OpenGroup TweetJam on healthcare-information

How can we improve healthcare-information, and the information-flow around the healthcare context? And what part can enterprise-architecture play in helping that to happen?

The Open Group ran a one-hour ‘TweetJam‘ on this yesterday on Twitter, keyed on the ‘#ogChat‘ hashtag. This time I was able to join in (as ‘@tetradian’): so here’s the cleaned-up Twitterstream, with a few extra comments on my own after each of the six-and-a-bit questions.

(I’ve sorted the tweets into something resembling a more readable order; removed any duplicates; deleted the ‘RT @‘ preceding each Tweet and most ‘#ogChat‘ hashtags, and corrected a few of the more obviously-unintended spelling-errors; but otherwise it’s pretty much exactly as per the original Twitterstream. Copyright etc belongs to the respective participants, of course.)

It might also be useful here to look back at my blog-post ‘Healthcare and information-flow‘, about a previous Open Group discussion on healthcare-information earlier this year, when their healthcare-initiative was just starting to take off.

Anyway, here it is…

• efeatherston: Introduction, Ed Featherston, enterprise architect from @consultcollab
• jim_hietala: I’m Jim Hietala, VP Healthcare and Security for The Open Group
• EricStephens: Intro: @Oracle Business & Enterprise Architect – member of OG healthcare forum  Tweets are my own etc. etc.
• tetradian: Tom Graves, enterprise-architect (and general nuisance?), Tetradian
• EricStephens: @tetradian I suppose if we’re weren’t a nuisance, we wouldn’t be doing our jobs as #entarchs?
• jasonsleephd: Welcome all.  I’m Jason Lee, Director of The Healthcare Forum at The Open Group.
• Dana_Gardner: Now joining The Open Group tweet jam on #Healthcare as principal analyst at Interarbor Solutions. Profile: http://t.co/C2MNJGRR5I
• Technodad: Hello all! I’m Dave Lounsbury, Chief Technical Officer of @theopengroup joining the #ogchat on #healthcare .
• loseby:  Intro: Business Analyst with #BizArch / #EntArch streak, working on gov’t healthcare initiatives. Tweets my own.
• dianedanamac: Hi! Diane MacDonald, Membership Coordinator & Social Media Manager of @theopengroup!  Welcome to the #healthcare TweetJam
• TerryBlevins: Hello! I’m Terry Blevins joining the #ogchat on #healthcare .

• theopengroup: Get ready for question 1, identified by “Q1” …and so on. You may respond with “A1” and so on using #ogChat

