1 
JAMES A ROBERTSON AND ASSOCIATES 
EFFECTIVE STRATEGIC BUSINESS SOLUTIONS 
Why Information Technology 
Dr James Robertso...
MANAGED HEALTHCARE 
WHAT IS IT? 
Is 
MANAGED HEALTHCARE 
about cost and quality? 
OR 
about HEALTH? 
Some thoughts about t...
A HUGE OPPORTUNITY 
STATISTICAL HEALTH MANAGEMENT 
Human beings are far less diverse than aircraft or factories 
There is ...
CONTEXT: INFORMATION TECHNOLOGY 
AN INDUSTRY CHARACTERISED BY FAILURE 
Seventy percent of I.T. investments fail TOTALLY 
A...
I.T. AN INDUSTRY CHARACTERISED BY FAILURE 
WHY DATA ENGINEERING IS CRITICAL 
"Attendees of Gartner's Business Intelligence...
UNLOCKING CORPORATE DATA 
The role of computers and the role of people 
Interpret 
Results 
COMPUTERS 
I.T. Take Decision ...
DATA ENGINEERING 
The definition of information content 
in a way that is structurally (taxonomically) fundamentally 
mean...
CAUSES OF INFORMATION TECHNOLOGY 
INVESTMENT FAILURE 
Information technology mythology (30%) 
Lack of executive custody an...
MANAGING I.T. FOR SUCCESS 
MANAGEMENT COMPONENTS (% FOR SUCCESS) 
Executive Custody (25%) 
* 
* 
Strategic Solution Archit...
THE BIGGEST I.T. OPPORTUNITY? 
SOME IMPORTANT PRINCIPLES 
Computers can only add 0's and 1's 
People only understand plain...
11 
DATA ENGINEERING / TAXONOMY 
Vital Concept -- Data Hierarchy 
Presentation and interpretation <5 = too few > 10 = too ...
12 
DATA ENGINEERING / TAXONOMY 
HIERARCHICAL DATA ENQUIRY 
JJAR&A http://www.jar-a.com 
Design all 
components with 
five...
DATA ENGINEERING / TAXONOMY 
Vital Concept -- Detail 
Computers (and humans) find it easy to add or combine things, 
NOT t...
THE BIGGEST I.T. OPPORTUNITY IN 
HEALTHCARE? 
ICD10 Diagnosis code 
CPT4 Clinical procedure code 
Brief Overview 
Like wat...
15 
CLINICAL DATA ENGINEERING / TAXONOMY 
Cubic Clinical Data Model 
Core clinical data has a location axis -- anatomic si...
CLINICAL DATA ENGINEERING / TAXONOMY 
Conceptual Anatomic Site (Location) Code 
CS.... CIRCULATORY SYSTEM 
DS.... DIGESTIV...
UNLOCKING CLINICAL DATA 
GIVE HEALTH PRACTITIONERS REAL INFORMATION 
THE SOLUTION 
Create a family 
of 
logically discrete...
18 
ACKNOWLEDGEMENTS 
AND DEDICATION 
I would like to acknowledge 
the contributions and inputs of all my 
clients, associ...
19 
UNLOCKING CLINICAL DATA 
GIVE HEALTH PRACTITIONERS REAL INFORMATION 
QUESTIONS ? 
http://www.jar-a.com 
James A Robert...
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060 Why Information Technology In Managed Healthcare Does Not Deliver What Is Expected And How To Fix It -- by Dr James A Robertson PrEng

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Healthcare industry standard codes like ICD 10 and CPT 4 are amongst the worst examples of bad computer data engineering practice in the world today, there is huge scope for improvement in ways that will allow the application of computer based maintenance management techniques to be applied in countries where there is a severe shortage of qualified medical practitioners, the case for investing in such code schemes is present

See also http://www.James-A-Robertson-and-Associates.com/

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060 Why Information Technology In Managed Healthcare Does Not Deliver What Is Expected And How To Fix It -- by Dr James A Robertson PrEng

