Introduction

This anonymous organization located in North America delivers healthcare through almost 500 facilities, including hospitals, clinics, continuing care facilities, mental health facilities and community health sites, while providing a variety of programs and services with a total number of employees well over 100,000 all located in one state/province. This healthcare organization has an annual budget of over US$10 billion, which represents an important portion of the total healthcare spending in this state/province. This state/province spends less then US$4,500 in healthcare per citizen, which has an average life expectancy of over 81.5 years. In perspective, the USA spends in healthcare US$8,617 per American citizen[1], who has an average life expectancy of 79.1 years[2].

This healthcare organization has information technology expenses totaling about US$500 million, or about 4% of its total expenses. The Information Management/Information Technology (IMIT) Strategy puts information at the fingertips of patients, clinicians and researchers to inform and to improve decision-making at all levels of the organization. To execute the IMIT Strategy there are three key themes: Strengthen our Foundation, Optimize Operations, and finally Transform Care.

Rationalizing almost 1,400 applications in 4-6 years

To transform care this healthcare organization has started making investments in anticipation of deploying a Clinical Information System through a 4 to 6-year program. Foundational components include development of wireless technology, consolidated data centers, and modernizing technological infrastructure, applications and end user devices. This 4 to 6-year program consist in 2 years of design and build followed by 2 to 4 years of implementation and training.

Implementing this Clinical Information System builds on investment already made in the consolidation of Corporate Services onto a common ERP management system to manage its finance, supply chain, employees and facilities. The end result will allow this healthcare organization to lower the number of its server-based applications dramatically from the 1,400 currently in operation.

This application rationalization will be a catalyst to first harmonize the clinical practices across different geographical zones as well as business and clinical domains to stop working in silos, second simplify information management and most importantly to increase the patient-facing experience.

The Use of Business Architecture to Facilitate Transformation

Enterprise Architecture was a key aspect of developing the initial value case and throughout the procurement life cycle. The level of detail and completeness has improved at each step along the journey. In the most recent step, enterprise architects at this healthcare organization have expanded the scope of its Business Architecture to understand better each of the 26 clinical and business domains in the following ways:

  • Create a common vocabulary through consistent use of business capabilities to describe the business of healthcare delivery across the organization and;
  • Set the stage for an organization that will need to share a common clinical information system and retire legacy applications that will be replaced.

The approach involved many meetings/interviews among the healthcare organization’s business and clinical stakeholders to build their business architecture model. These facilitated sessions allowed the enterprise architects to document healthcare value chains and/or mission model canvas for each clinical and business domain and develop a common business capability model. The model is divided in 3 tiers (Tier 1: Planning & Strategy/Strategic Direction Setting; Tier 2: Clinical Care/Customer-Facing; and Tier 3: Clinical and Corporate Operations/Supporting). With the Capability Model in place, each application was mapped to confirm which business capabilities the applications enabled and in which locations for applications that only serve a specific geographic area.

Moving forward

The healthcare organization’s enterprise architects will soon be looking to the future to confirm which business and clinical capabilities will be enhanced through their 4 to 6-year program. A gap analysis of this target against the current state assessment will allow the healthcare organization to find redundancies among applications and plan the transition throughout the program lifecycle.

During the design and build phase, this 4 to 6-year program will be split into several parallel initiatives focussed on different aspects of the design and build scope. The Value Chains and/or Mission model Canvas will provide context for the configuration of the system. Use of the capability model will be a basis to understand where capabilities are shared between business areas and across applications for dependency and risk analysis.
As this Clinical Information System gets implemented, the business architecture model will support an understanding of sites and clinical services that will be impacted in each successive wave of deployment. In the wake of the deployment, legacy systems will be retired and clinical outcomes realized that will improve the effectiveness and efficiency of care delivery for all its patients.

Conclusion

The journey has just begun. Since the Clinical Information System value case was initially created and through the final two stages of the program lifecycle, the overall business architecture will be evolved in more detail to inform the continuous improvement that a stable set of commonly instantiated business and clinical capabilities can provide.

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[1] US Health care expenditure per capital of US$8,617 in 2013 as per this Wikipedia table.
[2] US life expectancy of 79.1 years in 2014 according to this Reuters article.