• jim_hietala: A1: healthcare is very consumed with must do’s (ICD10 transition, meaningful use)
• tetradian: A1 Huge barriers of language, terminology, mindset, worldview, paradigm, hierarchy, role and much more
• jasonsleephd: A1a:  Barriers:  financial, organizational, structural, lack of enabling technology, cultural, educational, professional insulation
• jim_hietala: A1: EHRs with proprietary interfaces represent a big barrier in healthcare
• Technodad: A1: Isn’t question really what barriers exist for collaboration between providers and patients in healthcare?
• tetradian: .@Technodad communication b/w patients and providers is only one (type) amongst v.many
• Technodad: @tetradian Agree. Debate needs to identify whose point of view the #healthcare problem is addressing.
• Dana_Gardner: A1 Where to begin? A Tower of Babel exists on multiple levels among #healthcare ecosystems. Too complex to fix wholesale.
• EricStephens: A1 – also, legal ramifications of sharing information may impede sharing
• efeatherston: @Technodad Patient needs provider collaboration to see any true benefit (I don’t just go to one provider)
• Dana_Gardner: A1 Improve first by identifying essential collaborative processes that have most impact, and then enable them as secure services.
• Technodad: A1: In US at least, solutions will need to be patient-centric to span providers- Bring Your Own Wellness (BYOW™) for HC info.
• efeatherston: And perception of that slows adoption yes RT @EricStephens A1 – also, legal ramifications of sharing information may impede sharing
• loseby: A1: Lack of shared capabilities & interfaces between EHRs leads to providers w/o comprehensive view of patient /cc @jim_hietala
• EricStephens: A1b – Are incentives aligned sufficiently to encourage collaboration? + lack of technology integration.
• tetradian: A1: vast numbers of stakeholder-groups, many beyond medicine – e.g. pharma, university, politics, local care (esp. outside of US)
• jim_hietala: A1: gap = patient-centric information flow???
• Technodad: . @efeatherston I think patents will need to drive the collaboration – they have more incentive to manage info than providers.
• efeatherston: @tetradian Agreed, stakholder list could be huge
• Technodad: . @efeatherston I think patents will need to drive the collaboration – they have more incentive to manage info than providers.
• EricStephens: @Technodad @efeatherston high-deductible plans will drive patients (us) to own our health care experience better
• Dana_Gardner: A1 Take patient-centric approach to making #healthcare processes better: drives adoption, which drives productivity, more adoption
• jasonsleephd: .@Dana_Gardner Great point.  Who thinks standards development and data sharing is an essential collaboration tool?
• tetradian: .@Technodad not always patient-centric – eg. epidemiology /public-health is population-centric  – i.e. _everything_ is ‘the centre’
• jasonsleephd: A1b:  How We Improve:  create financial incentives to collaborate (e.g., ACOs)
• efeatherston: @EricStephens  @Technodad Agreed, the challenge is to get them to challenge (if that makes sense). Many do not question
• EricStephens: @efeatherston  @Technodad some will deify those in a lab coat.
• efeatherston: Still do, especially older generations, cultural RT @EricStephens @efeatherston  @Technodad some will deify those in a lab coat.
• Technodad: . @EricStephens @efeatherston Agree – also displaying, fusing data from different providers, labs, monitors etc.
• dianedanamac: Online collaboration, can be cost effective & Promote better quality but must financially incented
• efeatherston: @dianedanamac Good point, unless there is a benefit/incentive for provider, they may not be bothered to try
• tetradian: @dianedanamac “must financially incented” – often other incentives work better – money can be a distraction – also who pays?

No big disagreements from me about any of that, though I do worry that there seems to be rather too much of the over-simplistic point-to-point thinking that we see all too often in IT-type contexts – here seen mainly as an assumption that things somehow ought to be ‘patient-centric’. I did like Dave Lounsbury (@Technodad)’s comment that “Debate needs to identify whose point of view the #healthcare problem is addressing” – that’s a really important point that too often seems a bit too easily glossed-over here.

Q2: Does implementing remote patient telemonitoring and online collaboration drive better and more cost-effective patient care?

• EricStephens: A2 – “hell yes” comes to mind. why drag yourself into a dr. office when a device can send the information (w/ video)
• efeatherston: @EricStephens @Technodad Will it? Will those with high deductible plans have ability/understanding/influence to push for it?
• EricStephens: A2 – driving up participation could drive up efficacy
• jim_hietala: A2:  Big opportunities to improve patient care thru remote tele monitoring
• jasonsleephd: A2:  Telemonitoring:  Tele-ICUs can keep patients (and money) in remote settings while receiving quality care
• jasonsleephd: A2:  Telemonitoring: Remote monitoring of patients admitted with CHF can reduce rehospitalization w/i 6 months @connectedhealth.org
• Dana_Gardner: A2 Yes! Pacemakers now uplink to centralized analysis centers, communicate trends back to attending doctor. Just scratches surface
• efeatherston: @Dana_Gardner Amen. Do that now, monthly uplink, annual check in with doctor to discuss any trends he sees.
• tetradian: A2: assumes telemonitoring options even exist – v.wide range of device-capabilities, from v.high to not-much, and still not common
• tetradian: (general request to remember that there’s more to the world, and medicine, than just the US and its somewhat idiosyncratic systems?)
• efeatherston: @tetradian yes, i do find myself looking through the lens of my own experiences, forgetting the way we do things may not translate
• jasonsleephd: .@tetradian Amen to our idiosyncrasies!  Still, we have to live with them, and we can do so much better with good information flow!
• Dana_Gardner: A2 Governments should remove barriers so more remote patient telemonitoring occurs. Need to address the malpractice risks issue.
• TerryBlevins: A2: Absolutely. Just want the information to go to the right place!   #ogchat on #healthcare.
• Technodad: . @TerryBlevins Isn’t “right place” someplace you & all your providers can access? Need interoperability!
• TerryBlevins: @Technodad It requires interoperability yes – the info must flow to those that must know.
• Technodad: A2: Many areas where continuous monitoring can help. Improved IoT sensors e.g. cardio, blood chem coming. http://t.co/M3xw3tNvv3
• tetradian: A2: ethical/privacy concerns re how/with-whom that data is shared – e.g. with pharma, research, epidemiology etc
• efeatherston: @tetradian add employers to that etc. list of how/who/what is shared

