Healthcare Among Thorniest and Yet Most Opportunistic Use Cases for Boundaryless Information Flow Improvement
Healthcare Among Thorniest and Yet Most Opportunistic
Use Cases for Boundaryless Information Flow Improvement
Transcript of a BrieﬁngsDirect podcast on how The Open Group is addressing the information
needs and challenges in the healthcare ecosystem.
Listen to the podcast. Find it on iTunes. Sponsor: The Open Group
Dana Gardner: Hello, and welcome to a special BrieﬁngsDirect panel discussion coming to you
in conjunction with The Open Group Conference on February 3 in San Francisco.
I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator as we
examine how the healthcare industry can beneﬁt from improved and
methodological information ﬂow.
Healthcare, like no other sector of the economy, exempliﬁes the challenges and
the opportunity for improving how the various participants in a complex
ecosystem interact. The Open Group, at its next North American conference, has
made improved information ﬂow across so-called boundaryless organizations the
theme of its gathering of IT leaders, enterprise architects, and standards
developers, and implementers.
Join us now, as we explore what it takes to bring rigorous interactions, process efﬁciency, and
governance to data and workﬂows that must extend across many healthcare participants with
speed and dependability.
Learn how improved cross-organization collaboration plays a huge part in helping to make
healthcare more responsive, effective, safe, and cost-efﬁcient. And also become
acquainted with what The Open Group’s new Healthcare Industry Forum
is doing to improve the situation.
With that, please join me in welcoming our guests. We’re here with Larry Schmidt, the Chief
Technologist at HP for the America’s Health and Life Sciences Industries, as well as the
Chairman of The Open Group Healthcare Industry Forum. Welcome, Larry.
Larry Schmidt: Thank you.
Gardner: We’re also here with Eric Stephens, an Oracle Enterprise Architect. Welcome, Eric.
Eric Stephens: Thank you, Dana.
Gardner: Gentlemen, we have you both here because you are going to be at The Open Group
Conference, coming up very rapidly, early February. in San Francisco. We want to get into this
new Healthcare Forum, but before we get into the particulars of what we can do to help the
healthcare situation, let’s try to deﬁne a little bit better the state of affairs.
So ﬁrst to you, Larry. Why is healthcare such a tough nut to crack when it comes to this
information ﬂow? Is there something unique about healthcare that we don't necessarily ﬁnd in
other vertical industries?
Schmidt: What’s unique about healthcare right now is that in order to answer the question we
have to go back to some of the challenges we’ve seen in healthcare.
We’ve progressed in healthcare from a healthcare delivery model that was more based on acute
care -- that is, I get sick, I go to the doctor -- to more of a managed-care type capability with the
healthcare delivery, where a doctor at times is watching and trying to coach you. Now, we’ve
gotten to where the individual is in charge of their own healthcare.
A lot of fragmentation
With that, the ecosystem around healthcare has not had the opportunity to focus the overall
interactions based on the individual. So we see an awful lot of fragmentation
occurring. There are many great standards across the powers that exist within the
ecosystem, but if you take the individual and place that individual in the center of
this universe, the whole information model changes.
Then, of course, there are other things, such as technology advances, personal
biometric devices, and things like that that come into play and allow us to be
much more effective with information that can be captured for healthcare. As a
result, it’s the change with the focus on the individual that is allowing us the opportunity to
redeﬁne how information should ﬂow across the healthcare ecosystem.
Gardner: So I guess it’s interesting, Larry, that the individual is at the center or hub of this
ongoing moving ecosystem with many spokes, if you will. Is that a characterization, or is there
no hub and that’s perhaps one of the challenges for this?
Schmidt: What you said ﬁrst is a good way to categorize it. The scenario of the individual being
more in charge of their healthcare -- care of their health would be a better way to think of this -is a way to see both improvements in the information ﬂow as well as making improvements in
the overall cost of healthcare going forward.
As I offered earlier, because the ecosystem had pretty much been focused around the doctor's
visit, or the doctor’s work with an individual, as opposed to the individual’s work with the
doctor. We see tremendous opportunity in making advancements in the communications models
that can occur across healthcare.
Gardner: Larry, is this speciﬁc to the United States or North America, is this global in nature, or
is it very much a mixed bag, market to market as to how the challenges have mounted?
Schmidt: I think in any country, across the world, the individual being the focus of the
ecosystem goes across the boundaries of countries. Of course, The Open Group is responsible
and is a worldwide standards body. As a result of that, it's a great match for us to be able to focus
the healthcare ecosystem to the individual and use the capabilities of The Open Group to be able
to make advances in the communication models across all countries around healthcare.
