Welcome!

Microservices Expo Authors: AppDynamics Blog, Robert Reeves, Automic Blog, PagerDuty Blog, Pat Romanski

Related Topics: @BigDataExpo, Java IoT, Microservices Expo, Linux Containers, Containers Expo Blog, @CloudExpo

@BigDataExpo: Article

Healthcare Delivery Requires New Approaches to Dealing with Data

Health data deluge requires secure information flow via standards, says The Open Group’s new healthcare director

An expected deluge of data and information about patients, providers, outcomes, and needed efficiencies is pushing the healthcare industry to rapid change. But more than dealing with just the volume of data is required. Interoperability, security and the ability to adapt rapidly to the lessons in the data are all essential.

The means of enabling Boundaryless Information Flow, Open Platform 3.0 adaptation, and security for the healthcare industry are then, not surprisingly, headline topics for The Open Group’s upcoming event, Enabling Boundaryless Information Flow on July 21 and 22 in Boston.

And Boston is a hotbed of innovation and adaption for how technology, enterprise architecture, and open standards can improve the communication and collaboration among healthcare ecosystem players.

In preparation for the conference, BriefingsDirect had the opportunity to interview Jason Lee, the new Healthcare and Security Forums Director at The Open Group. The discussion is moderated by me, Dana Gardner, Principal Analyst at Interarbor Solutions.

Here are some excerpts:

Gardner: I'm looking forward to the Boston conference next week and want to remind our listeners and readers that it's not too late to sign up to attend. You can learn more at www.opengroup.org.

Let’s start by talking about the relationship between Boundaryless Information Flow, which is a major theme of the conference, and healthcare. Healthcare perhaps is the killer application for Boundaryless Information Flow.

Lee: Interesting, I haven’t heard it referred to that way, but healthcare is 17 percent of the US economy. It's upwards of $3 trillion. The costs of healthcare are a problem, not just in the United States, but all over the world, and there are a great number of inefficiencies in the way we practice healthcare.

Lee

We don’t necessarily intend to be inefficient, but there are so many places and people involved in healthcare, it's very difficult to get them to speak the same language. It's almost as if you're in a large house with lots of different rooms, and  every room you walk into they speak a different language. To get information to flow from one room to the other requires some active efforts, and that’s what we're undertaking here at The Open Group.

Gardner: What is it about the current collaboration approaches that don’t work? Obviously, healthcare has been around for a long time and there have been different players involved. What are the hurdles? What prevents a nice, seamless, easy flow and collaboration in information that creates better outcomes? What’s the holdup?

Many barriers

Lee: There are many ways to answer that question, because there are many barriers. Perhaps the simplest is the transformation of healthcare from a paper-based industry to a digital industry. Everyone has walked into a medical office, looked behind the people at the front desk, and seen file upon file and row upon row of folders, information that’s kept in a written format.

When there's been movement toward digitizing that information, not everyone has used the same system. It's almost like trains running on different gauge track. Obviously if the track going east to west is a different gauge than going north to south, then trains aren’t going to be able to travel on those same tracks. In the same way, healthcare information does not flow easily from one office to another or from one provider to another.

Gardner: So not only do we have disparate strategies for collecting and communicating health data, but we're also seeing much larger amounts of data coming from a variety of new and different places. Some of them now even involve sensors inside of patients themselves or devices that people will wear. So is the data deluge, the volume, also an issue here?

Lee: Certainly. I heard recently that an integrated health plan, which has multiple hospitals involved, contains more elements of data than the Library of Congress. As information is collected at multiple points in time, over a relatively short period of time, you really do have a data deluge. Figuring out how to find your way through all the data and look at the most relevant [information] for the patient is a great challenge.

Gardner: I suppose the bad news is that there is this deluge of data, but it’s also good news, because more data means more opportunity for analysis, a better ability to predict and determine best practices, and also provide overall lower costs with better patient care.