Again, no huge disagreements from me, though I worry (again) that it’s (again) way too narrow, and probably too US-centric, too, in its assumptions about always-on availability of high-bandwidth networks and the like. And whilst it’s easy enough to say – as Dana Gardner does above – that “Governments should remove barriers so more remote patient telemonitoring occurs”, the real barriers there relate to the shambolic ‘rights’-based mess that is the US legal system and the huge vested-interests that fight full-on against any moves towards a more sane or viable health-system. That’s way beyond the scope or scale that Open Group would be able to resolve: instead, the focus needs to be more realist-oriented, working both within the constraints of the mess, yet also developing shared-data-structures and suchlike that can quietly sidestep at least some of it. And that’ll require a lot more clarity and realism than leaping after every possible shiny new technological toy such as telemonitoring. So whilst, yes, there is definite value in exploring all of these new avenues, we also need to keep realism and realpolitik in place whilst we do so, otherwise – for most people, anyway – it will remain stranded at the ‘shiny toy’ level, possibly forever.

Q3: Can a #mobile strategy improve #patientexperience, empowerment and satisfaction? If so, how? #mhealth #oghealthIT

• jim_hietala: A3: mobile is a key area where patient health information can be developed/captured
• EricStephens: A3 – example: link blood sugar monitor to iPhone to MyFitnessPal + gamification to drive adherence (and drive $$ down?)
• efeatherston: A3: Mobile along with #InternetOfThings, wearables linked to mobile. Contact lens measuring blood sugar in recent article as ex.
• TerryBlevins: @theopengroup A3: sick people, or people getting sick are on the move. In a patient centric world we must match need.
• EricStephens: A3 – mobile becomes a great data acquisition point. Something as simple as SMS can drive adherence with complication drug treatments
• jasonsleephd: A3: mHealth is a v imp area for innovation, better collaboration, $ reduction & quality improv.  See Webby Awards & handheld devices
• tetradian: A3: #mobile can help – e.g. use of SMS for medicine in Africa etc
• Technodad: A3: Mobile isn’t option any more. Retail, prescription IoT, mobile network & computing make this a must-have.  http://t.co/b5atiprIU9
• dianedanamac: A3 @Technodad Providers need to be able to receive the information #Mhealth
• Dana_Gardner: A3 #healthcare should go location-independent. Patient is anywhere, therefore so is care, data, access. More than #mobile, IMHO.
• Technodad: . @Dana_Gardner Technology and mobile demand will outrun regional provider systems, payers, regulation
• Dana_Gardner: @Technodad As so why do they need to be regional? Cloud can enable supply-demand optimization regardless of location for much.
• TerryBlevins: @Dana_Gardner And the care givers are also on the move!
• Dana_Gardner: @Technodad Also, more machine-driven care, i.e. IBM Watson, for managing the routing and prioritization. Helps mitigate overload.
• Technodad: . @Dana_Gardner Agree – more on that later!
• Technodad: . @Dana_Gardner Regional providers are the reality in the US. Would love to have more national/global coverage.
• Dana_Gardner: @Technodad Yes, let the market work its magic by making it a larger market, when information is the key.
• tetradian: .@Dana_Gardner “let the market do its work” – ‘the market’ is probably the quickest way to destroy trust! – not a good idea…
• Technodad: . @tetradian To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• tetradian: A3: “Regional providers are the reality in the US.” – people move around: get info follow them is _hard_ (1st-hand exp. there…)
• tetradian: A3: danger of hype/fear-driven apps – may need regulation, or at least regulatory monitoring
• jasonsleephd: .@tetradian  Regulators, as in FDA or something similar?
• tetradian: .@jasonsleephd “Regulators as in FDA” etc – at least oversight of that kind, yes (cf. vitamins, supplements, health-advice services)
• jim_hietala: A3: mobile, consumer health device innovation moving much faster than IT ability to absorb
• tetradian: A3: also beware of IT-centrism and culture – my 90yr-old mother has a cell-phone, but has almost no idea how to use it!
• Dana_Gardner: A3 Information and rely of next steps (in prevention or acute care) are key, and can be #mobile. Bring care to the patient ASAP.