Gardner: I should point out for our audience that the views of our panelists today are theirs
alone and not necessarily those of their employers.
I’d like to go to you now, Eric. Thinking about this from a technological point of view, as an
enterprise architect, we’re now dealing with this hub and spoke with the patient at the middle. A
lot of this does have to do with information, data, and workﬂow, but we’ve dealt with these
things before in many instances in the enterprise and in IT.
Is there anything particular about the technology that is difﬁcult for healthcare, or is this really
more a function of the healthcare verticals and the technology is really ready to step up to the
Stephens: Well, Dana, the technology is there and it is ready to step up to the plate. I’ll start
with transparency of the information. Let’s pick a favorite poster child, Amazon.
In terms of the detail that's available on my account. I can look at past orders. I
can look up and see the cost of services, I can track activity that's taking place,
both from a purchase and a return standpoint. That level of visibility that you’re
alluding to exists. The technology is there, and it’s a matter of applying it.
As to why it's not being applied in a rapid fashion in the healthcare industry, we
could surmise a number of reasons. One of them is potentially around the
cacophony of standards that exist and the lack of a “Rosetta Stone” that links
those standards together to maximum operability.
The other challenge that exists is simply the focus in healthcare around the healthcare technology
that’s being used, the surgical instruments, the diagnostic tools, and such. There is focus and
great innovation there, but when it comes to the plumbing of IT, oftentimes that will suffer.
Gardner: So we have some hurdles on a number of fronts, but not necessarily the technology
itself. This is a perfect case study for this concept of the boundaryless information ﬂow, which is
really the main theme of The Open Group Conference coming up on February 3.
Back to you, Larry, on this boundaryless myth. There are standards in place in other industries
that help foster a supply-chain ecosystem or a community of partners that work together.
Is that what The Open Group is seeking? Are they going to take what they’ve done in other
industries for standardization and apply it to healthcare, or do you perhaps need to start from
scratch? Is this such a unique challenge that you can't simply retroﬁt other standardization
activities? How do you approach something like healthcare from a standards perspective?
Schmidt: The ﬁrst thing we have to do is gain an appreciation for the stakeholders that interact.
We’re using the term “ecosystem” here. I think it's a great term to reﬂect the vast number of
stakeholders that would exist across the healthcare ecosystem. Anywhere from the patient, to the
doctor, to payment organization for paying claims, the life sciences organizations, for
pharmaceuticals, and things like that, there are so many places that stakeholders can interact
So it’s being able to use The Open Group’s assets to ﬁrst understand what the ecosystem can be,
and then secondly, use The Open Group’s capabilities around things like security, TOGAF from
an architecture methodology, enablement and so on. Those assets are things that we can leverage
to allow us to be able to use the tools of The Open Group to make advances within the healthcare
It’s an amazing challenge, but you have to take it one step at a time, and the ﬁrst step is going to
be that deﬁnition of the ecosystem.
Gardner: I suppose there’s no better place to go for teasing out what the issues are and what the
right prioritization should be than to go to the actual participants. The Open Group did just that
last summer in Philadelphia at their earlier North American conference. They had some 60
individuals representing primary stakeholders in healthcare in the same room and they conducted
Larry, maybe you can provide us an overview of what they found and how that’s been a guide to
how to proceed?
Schmidt: What we wanted to do was present the concept of boundaryless information ﬂow
across the healthcare ecosystem. So we surveyed the participants that were part of the conference
itself. One of the questions we asked was about the healthcare quality of data, as well as the
efﬁciency and the effectiveness of data. Speciﬁcally, the polling questions, were designed to
gauge the state of healthcare data quality and effective information ﬂow.
We understood that 86 percent of those participants felt very uncomfortable with the quality of
healthcare information ﬂows, and 91 percent of the participants felt very uncomfortable with the
efﬁciency of healthcare information ﬂows.
In the discussion in Philadelphia, we talked about why information isn’t ﬂowing much more
easily and freely within this ecosystem. We discovered that a lot of the standards that currently
exist within the ecosystem are very much tower-oriented. That is, they only handle a portion of
the ecosystem, and the interoperability across those standards is an area that needs to be focused
But we do think that, because the individual should be placed into the center of the ecosystem,
there's new ground that will come into play. Our Philadelphia participants actually conﬁrmed
that, as we were working through our workshop. That was one of the big, big ﬁndings that we
had in the Philadelphia conference.
