Consider “Nirvana Health System” (fictionalized) a nearly
1000 bed system in the City of Nirvana that has 7000 employees, 7 hospitals,
200+ doctors on staff, with another 800 or so who independently perform services
in the area. Historically they have done what all Hospitals do, that is,
they have purchased commercial off the shelf (COTS) systems to run their
business, manage patient care, and even market their services on-line. This
approach largely met their needs for years, but now after a series of
acquisitions, recent and looming changes to their reimbursement model, and myriad
technology challenges that result from the shift from “Hospital” to Health
System” they are now at a cross-roads. These
systems may have performed fairly well independently, but they were never designed
or intended to function as one, the vendors who supplied them have run out of
answers, and Nirvana is suffering the consequences.
Nirvana has successfully standardized on Epic, one of the
tier one vendors, as the primary electronic medical records (EMR) vendor at the
main hospital, but they desire a single view across the entire patient
experience. Patients in Nirvana receive services without consideration for
Nirvana Health’s desire for a comprehensive patient record. Most will likely
receive some health services beyond the reach of the EPIC, often simply by receiving
care at a nearby doctor’s office not using Epic. So why don’t they just demand
that EPIC integrate with other EMR systems? No doubt Nirvana and countless
others have. But for EPIC to do so is counter to EPIC’s commercial interest. To
do so effectively makes the patient record portable, and by extension the EMR
system as well. Machiavellian principles of self-interest have proven
themselves out in healthcare information technology (HIT). The only way out for
today’s Health Care Systems is to for them to wean themselves from reliance on any one software vendor for any
critically required systems.
One way we recommend that Nirvana and others who face
similar challenges introduce effective portability and reduce vendor lock-in is
through adoption of standards across an array of disciplines, one specific
recommendation would likely be for them to adopt a Service Oriented
Architecture (SOA) yet SOA is largely a foreign concept to them, not to mention
the notion of web services (WS) and enterprise services buses (ESB). SOA is not
a product, but a philosophy. As described in OASIS SOA Reference Model’s
definition, SOA is a model for “organizing and utilizing distributed
capabilities”, and especially “capabilities that may be under the control of
different ownership domains”. Nirvana will likely never fully control all the
patient access points, certainly not soon enough to reach their stated
timelines, and the SOA approach places a layer between the applications they
rely on and the user experience they desire.
Success with a SOA initiative will require strong support by
executive leadership at Nirvana, but will put in place the foundation upon
which Nirvana and others like them will be able to address the requirements of
today and the unforeseen challenges of tomorrow. When Nirvana and others like them realize the
cure they seek does not come from a pill they can buy, but rather from a new
approach that removes their reliance on any vendor, they will prevail, and
perhaps we will have yet another new customer.