Same as for #2, really. All good points in their own way, yet way too much of what we see described here requires massive bandwidth, seriously-expensive technology, and data-structures and protocols that don’t as yet exist. In the meantime, Africa and India are doing some very good work with simple SMS messaging, and with home-grown medical-tech that’s a fifth the cost of US or European kit, that can work with intermittent (if any) power-supplies and intermittent (if any) network-connections, and can survive being carried on (and dropped from) the back of a donkey over miles of dirt-tracks. A lot of really valuable lessons there that simply aren’t even being noticed yet back in the self-styled ‘developed’ world.

The other theme that I’m not seeing here is some kind of solid grasp of what mobility actually means, in terms of medical practice. It’s less about ‘fun-toys’ apps for smartphones and the other kind of tablets, and much more about how people move from place to place – not just within a city, but across a whole country, a whole planet. Even way back when my parents were both practicing family-doctors, records-management for fast-changing populations was already a serious nightmare: it’s no better now. And there are many major concerns – particularly epidemiology for serious infectious-diseases – that reach far beyond the individual, and far beyond any single town, city, region or country. As with the responses to the previous question, we really need to get some clarity on the scope and scale and context at big-picture before rushing off down into the ever-popular quick-profit-solutioneering path – otherwise we’ll merely make things even worse than they already are.

Q4: Does better information flow and availability in healthcare reduce operation cost, and free up resources for more patient care?

• tetradian: A4: should do, but it’s _way_ more complex than most IT-folks seem to expect or understand (e.g. repeated health-IT fails in UK)
• jim_hietala: A4: removing barriers to health info flow may reduce costs, but for me it’s mostly about oppty to improve patient care
• jasonsleephd: A4:  Absolutely.  Consider claims processing alone.  Admin costs in private health ins. are 20% or more.  In Medicare less than 2%.
• loseby: A4: Absolutely! ACO model is proving it. Better information flow and availability also significantly reduces hospital admissions
• dianedanamac: A4 I love it when the MD can access my x-rays and lab results so we have more time.
• efeatherston: Ditto RT @dianedanamac A4 I love it when the MD can access my x-rays and lab results so we have more time.
• EricStephens: A4 More info flow + availability -> less admin staff -> more med staff.
• EricStephens: A4 – Get the right info to the ER Dr. can save a life by avoiding contraindicated medicines
• jasonsleephd: .@EricStephens GO CPOE!!
• TerryBlevins: A4: @theopengroup. believe so, but ask the providers. My doctor is more focused on patient by using simple tech to improve info flo
• tetradian: A4: don’t forget link b/w information-flows and trust – if trust fails, so does the information-flow – worse than where we started!
• jasonsleephd: .@tetradian  Yes!  Trust is really key to this conversation!
• EricStephens: A4 – processing a claim, in most cases, should be no more difficult than an expense report or online order. Real-time adjudication
• TerryBlevins: A4: @EricStephens Great point.
• efeatherston: @EricStephens Agreed should be, would love to see it happen. Trust in the data as mentioned earlier is key (and the process)
• tetradian: A4: sharing b/w patient and MD is core, yes, but who else needs to access that data – or _not_ see it? #privacy
• TerryBlevins: A4: @theopengroup can’t forget that if info doesn’t flo sometimes the consequences are fatal, so unblocked the flow.
• tetradian: .@TerryBlevins A4: “if info doesn’t flo sometimes the consequences are fatal,” – v.important!
• Technodad: . @tetradian To me, problem is coordinating among multi providers, labs etc. My health info seems to move at glacial pace then.
• TerryBlevins: A4: @Technodad @tetradian I have heard that a patient moving on a gurney moves faster than the info in a hospital.
• Dana_Gardner: A4 Better info flow in #healthcare like web access has helped. Now needs to go further to be interactive, responsive, predictive.
• jim_hietala: A4: how about pricing info flow in healthcare, which is almost totally lacking
• Dana_Gardner: A4 #BigData, #cloud, machine learning can make 1st points of #healthcare contact a tech interface. Not sci-fi, but not here either.