Gardner: Just so our audience understands, the resulting work that’s been going on for months
now will culminate with the Healthcare Industry Forum being ofﬁcially announced and open for
business,, beginning with the San Francisco Conference.
Tell us a little about how the mission statement for the Healthcare Industry Forum was
inﬂuenced by your survey. Is there other information, perhaps a white paper or other collateral
out there, that people can look to, to either learn more about this or maybe even take part in it?
Schmidt: We presented ﬁrst a vision statement around boundaryless information ﬂow. I’ll go
ahead and just offer that to the team here. Boundaryless information ﬂow of healthcare data is
enabled throughout a complete healthcare ecosystem to standardization of both vocabulary and
messaging that is understood by all participants within the system. This results in higher quality
outcomes, streamlined business processes, reduction of fraud, and innovation enablement.
When we presented that in the conference, there was big consensus among the participants
around that statement and buy in to the idea that we want that as our vision for a Healthcare
Forum to actually occur.
Since then, of course, we’ve published this white paper that is the ﬁndings of the Philadelphia
Conference. We’re working towards the production of a treatise, which is really the study of the
problem domain that we believe we can be successful in. We also can make a major impact
around this individual communication ﬂow, enabling individuals to be in charge of more of their
Our mission will be to provide the means to enable boundaryless information ﬂow across the
ecosystem. What we’re trying to do is make sure that we work in concert with other standards
bodies to recognize the great work that’s happening around this tower concept that we believe is
a boundary within the ecosystem.
Hopefully, we’ll get to a point where we’re able to collaborate, both with those standards
bodies, as well as work within our own means to come up with additional standards that allows
us to make this communication ﬂow seamless or boundaryless.
Gardner: Eric Stephens, back to you with the enterprise architect questions. Of course, it’s
important to solve the Tower of Babel issues around taxonomy, deﬁnitions, and vocabulary, but I
suppose there is also a methodology issue.
Frameworks have worked quite well in enterprise architecture and in other verticals and in the
IT organizations and enterprises. Is there something from your vantage point as an enterprise
architect that needs to be included in this vision, perhaps looking to the next steps after you’ve
gotten some of the taxonomy and deﬁnitions worked out?
Stephens: Dana, in terms of working through the taxonomies and such, as an enterprise
architect, I view it as part of a larger activity around going through a process, like the TOGAF
methodology, it’s architecture development methodology.
By doing so, using a tailored version of that, we’ll get to that taxonomy deﬁnition and the
alignment of standards and such. But there's also the addressing alignment and business
processes and other application components that comes into play. That’s going to drive us
towards improving the viscosity of the information, that's moving both within an enterprise and
outside of the enterprise.
In the healthcare landscape, and in other industries, there are a lot of players coming to the table
and need to interact, especially if you are talking about a complex episode of care. You may have
two, three, or four different organizations in play. You have labs, the doctors, specialized centers,
and such, and all that requires information ﬂow.
Coming back to the methodology, I think it’s bringing to bear an architecture methodology like
provided in TOGAF. It’s going to aid individuals in getting a broad picture, and also a detailed
picture, of what needs to be done in order to achieve this goal of boundaryless information ﬂow.
Gardner: I suppose, gentlemen, that we should also recognize that we are going about this in the
larger context of change in the IT and business landscapes. We’re seeing many more mobile
devices. We’re probably going to see patients accessing more information that we have been
discussing through some sort of a mobile device, which is good news, because more and more
patients and their providers can access information regardless of where they are. So mobility, I
think, is a fairly important accelerant to some of this.
And, of course, there’s big data, the ability to take reams and reams of information, deal with it
rapidly, analyze it in near real-time and then scale accordingly for cost issues. It’s also another
So let’s just quickly step aside from the forum activities and look at how the larger context of
change is perhaps fortuitously timed for what we we’d like to do in terms of transformation
around healthcare. Let me ﬁrst direct that to you, Larry. How important are things like mobile
and big data in making signiﬁcant progress in the issues facing healthcare?
Schmidt: Well, that’s interesting, because when we ﬁrst stared with mobility devices, I actually
built and think that the mobile devices become, what I will call a personal integration server. It
will help the individual who wants to take charge of their healthcare or care of their health. It will
give them the opportunity to capture information using other devices, such as biometric devices,
blood pressure monitors, and things like that, and have that captured on a mobile device and
placed in a repository someplace to allow either a physician or others, or even that individual, to
look at trending over time.
