© 2009 vangent proprietary using process and architecture improvement to achieve health...

© 2009 Vangent Proprietary

Using Process and Architecture Improvement to Achieve Health

Transformation

Erik Pupo and Geeta Nayyar

Vangent


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?


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.


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


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


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?


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?


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

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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


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


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?


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”.


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


What does an architecture “look like”?

Example – caBIG NCI Architecture and HITSP Conceptual Design Architecture– It can be complex like these types of architectures


Hopefully an architecture won’t look like this

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Or it may be more simplified like this

Examples – HHS enterprise architecture and CMS CARE System Architecture

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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 time-consuming to compose new applications that can support innovative processes – especially when they span system or organizational boundaries.


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


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

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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


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


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


Why architecture is so valuable in healthcare

Administrative System Inefficiencies

Provider Inefficiency and Errors

Lack of Care Coordination

Unwarranted Use

Preventable Conditions and Avoidable Care

Fraud and Abuse

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Nearly 700 billion in waste annually in the healthcare system

Nearly 40% of that can be derived directly or indirectly from architectural issues


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


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 using process and architecture improvement to achieve health...

Documents

architecture improvement

privacy architecture

role of architecture

importance of architecture

architecture tie

target architecture

use of enterprise architecture

future data architecture