Short answer: yes. The catch is how to support making it happen…

That thread of US-centrism is a bit too evident here, too: the US is perhaps the only country in the world to have such a dysfunctional profit-driven ‘health-system’, centred more around the billing-systems than patient-outcomes – and we really need to think broader than that if we’re working on standards that, by definition, need to be usable across the entire globe.

And whilst money-issues do get perhaps too much of a mention above, several other much-more-fundamental themes barely get any attention at all: privacy, for example, or trust. We need to start there, first, exactly in parallel with the information-flows and the like – otherwise, in practice, this whole thing will grind to a halt barely before it’s even got started.

Q5: Do you think payers and providers are placing enough focus on using technology to positively impact patient satisfaction?

• Technodad: A5: I think there are positive signs but good architecture is lacking. Current course will end w/ provider information stovepipes.
• TerryBlevins: A5: @theopengroup Providers are doing more. I think much more is needed for payers – they actually may be worse.
• theopengroup: @TerryBlevins Interesting – where do you see opportunities for improvements with payers?
• TerryBlevins: A5: @theopengroup like was said below claims processing – an onerous job for providers and patients – mostly info issue.
• tetradian: A5: “enough focus on using tech”? – no, not yet – but probably won’t until tech folks properly face the non-tech issues…
• EricStephens: A5 No. I’m not sure patient satisfaction (customer experience/CX?) is even a factor sometimes. Patients not treated like customers
• dianedanamac: .@EricStephens SO TRUE!  Patients not treated like customers
• Technodad: . @EricStephens Amen to that. Stovepipe data in provider systems is barrier to understanding my health & therefore satisfaction.
• dianedanamac: “@mclark497: @EricStephens issue is the customer is treat as only 1 dimension. There is also the family experience to consider too
• tetradian: .@EricStephens A5: “Patients not treated like customers” – who _is_ ‘the customer’? – that’s a really tricky question…
• efeatherston: @tetradian @EricStephens Trickiest question. to the provider is the patient or the payer the customer?
• tetradian: .@efeatherston “patient or payer” – yeah, though it gets _way_ more complex than that once we explore real stakeholder-relations
• efeatherston: @tetradian So true.
• jasonsleephd: .@tetradian @efeatherston Very true.  There are so many diff stakeholders.  But to align payers and pts would be huge
• efeatherston: @jasonsleephd @tetradian re: aligning payers and patients, agree, it would be huge and a good thing
• jasonsleephd: .@efeatherston @tetradian @EricStephens Ideally, there should be no dividing line between the payer and the patient!
• efeatherston: @jasonsleephd  @tetradian @EricStephens Ideally I agree, and long for that ideal world.
• EricStephens: .@jasonsleephd @efeatherston @tetradian the payer s/b a financial proxy for the patient.  and nothing more
• TerryBlevins: @EricStephens @jasonsleephd @efeatherston @tetradian … got a LOL out of me.
• Technodad: . @tetradian @EricStephens That’s a case of distorted marketplace. #Healthcare architecture must cut through to patient.
• tetradian: .@Technodad “That’s a case of distorted marketplace.” – yep. now add in the politics of consultants and their hierarchies, etc? 😐
• TerryBlevins: A5: @efeatherston @tetradian @EricStephens in patient cetric world it is the patient and or their proxy.
• jasonsleephd: A5: Not enough emphasis on how proven technologies and architectural structures in other industries can benefit healthcare
• jim_hietala: A5: distinct tension in healthcare between patient-focus and meeting mandates (a US issue)
• tetradian: .@jim_hietala A5: “meeting mandates (a US issue)” – UK NHS (national-health-service) may be even worse than US – a mess of ‘targets’
• EricStephens: A5 @jim_hietala …and avoiding lawsuits
• tetradian: A5: most IT-type tech still not well-suited to the level of mass-uniqueness inherent in the healthcare context
• Dana_Gardner: A5 They are using tech, but patient “satisfaction” not yet a top driver. We have a long ways to go on that. But it can help a ton.
• theopengroup: @Dana_Gardner Agree, there’s a long way to go. What would you say is the starting point for providers to tie the two together?
• Dana_Gardner: @theopengroup An incentive other than to avoid lawsuits. A transparent care ratings capability. Outcomes focus based on total health
• Technodad: A5: I’d be satisfied just to not have to enter my patient info & hstory on a clipboard in every different provider I go to!
• dianedanamac: A5 @tetradian  Better data sharing & Collab. less redundancy, lower cost, more focus on patient needs -all possible w/ technology
• Technodad: A5: The patient/payer discussion is a red herring. If the patient weren’t there, rest of the system would be unnecessary.
• jim_hietala: RT @Technodad: The patient/payer discussion is a red herring. If the patient weren’t there, rest of system unnecessary.  AMEN