  1. 1. 1 JAMES A ROBERTSON AND ASSOCIATES EFFECTIVE STRATEGIC BUSINESS SOLUTIONS Why Information Technology Dr James Robertson Chief Executive Officer James A Robertson and Associates JJAR&A (Copyright : JAR&A) http://www.jar-a.com In Managed Healthcare Does Not Deliver What Is Expected And How To Fix It 4th Annual Managed Healthcare Congress MANAGED HEALTHCARE New Approaches To Reducing Costs And Improving Quality
  2. 2. MANAGED HEALTHCARE WHAT IS IT? Is MANAGED HEALTHCARE about cost and quality? OR about HEALTH? Some thoughts about the role that Information Technology SHOULD play, why it does not and what can be done to deliver on the potential JJAR&A http://www.jar-a.com 2
  3. 3. A HUGE OPPORTUNITY STATISTICAL HEALTH MANAGEMENT Human beings are far less diverse than aircraft or factories There is a huge body of statistical process control and maintenance management computerized method that could be profitably used in managing HEALTH -- why is this not happening? JJAR&A http://www.jar-a.com 3
  4. 4. CONTEXT: INFORMATION TECHNOLOGY AN INDUSTRY CHARACTERISED BY FAILURE Seventy percent of I.T. investments fail TOTALLY Another twenty percent fail to fully satisfy the original business requirement "19 out of 20 E.R.P. implementations do not deliver "what was promised" Financial Mail "Most organisations are not making better decisions than they did five years ago." 1. 2. 3. 4. JJAR&A Gartner http://www.jar-a.com 4
  5. 5. I.T. AN INDUSTRY CHARACTERISED BY FAILURE WHY DATA ENGINEERING IS CRITICAL "Attendees of Gartner's Business Intelligence Summit in London last month were not surprised to hear that most enterprises are still failing to use business intelligence (BI) strategically. Gartner's survey of over 1300 CIOs returned some unimpressive findings about the state of BI implementations: Gartner's vice president of research summed up the situation nicely by saying: "Most organisations are not making better decisions than they did five years go." BUSINESS INTELLIGENCE Article published in Computer Business Review Africa May 2005 published by Network Times. JJAR&A http://www.jar-a.com 5
  6. 6. UNLOCKING CORPORATE DATA The role of computers and the role of people Interpret Results COMPUTERS I.T. Take Decision PEOPLE Implement Decision Collect Collate Summarise Synthesize Present JJAR&A 6 http://www.jar-a.com
  7. 7. DATA ENGINEERING The definition of information content in a way that is structurally (taxonomically) fundamentally meaningful to human beings who understand the business and the translation of this content into structured codes which faithfully and accurately reflect human understanding in a way that the computer can manipulate with minimal human intervention I.T. Take Decision Collect Collate Summarise Synthesize Present so that the computer system appears to be intelligent JJAR&A Interpret Results PEOPLE Implement Decision http://www.jar-a.com 7
  8. 8. CAUSES OF INFORMATION TECHNOLOGY INVESTMENT FAILURE Information technology mythology (30%) Lack of executive custody and inappropriate policies (20%) Lack of strategic alignment (15%) Lack of an engineering approach (12%) Poor data engineering (10%) People / soft issues (8%) Technology issues (5%) 1. 2. 3. 4. 5. 6. 7. JJAR&A 8 http://www.jar-a.com
  9. 9. MANAGING I.T. FOR SUCCESS MANAGEMENT COMPONENTS (% FOR SUCCESS) Executive Custody (25%) * * Strategic Solution Architecture (18%) Strategic Alignment (16%) * Outcome Journey Business Integration and Optimization (14%) Project Management (12%) Data Engineering (10%) Technology Components (5%) 1. 2. 3. 4. 5. 6. 7. * First 3 = 59% JJAR&A 9 http://www.jar-a.com