We, like others, put a great deal of effort into describing the problems, but figuring out how to bring IT technologies to bear on business problems.

So it seems like the stakes are rather high here to get this right, to not just crumble under a volume or an avalanche of data, but to master it, because it's perhaps the future. The solution is somewhere in there, too.

Lee: No question about it. At The Open Group, our focus is on solutions. We, like others, put a great deal of effort into describing the problems, but figuring out how to bring IT technologies to bear on business problems, how to encourage different parts of organizations to speak to one another and across organizations to speak the same language, and to operate using common standards and language. That’s really what we're all about.

And it is, in a large sense, part of the process of helping to bring healthcare into the 21st Century. A number of industries are a couple of decades ahead of healthcare in the way they use large datasets -- big data, some people refer to it as. I'm talking about companies like big department stores and large online retailers. They really have stepped up to the plate and are using that deluge of data in ways that are very beneficial to them -- and healthcare can do the same. We're just not quite at the same level of evolution.

Gardner: And to your point, the stakes are so much higher. Retail is, of course, a big deal in the economy, but as you pointed out, healthcare is such a much larger segment. So just making modest improvements in communication, collaboration, or data analysis can reap huge rewards.

Quality side

Lee: Absolutely true. There is the cost side of things, but there is also the quality side. So there are many ways in which healthcare can improve through standardization and coordinated development, using modern technology that cannot just reduce cost, but improve quality at the same time.

Gardner: I'd like to get into a few of the hotter trends. But before we do, it seems that The Open Group has recognized the importance here by devoting the entire second day of their conference in Boston, that will be on July 22, to healthcare.

Maybe you could provide us a brief overview of what participants, and even those who come in online and view recorded sessions of the conference at http://new.livestream.com/opengroup should expect? What’s going to go on July 22?

Lee: We have a packed day. We're very excited to have Dr. Joe Kvedar, a physician at Partners HealthCare and Founding Director of the Center for Connected Health, as our first plenary speaker. The title of his presentation is “Making Health Additive.”

It will become an area where standards development and The Open Group can be very helpful.

Dr. Kvedar is a widely respected expert on mobile health, which is currently the Healthcare Forum’s top work priority.  As mobile medical devices become ever more available and diversified, they will enable consumers to know more about their own health and wellness.

A great deal of data of potentially useful health data will be generated.  How this information can be used -- not just by consumers but also by the healthcare establishment that takes care of them as patients -- will become a question of increasing importance. It will become an area where standards development and The Open Group can be very helpful.

Our second plenary speaker, Proteus Duxbury, Chief Technology Officer at Connect for Health Colorado, will discuss a major feature of the Affordable Care Act — the health insurance exchanges -- which are designed to bring health insurance to tens of millions of people who previous did not have access to it.

He is going to talk about how enterprise architecture -- which is really about getting to solutions by helping the IT folks talk to the business folks and vice versa -- has helped the State of Colorado develop their health insurance exchange.

After the plenaries, we will break up into three tracks, one of which is healthcare-focused. In this track there will be three presentations, all of which discuss how enterprise architecture and the approach to Boundaryless Information Flow can help healthcare and healthcare decision-makers become more effective and efficient.

Care delivery

One presentation will focus on the transformation of care delivery at the Visiting Nurse Service of New York. Another will address stewarding healthcare transformation using enterprise architecture, focusing on one of our platinum members, Oracle, and a company called Intelligent Medical Objects, and how they're working together in a productive way, bringing IT and healthcare decision-making together.

Then, the final presentation in this track will focus on the development of an enterprise architecture-based solution at an insurance company. The payers, or the insurers -- the big companies that are responsible for paying bills and collecting premiums -- have a very important role in the healthcare system that extends beyond administration of benefits. Yet, payers are not always recognized for their key responsibilities and capabilities in the area of clinical improvements and cost improvements.