Oh dear: the habitual recourse to the usual ‘the technology is the centre of everything!’ assertions… (Okay, it’s a bit better than that, but not much – not enough for my taste, anyway.)

What does come out in people’s responses here – and really for the first time in the TweetJam – is that this is actually about people. Part of the reason, I suspect, is that just about everyone here has some fairly solid first-hand experience of how much the existing information-and-much-more-systems don’t work – one of the few areas where IT-folks recognise from their own perspective that technology alone is not ‘the answer’. I just wish they’d acknowledge that the same also applies in just about every other context too, that’s all…

Perhaps unsurprisingly, that first-hand experience tends to lead on into somewhat of a ‘patient-centric’ (because actually self-centric) view of the whole information-and-more-system. The reality is that there are many, many, many actors and stakeholders in any health-context – and the nominal patient, whilst obviously ‘the centre’ in one sense, at any one given moment, is merely one amongst all of those players. There’s a real need to get a much more solid grasp of the sheer complexity of the healthcare context – all of the stakeholders and their interactions and interrelationships, for starters, though there’s much, much more – before rushing off into assumptions about the information-needs in that context.

Q6: As some have pointed out, many of the EHR systems are highly proprietary, how can standards deliver benefits in healthcare?

• jim_hietala: A6: Standards will help by lowering the barriers to capturing data, esp. for mhealth, and getting it to point of care
• tetradian: .@jim_hietala “esp. for mhealth” – focus on mhealth may be a way to break the proprietary logjam, ‘cos it ain’t proprietary yet
• TerryBlevins: A6: @theopengroup So now I deal with at least 3 different EHR systems. All requiring me to be the info steward! Hmmm
• TerryBlevins: A6 @theopengroup following up if they shared data through standards maybe they can synchronize.
• EricStephens: A6 – Standards lead to better interoperability, increased viscosity of information which will lead to lowers costs, better outcomes.
• efeatherston: @EricStephens and greater trust in the info (as was mentioned earlier, trust in the information key to success)
• jasonsleephd: A6:  Standards development will not kill innovation but rather make proprietary systems interoperable
• Technodad: A6: Metcalfe’s law rules! HC’s many providers-many patients structure means interop systems will be > cost effective in long run.
• tetradian: A6: the politics of this are _huge_, likewise the complexities – if we don’t face those issues right up-front, this is going nowhere

To me, this is where Open Group has an obvious place and a much-needed role, because it’s more than just an IT-standards body. The Open Group membership are mostly IT-type organisations, yes, which tends to guide towards IT-standards, and that’s unquestionably of importance here. Yet perhaps the real role for Open Group as an organisation is in its capabilities and experience in building consortia across whole industries: EMMMV and FACE are two that come immediately to mind. Given the maze of stakeholders and the minefields of vested-interests across the health-context, those consortia-building skills and experience are perhaps what’s most needed here.