  10. 10. THE BIGGEST I.T. OPPORTUNITY? SOME IMPORTANT PRINCIPLES Computers can only add 0's and 1's People only understand plain language Getting data onto the disc 10011010... Versus getting decision support INFORMATION to management Computers add items easily - detail is no problem Embed the finest level of granularity (greatest detail) available in codes Computers cannot analyse in more detail or structure than is in the data Structured taxonomy MUST be applied when the data is captured OR Must be contained in the software -- huge limitations on this! Maximum use of validation tables in the software JJAR&A 1. 2. 3. 4. 5. 6. http://www.jar-a.com 10
  11. 11. 11 DATA ENGINEERING / TAXONOMY Vital Concept -- Data Hierarchy Presentation and interpretation <5 = too few > 10 = too many 5 TO 10 SLICES OPTIMUM ABSTRACT THINKING / MANAGEMENT The average person can manage 7 plus or minus 2 distinct areas or concepts Design the information structure accordingly at every level JJAR&A http://www.jar-a.com
  12. 12. 12 DATA ENGINEERING / TAXONOMY HIERARCHICAL DATA ENQUIRY JJAR&A http://www.jar-a.com Design all components with five to ten items per level Vital Concept -- Hierarchy
  13. 13. DATA ENGINEERING / TAXONOMY Vital Concept -- Detail Computers (and humans) find it easy to add or combine things, NOT to separate them -- consider wood screws in a hardware store Embed the greatest available level of structured, ordered detail -- may require software modifications -- worth the investment Remember - computers are VERY FAST adding machines BUT they only do what you tell them JJAR&A 13 http://www.jar-a.com
  14. 14. THE BIGGEST I.T. OPPORTUNITY IN HEALTHCARE? ICD10 Diagnosis code CPT4 Clinical procedure code Brief Overview Like water in the petrol tank of a high performance car! Humans are superintelligent compared to computers -- look at the codes the way a dumb computer sees them JJAR&A 1. 2. http://www.jar-a.com 14
  15. 15. 15 CLINICAL DATA ENGINEERING / TAXONOMY Cubic Clinical Data Model Core clinical data has a location axis -- anatomic site AND a "dysfunction" axis, similar to matrices that occur in other data DYSFUNCTION AXIS What Is Clinically Wrong LOCATION AXIS It is very important to rigorously distinguish between the axes -- choice of words is VERY important Body Part or System Being Considered JJAR&A http://www.jar-a.com
  16. 16. CLINICAL DATA ENGINEERING / TAXONOMY Conceptual Anatomic Site (Location) Code CS.... CIRCULATORY SYSTEM DS.... DIGESTIVE SYSTEM EM.... EAR & MASTOID PROCESS ES.... ENDOCRINE SYSTEM EA.... EYE & ADNEXA LS.... LYMPHATIC SYSTEM MS.... MUSCULOSKELETAL SYSTEM MSM... MUSCULO SYSTEM MSS... SKELETAL SYSTEM MSSL.. LOWER LIMB - APPENDICULAR MSSN.. NON - APPENDICULAR MSSU.. UPPER LIMB - APPENDICULAR MSSUAL Arm Lower MSSUAU Arm Upper MSSUHA Hand MSSUWR Wrist ... ZN.... NON-SITE SPECIFIC Cause Severity etc JJAR&A 16 http://www.jar-a.com
  17. 17. UNLOCKING CLINICAL DATA GIVE HEALTH PRACTITIONERS REAL INFORMATION THE SOLUTION Create a family of logically discrete highly structured codes that are simple to understand thereby liberating the huge processing power of computers in support of HEALTH JJAR&A 17 http://www.jar-a.com
  18. 18. 18 ACKNOWLEDGEMENTS AND DEDICATION I would like to acknowledge the contributions and inputs of all my clients, associates, staff and family without whom the work on which these ideas are based would not have been possible Particularly my father and mother, Angus and Thelma, whose love and support for all my endeavours made it possible for me to gain this knowledge This presentation is dedicated to The Glory of The Eternal Creator who is the source and reason for our existence Psalm 136:5 "To Him who by wisdom made the heavens, for His mercy endures forever;" JJAR&A http://www.jar-a.com
  19. 19. 19 UNLOCKING CLINICAL DATA GIVE HEALTH PRACTITIONERS REAL INFORMATION QUESTIONS ? http://www.jar-a.com James A Robertson & Associates Tel +27-11- 791-2327 / 083-251-6644 P O Box 4206, Randburg, 2125, South Africa

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