With the increase in payer data brought on in large part by the adoption of a new coding system -- the ICD-10 -- which will come online this year, there will be a huge amount of additional data, including clinical data, that become available. At The Open Group, we consider payers -- health insurance companies (some of which are integrated with providers) -- as very important stakeholders in the big picture.

In the afternoon, we're going to switch gears a bit and have a speaker talk about the challenges, the barriers, the “pain points” in introducing new technology into the healthcare systems. The focus will return to remote or mobile medical devices and the predictable but challenging barriers to getting newly generated health information to flow to doctors’ offices and into patients records, electronic health records, and hospitals' data-keeping and data-sharing systems.

Payers are not always  recognized for their key responsibilities and capabilities in the area of clinical improvements and cost improvements.

We'll have a panel of experts that responds to these pain points, these challenges, and then we'll draw heavily from the audience, who we believe will be very, very helpful, because they bring a great deal of expertise in guiding us in our work. So we're very much looking forward to the afternoon as well.

Gardner: I'd also like to remind our readers and listeners that they can take part in this by attending the conference, and there is information about that at the opengroup.org website.

It's really interesting. A couple of these different plenaries and discussions in the afternoon come back to this user-generated data. Jason, we really seem to be on the cusp of a whole new level of information that people will be able to develop from themselves through their lifestyle, new devices that are connected.

We hear from folks like Apple, Samsung, Google, and Microsoft. They're all pulling together information and making it easier for people to not only monitor their exercise, but their diet, and maybe even start to use sensors to keep track of blood sugar levels, for example.

In fact, a new Flurry Analytics survey showed 62 percent increase in the use of health and fitness application over the last six months on the popular mobile devices. This compares to a 33 percent increase in other applications in general. So there's an 87 percent faster uptick in the use of health and fitness applications.

Tell me a little bit how you see this factoring in. Is this a mixed blessing? Will so much data generated from people in addition to the electronic medical records, for example, be a bad thing? Is this going to be a garbage in, garbage out, or is this something that could potentially be a game changer in terms of how people react to their own data -- and then bring more data into the interactions they have with healthcare providers?

Challenge to predict

Lee: It's always a challenge to predict what the market is going to do, but I think that’s a remarkable statistic that you cited. My prediction is that the increased volume of person-generated data from mobile health devices is going to be a game changer. This view also reflects how the Healthcare Forum members (which includes members from Capgemini, Philips, IBM, Oracle and HP) view the future.

The commercial demand for mobile medical devices, things that can be worn, embedded, or swallowed, as in pills, as you mentioned, is growing ever more. The software and the applications that will be developed to be used with the devices is going to grow by leaps and bounds.

As you say, there are big players getting involved. Already some of the pedometer-type devices that measure the number of steps taken in a day have captured the interest of many, many people. Even David Sedaris, serious guy that he is, was writing about it recently in The New Yorker.

What we will find is that many of the health indicators that we used to have to go to the doctor or nurse or lab to get information on will become available to us through these remote devices.

There are already problems around interoperability and connectivity of information in the healthcare establishment as it is now.

There will be a question of course as to reliability and validity of the information, to your point about garbage in, garbage out, but I think standards development will help here This, again, is where The Open Group comes in. We might also see the FDA exercising its role in ensuring safety here, as well as other organizations, in determining which devices are reliable.

The Open Group is working in the area of mobile data and information systems that are developed around them, and their ability to (a) talk to one another, and (b) talk to the data devices/infrastructure used in doctors’ offices and in hospitals. This is called interoperability and it's certainly lacking in the country.

There are already problems around interoperability and connectivity of information in the healthcare establishment as it is now. When patients and consumers start collecting their own data, and the patient is put at the center of the nexus of healthcare, then the question becomes how does that information that patients collect get back to the doctor/clinician in ways in which the data can be trusted and where the data are helpful?

After all, if a patient is wearing a medical device, there is the opportunity to collect data, about blood-sugar level let's say, throughout the day. And this is really taking healthcare outside of the four walls of the clinic and bringing information to bear that can be very, very useful to clinicians and beneficial to patients.