Q6.1: Now that the cloud has matured, can we leverage its on demand usage and lower cost of capital to improve quality & efficiency?

• jasonsleephd: A6.1 Sure, yes, but this is not the biggest barrier we face now!  Baby steps first
• tetradian: Q6.1 beware of ‘solutioneering’!!! – cloud is merely a technology, get more clarity on the _real_ questions first!!!
• jasonsleephd: .@tetradian  AGREE!
• tetradian: A6.1 (I’m not knocking cloud, I’m just saying we need to beware of our own hype – _especially_ in high-politics context like health )
• TerryBlevins: A6.1 @theopengroup perhaps, but let’s not treat cloud as the new savior, clouds can be non-interoperable.
• Technodad: . @TerryBlevins @theopengroup Exactly – real focus need to be on data gathering & exchange – underlying tech is secondary.
• Technodad: A6.1: Cloud v own infrastructure really an internal decision for service provider. Scale, privacy, security > capex/opex decision.
• TerryBlevins: A6.1 @theopengroup but yes from a platform point of view there are efficiencies that could be exploited.
• efeatherston: A6: Cloud just a way to the destination, all the challenges discussed can be done with or without cloud, and are much harder

Oh no, not again: technology-centrism rears its mindless head… Why oh why oh why???

The one really good thing here is that not a single person above allowed themselves to get hooked up on the usual hype-laden sales-pitch for cloud. Instead, as can be seen above, there’s a full recognition that implementation-type concerns such as cloud come much later down the track: Jason Lee probably summarised it best in that first response, “Sure, yes, but this is not the biggest barrier we face now! Baby steps first”. Yet we really need to to give that kind of response not just here, but everywhere and everywhen that that dreaded dragon (or donkey?) of IT-centrism turns up.

A question of context

Finally, at some point during the TweetJam I threw in a question of my own:

• tetradian: (a general question: how many folks here regularly read the BMJ [BritMedicalJournal] or any national equiv.? – am I the only one?)
• jasonsleephd: .@tetradian No more than clinical articles in JAMA or NEJM!
• tetradian: .@jasonsleephd really glad to hear _someone_ else does read those journals – o/wise real risk of useless ‘solutions’…
• EricStephens: @tetradian I don’t. probably a good idea tho if we are going to posit ideas

Jason Lee is one of Open Group’s leads on healthcare-information, so it’s good to see that he is familiar with everyday practice in that context (JAMA is, I presume, Journal of the American Medical Association, and NEJM the New England Journal of Medicine). It would by somewhat worrying – to say the least – if Open Group members are rushing off to build information-systems and standards for a context for which they had little to no on-the-ground knowledge: they certainly wouldn’t do the same in, say, banking, or insurance.

Eric Stephens is right to say “probably a good idea tho if we are going to posit ideas” – because to be blunt, I don’t think we’re going to be able to get anywhere useful without it. Fair enough, I’m perhaps a bit unusual amongst enterprise-architects in being a regular reader of the BMJ: in part it’s because it happens to be lying around the house here anyway, given my parents’ medical-background. To me, though, one of the great things about the BMJ is that it’s much more than just a clinical journal: there are lot of peer-reviewed opinion-pieces that give a real sense of what it’s like to be dealing every day with the real-world chaos of that context, amidst all the pressures from information-systems that are still a long way from fully fit-for-purpose, and idiotic politicians and bean-counters who simply haven’t a clue what goes on in ‘their’ domains. If you don’t have access to the BMJ or its various equivalents elsewhere, one good place to start would be to read just about anything by Atul Gawande: he’s a surgeon and staff-writer for the New Yorker whose writings bring the everyday realities of medical practice brilliantly to life.

Best stop there – but hope it’s been useful, anyway.