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.
To learn more about improving the processes and IT that better supports healthcare, please welcome our panel of experts: Oliver Kipf, The Open Group Healthcare Forum Chairman and Business Process and Solution Architect at Philips, based in Germany; Dr. Jason Lee, Director of the Healthcare Forum at The Open Group, in Boston, and Gail Kalbfleisch, Director of the Federal Health Architecture at the US Department of Health and Human Services in Washington, D.C. The discussion is moderated by Dana Gardner, Principal Analyst at Interarbor Solutions.
Here are some excerpts:
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: 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: 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 email@example.com 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.
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 firstname.lastname@example.org.
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