Mature Market Experts Gem of The Day: Healthcare Delivery is a Systems Integration Challenge

Mature Market Experts: more mature market news and stats more often – Healthcare Delivery is a Systems Intergration Challenge – There’s an old saying: if you want a new idea, read an old book. There’s another saying: those who do not learn from history are doomed to repeat it. Keep these two thoughts in mind as you proceed through this piece.

The healthcare “system” is really a system of systems. Enterprise health information systems (eHIS) are but one component of this system of systems. The integrated whole of the healthcare environment involves the technology, the people providing the care, the people managing the enterprise, the payers, and the workflow peculiarities of the environment in general.

Herein lies the old book. Those working in the aerospace industry are, perhaps, those most familiar with the system of systems integration concept. Systems integration has been a discipline employed by those working in the aerospace and defense fields. In these fields, large-scale systems need to be combined, coexist, and cooperate harmoniously within a larger context or framework. These frameworks, sometimes referred to as system-of-systems (SoS) architecture, are typically used to achieve component and interface commonality to promote reuse across separate and potentially disparate subsystems and components. The Department of Defense (DoD) published a framework [1] for establishing a coordinated approach for Command, Control, Communications, Computers, Intelligence, Surveillance, and Reconnaissance (C4ISR), whose principal objective was to ensure that architectures created and systems developed by various branches of the DoD would be synergistic and standardized across operational, technical, and organizational boundaries. Chen & Clothier [2] discussed the maintenance of sustainable and controlled SoS evolution. However, their application related to the concept of SoS with respect to military applications, as does the C4ISR, being chartered by the DoD.

Attempts to apply the C4ISR framework to commercial industry abound. Systems Engineering processes and Systems Integration as disciplines are being discussed and applied outside of the DoD domain in telecommunications and healthcare, to name two specific instances. However, even in these industries the main focus of SoS has been on the integration of a single product (that is, the product’s architectural components). This is somewhat different from large-scale, multi-system SoS architecture, in which separate stakeholders and developers, quite possibly outside of the integrating organization, must also participate in the overall solution.

So, what are the parallels to healthcare? Healthcare delivery involves wide-ranging, disparate, seemingly autonomous enterprises: hospitals around the country and around the world. Commonality exists in the form of (fairly) consistent clinical training: medical treatment protocols are the same regardless of where you go in the United States. Basic medicine and its teaching are consistent and uniform worldwide. Yet, the infrastructure to support patients and providers in the delivery of that care can vary from hospital to hospital; enterprise to enterprise; region to region; and country to country. For instance, take any emergency department (ED) in the U.S., and you will see basic medicine being practiced consistently (for the most part). But, depending on the sophistication, financial health, population, and training of the providers and supporting staff, the tools with which care is delivered and managed can be quite different. One ED may have a computerized tracking board for managing patients. Another may have a white board and no computers; yet another may record patients on a simple clipboard. The methods of management are different, but the approaches to care are the same. The benefits derived from more efficient management can be astonishing: lower mortality rates, higher throughput, and higher customer satisfaction.

Standardization across the healthcare enterprise is the subject of efforts by many standards and oversight organizations. One example includes the HL7 standard for healthcare data communication and interoperability standards related to medical device integration with electronic health information systems. But, where healthcare could benefit is by recognizing that this truly represents system of systems integration: each separate healthcare enterprise represents a separate system. The ability to communicate, interoperate, and exchange information among these separate enterprises is the subject and the goal of the system of systems: each autonomous enterprise can interact with its sister enterprise.

So, what are the benefits of achieving this result? One that resonates most closely to home is described in the following scenario. Consider falling ill in a foreign city—regardless of whether in country or globally—and being able to go to the local hospital and have all of your medical records displayed in a format consistent with that display in your home town. The benefit to you is any remote or foreign healthcare enterprise can have the complete detailed record of you. This mitigates errors, reduces the time required to provide treatment, and ensures that your entire history is accurately presented to any clinical user to provide the capability to manage your health better.

This is where history can teach us a lesson: those in the aerospace industry have understood this need for decades. However, the pace of progress has been much slower in healthcare than in the aerospace field. Yet, consider the benefits to patient, provider, insurer. Sometimes the cost of proliferating the not-invented-here attitude can have vast implications which complicate basic care. Healthcare would do well to think outside of its own “box” and draw upon the tools and stride the well-worn paths traversed by others in fields remote to medicine.

[1] C4ISR Architecture Framework, Version 2.0: Report of the C4ISR Architecture Working Group (AWG); 18 December 1997.

[2] Pin Chen, Jennie Clothier, “Advancing systems engineering for systems-of-systems challenges,” pp170-183, Systems Engineering Journal, Volume 6, Issue 3.

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