back to this user-generated data. Jason, we really seem to be on the cusp of a whole new level of information that people will be able to develop from themselves through their lifestyle, new devices that are connected.
We hear from folks like Apple, Samsung, Google, and Microsoft. They're all pulling together information and making it easier for people to not only monitor their exercise, but their diet, and maybe even start to use sensors to keep track of blood sugar levels, for example.
In fact, a new Flurry Analytics survey showed 62 percent increase in the use of health and fitness applications over the last six months on the popular mobile devices. This compares to a 33 percent increase in other applications in general. So there's an 87 percent faster uptick in the use of health and fitness applications.
Tell me a little bit how you see this factoring in. Is this a mixed blessing? Will so much data generated from people in addition to the electronic medical records, for example, be a bad thing? Is this going to be a garbage in, garbage out, or is this something that could potentially be a game changer in terms of how people react to their own data—and then bring more data into the interactions they have with healthcare providers?
Lee: It's always a challenge to predict what the market is going to do, but I think that’s a remarkable statistic that you cited. My prediction is that the increased volume of person-generated data from mobile health devices is going to be a game changer. This view also reflects how the Healthcare Forum members (which includes members from Capgemini, Philips, IBM, Oracle and HP) view the future.
The commercial demand for mobile medical devices, things that can be worn, embedded, or swallowed, as in pills, as you mentioned, is growing ever more. The software and the applications that will be developed to be used with the devices is going to grow by leaps and bounds.
As you say, there are big players getting involved. Already some of the pedometer-type devices that measure the number of steps taken in a day have captured the interest of many, many people. Even David Sedaris, serious guy that he is, was writing about it recently in The New Yorker.
What we will find is that many of the health indicators that we used to have to go to the doctor or nurse or lab to get information on will become available to us through these remote devices.
There will be a question of course as to reliability and validity of the information, to your point about garbage in, garbage out, but I think standards development will help here. This, again, is where The Open Group comes in. We might also see the FDA exercising its role in ensuring safety here, as well as other organizations, in determining which devices are reliable.
The Open Group is working in the area of mobile data and information systems that are developed around them, and their ability to (a) talk to one another, and (b) talk to the data devices/infrastructure used in doctors’ offices and in hospitals. This is called interoperability and it's certainly lacking in the country.
There are already problems around interoperability and connectivity of information in the healthcare establishment as it is now. When patients and consumers start collecting their own data, and the patient is put at the center of the nexus of healthcare, then the question becomes how does that information that patients collect get back to the doctor/clinician in ways in which the data can be trusted and where the data are helpful?
After all, if a patient is wearing a medical device, there is the opportunity to collect data, about blood-sugar level let's say, throughout the day. And this is really taking healthcare outside of the four walls of the clinic and bringing information to bear that can be very, very useful to clinicians and beneficial to patients.
In short, the rapid market dynamic in mobile medical devices and in the software and hardware that facilitates interoperability begs for standards-based solutions that reduce costs and improve quality, and all of which puts the patient at the center. This is The Open Group’s Healthcare Forum’s sweet spot.
Gardner: It seems to me a real potential game changer as well, and that something like Boundaryless Information Flow and standards will play an essential role in. Because one of the big question marks with many of the ailments in a modern society has to do with lifestyle and behavior.
So often, the providers of the care only really have the patient’s responses to questions, but imagine having a trove of data at their disposal, a 360-degree view of the patient to then further the cause of understanding what's really going on, on a day-to-day basis.
But then, it's also having a two-way street, being able to deliver perhaps in an automated fashion reinforcements and incentives, information back to the patient in real-time about behavior and lifestyles. So it strikes me as something quite promising, and I look forward to hearing more about it at the Boston conference.
Any other thoughts on this issue about patient flow of data, not just among and between providers and payers, for example, or providers in an ecosystem of care, but with the patient as the center of it all, as you said?
Lee: As more mobile medical devices come to the market, we'll find that consumers own multiple types of devices at least some of which collect multiple types of data. So even for the patient, being at the center of their own healthcare information collection, there can be barriers to having one device talk to the other. If a patient wants to keep their own personal health record, there may be difficulties in bringing all that information into one place.
So the interoperability issue, the need for standards, guidelines, and voluntary consensus among stakeholders about how information is represented becomes an issue, not just between patients and their providers, but for individual consumers as well.
Gardner: And also the cloud providers. There will be a variety of large organizations with cloud-modeled services, and they are going to need to be, in some fashion, brought together, so that a complete 360-degree view of the patient is available when needed. It's going to be an interesting time.
Of course, we've also looked at many other industries and tried to have a cloud synergy, a cloud-of-clouds approach to data and also the transaction. So it’s interesting how what's going on in multiple industries is common, but it strikes me that, again, the scale and the impact of the healthcare industry makes it a leader now, and perhaps a driver for some of these long overdue structured and standardized activities.
Lee: It could become a leader. There is no question about it. Moreover, there is a lot healthcare can learn from other companies, from mistakes that other companies have made, from lessons they have learned, from best practices they have developed (both on the content and process side). And there are issues, around security in particular, where healthcare will be at the leading edge in trying to figure out how much is enough, how much is too much, and what kinds of solutions work.
There's a great future ahead here. It's not going to be without bumps in the road, but organizations like The Open Group are designed and experienced to help multiple stakeholders come together and have the conversations that they need to have in order to push forward and solve some of these problems.
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