In short, the rapid market dynamic in mobile medical devices and in the software and hardware that facilitates interoperability begs for standards-based solutions that reduce costs and improve quality, and all of which puts the patient at the center. This is The Open Group’s Healthcare Forum’s sweet spot.

Game changer

Gardner: It seems to me a real potential game changer as well, and that something like Boundaryless Information Flow and standards will play an essential role in. Because one of the big question marks with many of the ailments in a modern society has to do with lifestyle and behavior.

So often, the providers of the care only really have the patient’s responses to questions, but imagine having a trove of data at their disposal, a 360-degree view of the patient to then further the cause of understanding what's really going on, on a day-to-day basis.

But then, it's also having a two-way street, being able to deliver perhaps in an automated fashion reinforcements and incentives, information back to the patient in real-time about behavior and lifestyles. So it strikes me as something quite promising, and I look forward to hearing more about it at the Boston conference.

Any other thoughts on this issue about patient flow of data, not just among and between providers and payers, for example, or providers in an ecosystem of care, but with the patient as the center of it all, as you said?

Lee: As more mobile medical devices come to the market, we'll find that consumers own multiple types of devices at least some of which collect multiple types of data. So even for the patient, being at the center of their own healthcare information collection, there can be barriers to having one device talk to the other. If a patient wants to keep their own personal health record, there may be difficulties in bringing all that information into one place.

There are issues, around security in particular, where healthcare will be at the leading edge.

So the interoperability issue, the need for standards, guidelines, and voluntary consensus among stakeholders about how information is represented becomes an issue, not just between patients and their providers, but for individual consumers as well.

Gardner: And also the cloud providers. There will be a variety of large organizations with cloud-modeled services, and they are going to need to be, in some fashion, brought together, so that a complete 360-degree view of the patient is available when needed. It's going to be an interesting time.

Of course, we've also looked at many other industries and tried to have a cloud synergy, a cloud-of-clouds approach to data and also the transaction. So it’s interesting how what's going on in multiple industries is common, but it strikes me that, again, the scale and the impact of the healthcare industry makes it a leader now, and perhaps a driver for some of these long overdue structured and standardized activities.

Lee: It could become a leader. There is no question about it. Moreover, there is a lot healthcare can learn from other companies, from mistakes that other companies have made, from lessons they have learned, from best practices they have developed (both on the content and process side). And there are issues, around security in particular, where healthcare will be at the leading edge in trying to figure out how much is enough, how much is too much, and what kinds of solutions work.

There's a great future ahead here. It's not going to be without bumps in the road, but organizations like The Open Group are designed and experienced to help multiple stakeholders come together and have the conversations that they need to have in order to push forward and solve some of these problems.

You may also be interested in:

More Stories By Dana Gardner

At Interarbor Solutions, we create the analysis and in-depth podcasts on enterprise software and cloud trends that help fuel the social media revolution. As a veteran IT analyst, Dana Gardner moderates discussions and interviews get to the meat of the hottest technology topics. We define and forecast the business productivity effects of enterprise infrastructure, SOA and cloud advances. Our social media vehicles become conversational platforms, powerfully distributed via the BriefingsDirect Network of online media partners like ZDNet and IT-Director.com. As founder and principal analyst at Interarbor Solutions, Dana Gardner created BriefingsDirect to give online readers and listeners in-depth and direct access to the brightest thought leaders on IT. Our twice-monthly BriefingsDirect Analyst Insights Edition podcasts examine the latest IT news with a panel of analysts and guests. Our sponsored discussions provide a unique, deep-dive focus on specific industry problems and the latest solutions. This podcast equivalent of an analyst briefing session -- made available as a podcast/transcript/blog to any interested viewer and search engine seeker -- breaks the mold on closed knowledge. These informational podcasts jump-start conversational evangelism, drive traffic to lead generation campaigns, and produce strong SEO returns. Interarbor Solutions provides fresh and creative thinking on IT, SOA, cloud and social media strategies based on the power of thoughtful content, made freely and easily available to proactive seekers of insights and information. As a result, marketers and branding professionals can communicate inexpensively with self-qualifiying readers/listeners in discreet market segments. BriefingsDirect podcasts hosted by Dana Gardner: Full turnkey planning, moderatiing, producing, hosting, and distribution via blogs and IT media partners of essential IT knowledge and understanding.

