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Where Is Enterprise Architecture In Healthcare?

Implementing healthcare technologies is just the beginning. We need to plan how

they will fit together.
Integration, interoperability, data quality, process automation analytics -- these
ideas are simple to describe but can be quite hard to execute in today's business
environments. The road to building information-driven businesses far from wellpaved.
Yet over the past two decades, enterprise architecture (EA) has gradually
emerged to help institutions in many markets build new operating models and
connect their as-is and to-be business strategies and IT capabilities. Though the
discipline still lacks industrywide consistency, EA advocates in both academia
and industry readily point to successful EA frameworks offering business-IT
governance, standardization, and more sophisticated software and information
So where is it in healthcare?
A Certification Commission for Health Information Technology report on
accountable care never mentions the concept of enterprise architecture. It
generally avoids describing any actual IT framework. And a Patient-Centered
Primary Care Collaborative report (registration required) offers a health IT
shopping list with more than 10 items but overlooks the obvious status quo
challenges: lots of software with very little process and data orchestration.
In fact, virtually all of today's healthcare buzzword initiatives -- population health,
health information exchanges, health analytics, medical neighborhood models,
performance and quality management -- share common capabilities manageable
through EA.
The industry's current preoccupation with electronic medical records (EMRs) is a
necessary precursor to more cost-effective, data-driven healthcare. But
technology veterans know that buying more software and dumping data into
warehouses does nothing to orchestrate sustainable business performance.
Information availability does not equate to usability, and databases filled with
electronic versions of paper document structures do not naturally improve health
outcomes or financial performance.
Delivery innovation initiatives such as Accountable Care Organizations (ACOs) -which numbered more than 400 at last count -- have challenged clinical leaders
to make headway against both real and perceived deficits in internal
infrastructure. Those leaders are turning to a growing market of external service
and technology partners to support their accountable care and patient-centered
medical home (PCMH) programs. These partners offer three things health leaders
desperately need: additional people to get work done, knowledge from other
health institutions, and the promise of usable intelligence that may seem
unattainable. But is it really so unattainable?

Many clinicians rightly point out that the way we provide care under ACOs should
not be all that different from the way we provide all care. Similarly, EA
opportunities transcend the business model du jour. Regardless of where an
institution might be on its transformational journey, there are clear reasons why
EA should be at the top of every health enterprise project portfolio.

Improving performance and health outcomes: The quality of an organization's

process execution and analytical insights is directly dependent on
interoperability, automation, data quality, and timeliness. If you want to build a
performance-oriented health delivery machine, EA provides the engine and fuel.
Controlling costs: EA has a proven track record of helping organizations control
operational expenditures and increase return on assets through reductions in
hardware purchasing, software licensing, staff training, and support costs. EA is
good business regardless of transformational goals.
Protecting profitability: Health organizations are increasingly carrying higher
financial risks. These risks are compounded when spending does not address
sustainable capability creation and instead erodes margins.
Managing security and risk: For all the right reasons, ACOs and PCMHs often
increase the number of people, processes, and systems involved in care delivery.
But complexity is the enemy of security. EA offers a means of controlling risks.
Encouraging better planning: Quality and consistency go hand in hand. In the
face of rising care practice and business model diversity, frontline practitioners
need consistent processes for treating and managing patients. EA provides a
common framework for both defining and operationalizing the to-be state of the
So why isn't EA more prominent in the eyes of health leaders? One reason is the
current preoccupation with operational issues; both people and funding are so
heavily tied to EMRs and quality metrics that organizations are struggling to find
capacity for much else. Another reason is the industry's general preference for
buying as opposed to building (except real estate). Unlike many other
technology-related areas, EA is not a commodity, and it can only be matured
through internal investment. It's also not just a technology issue. Let's be honest
-- EA is not broadly understood yet.
But the question is this: Can health care effectively transform without a stronger
emphasis on enterprise architecture? After all, every organization has an
enterprise architecture. It may not be well designed, well managed,
comprehensive, capable, or cost effective, but it exists.
But that is the point of health transformation, isn't it? If the data journey to
population health management -- including care coordination, health information
exchange, health analytics, and more -- seems arduous, maybe it's time to
consider a different path, even if it's unpaved.

Source :
Recommended by :
Jon Cohn ,CTO , VP IT Architecture

"Jon Cohn Exton PA" "Jon Cohn Exton" "Jon Cohn Evolution"