To me, the mobile device, from a standpoint of being able to gather data, is a great technology
enabler that has come of age. It allows us the opportunity to streamline that information
gathering that is necessary to provide the right diagnoses of working with your health coach or
Of course, that has the possibility, at the individual level, of producing a lot of data, and it could
be massive amount of data, depending on how the data is actually gathered. So big data and
analytics, even at the individual level, being able to decipher or to understand trending and things
that are happening to the individual over time outside of the doctor’s ofﬁce, is something I think
will really enable improvements in healthcare.
All that, of course, is fueled by the “Internet of things” and technology advances such as IPv6 to
allow us to use devices like this across a network and actually keep them identiﬁed. Those two
technologies that we see in IT trends, will be a great help in advancing healthcare and of course
the possibility of it enabling boundaryless information ﬂow.
Gardner: Eric Stephens, do you want to weigh in as well on where these new advances in IT can
play a huge role if those standards and the framework approach methodologies are in play?
Stephens: Larry really hit the points well. I was thinking about the new terminology, the Internet
of things or machine to machine, where mobile devices could end up being the size of a
ﬁngernail at some point.
Do we get to the point where there is real-time monitoring of critical patients, going back
through other mobile devices and into a doctor’s ofﬁce or something, will we have the ability to
do a virtual ofﬁce visit, and how much equipment will you need in a home, for example, to go
through and do routine checkups on children and such?
One of the key success factors that is going to have to be addressed is interoperability. Back
when we were all starting to cut our teeth on the Internet, one of the things that was fascinating
to me is that, you have a handful of standards and all these vendors are conforming to them, such
that you don’t have to think about plugging in a laptop to a network or accessing website. All
that’s driven by standardization.
One of the things that we can do in the Forum is start to drive some of that standardization, so
that we have these devices working together easily, and it provides the necessary medical
professionals the information they need, so they can make more timely decisions. It’s giving the
right information, to the right decision maker, at the right time. That, in turn, drives better health
outcomes, and it's going to, we hope, drive down the overall cost proﬁle of healthcare,
speciﬁcally here in the United States.
Gardner: I should think makes for a high incentive to work on these issues of standardization,
taxonomy, deﬁnitions, and methodologies so that you can take advantage of these great
technologies and the scale and efﬁciency they afford.
Getting back to the conference, I understand that the Healthcare Industry Forum is going to be
announced. There is going to be a charter, a steering committee program, deﬁnitions, and treatise
in the works. So there will be quite a bit kicking off. I would like to hear from you two, Larry
and Eric, what you will speciﬁcally be presenting at the conference in San Francisco in just a
matter of a week or two. Larry, what’s on the agenda for your presentations at the conference?
Schmidt: Actually, Eric and I are doing a joint presentation and we’re going to talk about some
of the challenges that we think we can see is ahead of us as a result of trying to enable our vision
around boundaryless information ﬂow, speciﬁcally around healthcare.
The culture of being able to produce standards in an industry like this is going to be a major
challenge to us. There is a lot of individualization that occurs across this industry. So having
people come together and recognize that there are going to be different views, different points of
views, and coming into more of a consensus on how information should ﬂow, speciﬁcally in
healthcare. Although I think any of the forums go through this cultural change.
We’re going to talk about that at the beginning in the conference as a part of how we’re planning
to address those challenges as part of the Industry Forum itself. Then, other meetings will allow
us to continue with some of the work that we have been doing around a treatise and other actions
that will help us get started down the path of understating the ecosystem and so on.
Those are the things that we’ll be addressing at this speciﬁc conference.
Gardner: Eric, anything to add to that, I didn't realize you are both doing this as a joint
Stephens: Yes, and thanks to Larry for allowing me to participate in it. One of the areas I will be
focusing on, and you alluded to this earlier, Dana, is around the information architecture.
As an enterprise architect, I look at things in terms of the business, the application, information,
technology, and architecture. When we talk about boundaryless information ﬂow, my remarks
and contributions are focused around the information architecture and speciﬁcally around an
ecosystem of an information architecture at a generic level, but also the need and importance of
integration. I will perhaps touch a little bit on the standards to integrate that with Larry’s
Schmidt: Dana, I just wanted to add the other work that we’ll be doing there at the conference.
We’ve invited some of the healthcare organizations in that area of the country, San Francisco and
so on, to come in on Tuesday. We plan to present the ﬁndings of the paper and the work that we
did in the Philadelphia Conference, and get opinions in reﬁning both the observations, as well as
some of the direction that we plan to take with the Healthcare Forum.