@MicroservicesExpo Stories
From the conception of Docker containers to the unfolding microservices revolution we see today, here is a brief history of what I like to call 'containerology'. In 2013, we were solidly in the monolithic application era. I had noticed that a growing amount of effort was going into deploying and configuring applications. As applications had grown in complexity and interdependency over the years, the effort to install and configure them was becoming significant. But the road did not end with a ...
In 2006, Martin Fowler posted his now famous essay on Continuous Integration. Looking back, what seemed revolutionary, radical or just plain crazy is now common, pedestrian and "just what you do." I love it. Back then, building and releasing software was a real pain. Integration was something you did at the end, after code complete, and we didn't know how long it would take. Some people may recall how we, as an industry, spent a massive amount of time integrating code from one team with another...
Admittedly, two years ago I was a bulk contributor to the DevOps noise with conversations rooted in the movement around culture, principles, and goals. And while all of these elements of DevOps environments are important, I’ve found that the biggest challenge now is a lack of understanding as to why DevOps is beneficial. It’s getting the wheels going, or just taking the next step. The best way to start on the road to change is to take a look at the companies that have already made great headway ...
Much of the value of DevOps comes from a (renewed) focus on measurement, sharing, and continuous feedback loops. In increasingly complex DevOps workflows and environments, and especially in larger, regulated, or more crystallized organizations, these core concepts become even more critical. In his session at @DevOpsSummit at 18th Cloud Expo, Andi Mann, Chief Technology Advocate at Splunk, will show how, by focusing on 'metrics that matter,' you can provide objective, transparent, and meaningfu...
Many private cloud projects were built to deliver self-service access to development and test resources. While those clouds delivered faster access to resources, they lacked visibility, control and security needed for production deployments. In their session at 18th Cloud Expo, Steve Anderson, Product Manager at BMC Software, and Rick Lefort, Principal Technical Marketing Consultant at BMC Software, will discuss how a cloud designed for production operations not only helps accelerate developer...
In a crowded world of popular computer languages, platforms and ecosystems, Node.js is one of the hottest. According to w3techs.com, Node.js usage has gone up 241 percent in the last year alone. Retailers have taken notice and are implementing it on many levels. I am going to share the basics of Node.js, and discuss why retailers are using it to reduce page load times and improve server efficiency. I’ll talk about similar developments such as Docker and microservices, and look at several compani...
Struggling to keep up with increasing application demand? Learn how Platform as a Service (PaaS) can streamline application development processes and make resource management easy.
In the world of DevOps there are ‘known good practices’ – aka ‘patterns’ – and ‘known bad practices’ – aka ‘anti-patterns.' Many of these patterns and anti-patterns have been developed from real world experience, especially by the early adopters of DevOps theory; but many are more feasible in theory than in practice, especially for more recent entrants to the DevOps scene. In this power panel at @DevOpsSummit at 18th Cloud Expo, moderated by DevOps Conference Chair Andi Mann, panelists will dis...
As the software delivery industry continues to evolve and mature, the challenge of managing the growing list of the tools and processes becomes more daunting every day. Today, Application Lifecycle Management (ALM) platforms are proving most valuable by providing the governance, management and coordination for every stage of development, deployment and release. Recently, I spoke with Madison Moore at SD Times about the changing market and where ALM is headed.
If there is anything we have learned by now, is that every business paves their own unique path for releasing software- every pipeline, implementation and practices are a bit different, and DevOps comes in all shapes and sizes. Software delivery practices are often comprised of set of several complementing (or even competing) methodologies – such as leveraging Agile, DevOps and even a mix of ITIL, to create the combination that’s most suitable for your organization and that maximize your busines...
