Using Process and
Architecture Improvement to
Achieve Health Transformation
Erik Pupo and Geeta Nayyar
Vangent
© 2009 Vangent Proprietary
Introduction to Webinar
What are we going to cover
today?
– What is an architecture?
– How does an architecture tie in to
process improvement?
– What are the various levels of
transformation required by
healthcare in the next decade?
– What is the role of architecture and
process improvement in achieve
healthcare transformation
outcomes?
© 2009 Vangent Proprietary
Webinar summary
This webinar will explore the use of business
process improvement methods, including
process modeling and analysis and enterprise
architecture techniques, to improve healthcare.
The use of health information technology
promises to produce many positives, but the
use of enterprise architecture will ensure that
technology is used to improve healthcare
outcomes and in a way that correlates to
current healthcare processes.
© 2009 Vangent Proprietary
What is architecture?
So what exactly is an architecture?
There are many different types of architecture to
consider within an organization
– Enterprise, systems, data, solution
So what is the right one?
– The one that works for your organization’s strategy and
requirements:
•
•
You must have an architecture to support process improvement
That view may include a lot of different architectures
This organizational view can take a wide variety of forms
– Architecture is not just models!
•
Would you drive to a destination without a map? Is a map just a
picture?
– Architecture should include data that is useful to the user
In the end, an architecture exists to ANSWER
QUESTIONS
© 2009 Vangent Proprietary
What is Process Improvement?
And what exactly is process improvement?
– Process improvement is a series of actions taken by a process
owner to identify, analyze and improve existing processes within an
organization to meet new goals and objectives. These actions often
follow a specific methodology or strategy to create successful results
The only way to improve a process is to know the process
© 2009 Vangent Proprietary
Why Architecture?
The primary driver of
architecture is its your plan for
transformation and change
– That’s why there are many
types of architecture – there
are many different forms of
change to plan for
• Enterprise to system to data to
privacy
The major struggle that many
in healthcare have though is:
– How do I construct that plan?
– How do I build an
architecture?
– Is it worth the investment of
time and money?
© 2009 Vangent Proprietary
The importance of architecture and
process improvement
Many areas of healthcare are
in need of transformation
– There are different types of
transformation needed
•
•
•
•
Meaningful Use
Healthcare Reform regulations
Payment and Administrative
CPOE and e-Prescribing
There are significant
concerns about how to
achieve this transformation
– Will implementing an EHR
inhibit current processes?
– Will new administrative
transaction rules not work
with existing data?
© 2009 Vangent Proprietary
The role of architecture with
health IT
The role of health IT has been
mandated by HITECH and meaningful
use
– But how can IT be deployed into a
diverse healthcare environment with
many stakeholders without causing
issues?
– In order to drive change, you need
to have a complete picture of what it
is you are changing and what effect
that change will have
You need an architecture, and it needs
to evolve as your organization evolves
– The architecture evolves as the
organization evolves
• It needs to change and evolve with the
transformation, and you need to have a
roadmap that supports this transformation
© 2009 Vangent Proprietary
8
So what goes into your
“architecture”?
Its not just a model
– A common view of architecture is it’s a bunch of diagrams
Architecture is about information – the most valuable
commodity to any organization
– Gap Analysis – what issues do we currently have now and how do we
plan to correct them?
– Target Architecture – this is how we look now and this is how we want to
look in the future
– Data Architecture – what data sources do I have and how does someone
access them?
– Privacy Architecture – what systems presents privacy risks and how can I
mitigate them?
What can you draw from to determine architecture
requirements?
ISO 18308 EHR Architecture Requirements
© 2009 Vangent Proprietary
Architecture – aligning process
to technology
One of the major failings of many
healthcare organizations is the
inability to attach process
improvement to technology
– Lets buy an EHR system
– Lets buy more storage capacity
– Organizations can’t “solve the
puzzle”
That’s one of the major benefits of
any enterprise architecture
– Tying your technology to your
strategy and your processes
– A line of sight from technology to
strategy allows decisions to be made
© 2009 Vangent Proprietary
Comparing architecture to
shoes
What does a woman do when they buy shoes?
She asks questions!
–
–
–
–
What would I wear these shoes for?
How much do they cost?
Will these shoes work with my wardrobe?
Do I have room in my closet for these shoes?
That’s an enterprise architecture – the same kind of
questions to consider
–
–
–
–
What is this new clinical system going to do?
What processes will this system support?
Is this system a privacy risk?
How much does this system cost compared to other
systems?
© 2009 Vangent Proprietary
Architecture isn’t everything
It has to be kept in alignment
with the strategy of your
healthcare organization
It has to be regularly updated
– Bad data in, bad data out
It has to be presented in a
way that makes sense to the
average person
– The modeling paradox - You
cant just draw pictures, it has
to connect with the user
It cant solve existing problems
– It only presents a picture, it
does not mandate what you
do with that picture nor make
the picture “prettier”.