Obviously we’ve shared here some of the thoughts of where we believe we’re moving with the
Healthcare Forum, but as the Forum continues to form, some of the direction of it will morph
based on the participants, and based on some of the things that we see happening with the
So, it’s a really exciting time and I’m actually very much looking forward to presenting the
ﬁndings of the Philadelphia Conference, getting, as I said, the next set of feedback, and starting
the discussion as to how we can make change going towards that vision of boundaryless
Gardner: I should also point out that it’s not too late for our listeners and readers to participate
themselves in this conference. If you’re in the San Francisco area, you’re able to get there and
partake, but there are also going to be online activities. There will be some of the presentations
delivered online and there will be Twitter feeds.
So if you can't make it to San Francisco on February 3, be aware that The Open Group
Conference will be available in several different ways online. Then, there will be materials
available after the fact to access on-demand. Of course, if you’re interested in taking more
activity under your wing with the Forum itself, there will be information on The Open Group
website as to how to get involved.
Before we sign off, I want to get a sense of what the stakes are here. It seems to me that if you do
this well and if you do this correctly, you get alignment across these different participants -- the
patient being at the hub of the wheel of the ecosystem. There’s a tremendous opportunity here for
improvement, not only in patient care and outcomes, but costs, efﬁciency, and process
So ﬁrst to you Larry. If we do this right, what can we expect?
Schmidt: There are several things to expect. Number one, I believe that the overall health of the
population will improve, because individuals are more knowledgeable about their individualized
healthcare and doctors have the necessary information, based on observations in place, as
opposed to observations or, again, through discussion and/or interview of the patient.
We’re actually able to see a better proﬁle of what the individual is doing throughout their life and
throughout their days. That can provide doctors the opportunity to make better diagnosis. Better
diagnosis, with better information, as Eric said earlier, the right information, at the right time, to
the right person, gives the whole ecosystem the opportunity to respond more efﬁciently and
effectively, both at the individual level and in the population. That plays well with any healthcare
system around the world. So it’s very exciting times here.
Metrics of success
Gardner: Eric, what’s your perspective on some of the paybacks or metrics of success, when
some of the fruits of the standardization begin to impact the overall healthcare system?
Stephens: At the risk of oversimplifying and repeating some of things that Larry said, it comes
down to cost and outcomes as the two main things. That’s what’s in my mind right now. I look at
these very scary graphs about the cost of healthcare in the United States, and it's hovering in the
17-18 percent of GDP. If I recall correctly, that’s at least ﬁve full percentage points larger than
other economically developed countries in the world.
The trend on individual premiums and such continues to tick upward. Anything we can do to
drive that cost down is going to be very beneﬁcial, and this goes right back to patient centricity.
It goes right back to their pocketbook.
And the outcomes are important as well. There are a myriad of diseases and such that we’re
dealing with in this country. More information and more education is going to help drive a
healthier population, which in turn drives down the cost. The expenditures that are being spent
are around the innovation. You leave room for innovation and you leave room for new advances
in medical technology and such to treat diseases going. So again, it’s back to cost and outcomes.
Gardner: Very good. I’m afraid we will have to leave it there. We’ve been talking with a panel
of experts on how the healthcare industry can beneﬁt from improved and methodological
information ﬂow. And we have seen how the healthcare industry itself is seeking large-scale
transformation and how improved cross-organizational interactions and collaborations seem to
be intrinsic to be able to move forward and capitalize and make that transformation possible.
And lastly, we have learned that The Open Group’s new Healthcare Industry Forum is doing a lot
now and is getting into its full speed to improve the situation.
This special BrieﬁngsDirect discussion comes to you in conjunction with The Open Group
Conference on February 3 in San Francisco. It’s not too late to register at The Open Group
website and you can also follow the proceedings during and after the conference online and via
So a big thank you to our panel, Larry Schmidt, the Chief Technologist at HP for the America’s
Health and Life Sciences Industries, as well as the Chairman of The new Open Group Healthcare
Industry Forum. Thanks so much, Larry.
Schmidt: You bet. Glad to be here.
Gardner: And thank you too to Eric Stephens, an Oracle Enterprise Architect. We appreciate
your time Eric.
Stephens: Thanks for having me, Dana.
Gardner: This is Dana Gardner, Principal Analyst at Interarbor Solutions, your host and
moderator for this look at the healthcare ecosystem process. Thanks for listening, and come back
next time for more BrieﬁngsDirect podcast discussion.
Listen to the podcast. Find it on iTunes. Sponsor: The Open Group
Transcript of a BrieﬁngsDirect podcast on how The Open Group is addressing the information
needs and challenges in the healthcare ecosystem. Copyright The Open Group and Interarbor
Solutions, LLC, 2005-2014. All rights reserved.
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