Tuesday, July 1, 2008

More on SOA in Healthcare

A reader commented: "In a future post, could you consider reflecting upon your reasoning for a "buy and develop" approach, the principles you use to govern this, and how you keep the vendor software/services/APIs and your own in-sync? Also, do you see this as a fundamental shift for all health care organizations, or only the largest?"

Differentiating Through "Buy and Develop": Although the key differentiators between organizations will always boil down to people and culture, it's fairly clear that information technology in the hands of great cultures can change the world. The effective use of IT is clearly an opportunity for all companies to differentiate themselves. Health care is nearly a green field IT environment in this regard, but if you imagine a future world in which we all deploy the same commercial-off-the-shelf (COTS) products, e.g., Epic, in more or less the same fashion, there is very little room to allow for the differentiating power of IT to blossom. Instead, the COTS investment becomes a utilitarian asset, not a discriminating advantage. The customers must do something "differentiating" with these COTS products, and vendors must allow for that by offering an open, standards-based SOA API in such a manner which allows Northwestern to differentiate itself from Loyola and Loyola from the University of Chicago, etc.

Balancing Development and COTS: Health care leaders such as Intermountain, Duke, Vanderbilt, Indiana Regenstrief, Partners, Columbia Presbyterian, et al saw the differentiating power of IT many years ago, and only in the past eight years or so have we seen COTS products which were capable of competing with the home grown systems of these leaders. Obviously, we can't and shouldn't all build our own version of HELP or TMR, but we also can't fall to the other extreme of buying a vanilla COTS product and expect doing so to differentiate us for very long as "leaders." A "buy and maintain" strategy around COTS products will not be enough to differentiate health care organizations of the future.

SOA Caution: The principles for governing and building SOA extensions to COTS products is worthy of a day-long discussion. Suffice to say for this blog that you must exercise caution in design so that your services don't dip too deeply with hooks into the proprietary dependencies of the COTS' product layers, thus creating problems for future upgrades, compatibility, and configuration management. Think of the "Services" in SOA as circles who interact at their tangents, but do not overlap.

Small Organizations: Differentiation between leaders and followers doesn't recognize boundaries around organizational size. Even if you are a small health care organization, yet you strive to be a leader within your realm, buying and maintaining COTS products will probably not be enough to achieve leadership-- unless, of course, the simple act of investing in a COTS product is enough to differentiate you, while your competitors are still wading in paper or constrained by minimalist legacy systems. I see ample of that scenario unfolding in the territory of private physician offices.

Repackaging Data: In addition to the differentiating power of SOA extensions, health care organizations of the future will distinguish themselves through the creative and powerful use of data-- i.e., in the traditional sense of reporting, analytics, and metrics-based decision making, and also through the secondary use of their data to support new perspectives on real-time workflow processes. They will extract their production systems' data, repackage it, mash it with other data, and present it back to the front line workflow, but not as a report or a metric-- but as a new perspective on transaction data.

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