© 2009 Vangent Proprietary
Common enterprise architecture
development problems
Not tying it to the
organizational strategy or
processes
Focusing on details in
areas that are not
important
Failing to represent it
properly in a way people
can understand
Keeping it up to date
Here is an example Medicaid
© 2009 Vangent Proprietary
What does an architecture “look
like”?
Example – caBIG NCI Architecture and HITSP
Conceptual Design Architecture
– It can be complex like these types of architectures
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Hopefully an architecture won’t
look like this
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15
Or it may be more simplified
like this
Examples – HHS enterprise architecture and CMS CARE
System Architecture
© 2009 Vangent Proprietary
16
So is there a need for architecture
in healthcare?
Virtually all healthcare organizations view IT as a
key enabler for innovation, collaboration, and
process improvement. Most healthcare providers
also have a variety of incompatible, isolated
systems in place.
– Many of these applications do a good job of supporting
dedicated processes like radiology, lab tests, and
medication schedules, but it’s expensive and timeconsuming to compose new applications that can support
innovative processes – especially when they span
system or organizational boundaries.
© 2009 Vangent Proprietary
Common Healthcare Pain
Points
Cumbersome interfaces
– The links between clinical, patient
management, and administrative systems
are not well documented or known, and
require constant maintenance
Redundant data
– Medical and patient-related data may be
stored in multiple places
Lack of visibility
– Clinical staff may not have access to unified
patient and treatment data, and IT staff may
not know where that data is
Inflexible IT resources
– Tightly coupled IT assets make it difficult
and costly to respond to changes in the
healthcare organization’s business climate
© 2009 Vangent Proprietary
Common myths about EHRs
Broken HIM processes are resolved in an EHR automatically
– Implementing an EHR will often shine a surprising spotlight on
operational areas that need work.
A new EHR will fix everything
– Technology works as an accelerator of momentum, not as a
creator
A Plan will solve everything
– It is often helpful to plan a basic “direction” and fill in the details
later when you understand the product better.
You can buy one EHR in your lifetime
– You should start planning for a replacement EHR system before
you implement your first one
© 2009 Vangent Proprietary
19
So how might architecture work
in healthcare?
Lets use a typical
inpatient scenario
The typical processes
involved with an
inpatient stay:
–
–
–
–
–
–
–
Admission
Diagnosis
Procedure Scheduling
Treatment
Medication
Discharge
Invoicing
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How does the inpatient scenario
linkage work?
Linkage may include phone,
fax, computer systems, and
handwritten notes
– But who really has a handle
on this scenario or its
processes?
And what would happen if
any of these current
processes was changed?
– Example – interfaces
between processes may be
“hard-coded” with
dependencies, making
changes to them
problematic
© 2009 Vangent Proprietary
Other examples where an
enterprise architecture can help
A healthcare organization can
develop a patient’s complete
medical history by drilling down
into several incompatible
systems managed by diverse
providers
Groups of hospitals, whether
allied informally or as part of a
network, can use strategic
sourcing techniques to jointly
manage demand planning and
fulfillment for drugs, supplies,
and equipment
Create a risk management
framework to help determine
whether a new system is
needed and what the risks of
that system are
© 2009 Vangent Proprietary
Why architecture is so valuable
in healthcare
Nearly 700 billion in waste annually
in the healthcare system
Nearly 40% of that can be derived
directly or indirectly from
architectural issues
Administrative System
Inefficiencies
Provider Inefficiency and Errors
Lack of Care Coordination
Unwarranted Use
Preventable Conditions and
Avoidable Care
Fraud and Abuse
© 2009 Vangent Proprietary
23
What are the primary benefits of an
enterprise architecture in healthcare?
Leverage IT assets to achieve business goals
– You can use the architecture to reengineer processes in support of
strategic and tactical objectives – reuse versus buy
Create a more flexible healthcare enterprise
– A more flexible IT environment can respond better to healthcare
challenges
Improve privacy and security
– Allows an organization to focus on privacy and security threats
Manage and minimize risk
– Allows for the identification of business and technical risks
Leverage opportunities for collaboration
– Allows for the connection of healthcare partners with visibility into you and
your partner’s processes– the true goal of interoperability
© 2009 Vangent Proprietary
Conclusions
Architecture is paramount to managing the changes
that are forthcoming in healthcare
Most healthcare organizations are not prepared to
manage this change and will invariably experience
process or technology “trauma”
Just getting started in building an enterprise
architecture is not enough – it has to be done right
Even a high-level enterprise architecture can help –
detail is important but not critical in all cases
© 2009 Vangent Proprietary