The goal of any tech business worth its salt is to provide the best product or service to its clients in the most efficient and cost-effective way possible. This is just as true in the development of software products as it is in other product design services. Microservices, an app architecture style that leans mostly on independent, self-contained programs, are quickly becoming the new norm, so to speak. With this change comes a declining reliance on older SOAs like COBRA, a push toward more s...
Digital means customer preferences and behavior are driving enterprise technology decisions to be sure, but let’s not forget our employees. After all, when we say customer, we mean customer writ large, including partners, supply chain participants, and yes, those salaried denizens whose daily labor forms the cornerstone of the enterprise. While your customers bask in the warm rays of your digital efforts, are your employees toiling away in the dark recesses of your enterprise, pecking data into...
I have an article in the recently released “DZone Guide to Building and Deploying Applications on the Cloud” entitled “Fullstack Engineering in the Age of Hybrid Cloud”. In this article I discuss the need and skills of a Fullstack Engineer with relation to troubleshooting and repairing complex, distributed hybrid cloud applications. My recent experiences with troubleshooting issues with my Docker WordPress container only reinforce the details I wrote about in this piece. Without my comprehensive...
Small teams are more effective. The general agreement is that anything from 5 to 12 is the 'right' small. But of course small teams will also have 'small' throughput - relatively speaking. So if your demand is X and the throughput of a small team is X/10, you probably need 10 teams to meet that demand. But more teams also mean more effort to coordinate and align their efforts in the same direction. So, the challenge is how to harness the power of small teams and yet orchestrate multiples of them...
You deployed your app with the Bluemix PaaS and it's gaining some serious traction, so it's time to make some tweaks. Did you design your application in a way that it can scale in the cloud? Were you even thinking about the cloud when you built the app? If not, chances are your app is going to break. Check out this webcast to learn various techniques for designing applications that will scale successfully in Bluemix, for the confidence you need to take your apps to the next level and beyond.
SYS-CON Events announced today that Peak 10, Inc., a national IT infrastructure and cloud services provider, will exhibit at SYS-CON's 18th International Cloud Expo®, which will take place on June 7-9, 2016, at the Javits Center in New York City, NY. Peak 10 provides reliable, tailored data center and network services, cloud and managed services. Its solutions are designed to scale and adapt to customers’ changing business needs, enabling them to lower costs, improve performance and focus inter...
With DevOps becoming more well-known and established practice in nearly every industry that delivers software, it is important to continually reassess its efficacy. This week’s top 10 includes a discussion on how the quick uptake of DevOps adoption in the enterprise has posed some serious challenges. Additionally, organizations who have taken the DevOps plunge must find ways to find, hire and keep their DevOps talent in order to keep the machine running smoothly.
Wow, if you ever wanted to learn about Rugged DevOps (some call it DevSecOps), sit down for a spell with Shannon Lietz, Ian Allison and Scott Kennedy from Intuit. We discussed a number of important topics including internal war games, culture hacking, gamification of Rugged DevOps and starting as a small team. There are 100 gold nuggets in this conversation for novices and experts alike.
The notion of customer journeys, of course, are central to the digital marketer’s playbook. Clearly, enterprises should focus their digital efforts on such journeys, as they represent customer interactions over time. But making customer journeys the centerpiece of the enterprise architecture, however, leaves more questions than answers. The challenge arises when EAs consider the context of the customer journey in the overall architecture as well as the architectural elements that make up each...
Much of the discussion around cloud DevOps focuses on the speed with which companies need to get new code into production. This focus is important – because in an increasingly digital marketplace, new code enables new value propositions. New code is also often essential for maintaining competitive parity with market innovators. But new code doesn’t just have to deliver the functionality the business requires. It also has to behave well because the behavior of code in the cloud affects performan...