Transcript of a BriefingsDirect podcast on how new devices and practices have the potential to expand the information available to healthcare providers and facilities.

1. New Health Data Deluges Require Secure Information Flow
Enablement Via Standards, Says The Open Group’s New
Healthcare Director
Transcript of a BriefingsDirect podcast on how new devices and practices have the potential to
expand the information available to healthcare providers and facilities.
Listen to the podcast. Find it on iTunes. Sponsor: The Open Group
Dana Gardner: Hello, and welcome to a special BriefingsDirect Thought Leadership
Interview coming to you in conjunction with The Open Group’s upcoming event, Enabling
Boundaryless Information Flow July 21-22, 2014 in Boston.
I'm Dana Gardner, Principal Analyst at Interarbor Solutions and I'll be your host
and moderator for the series of discussions from the conference on
Boundaryless Information Flow, Open Platform 3.0, Healthcare, and Security
issues.
One area of special interest is the healthcare arena, and Boston is a hotbed of
innovation and adaption for how technology, enterprise architecture, and standards can improve
the communication and collaboration among healthcare ecosystem players.
And so, we're joined by a new Forum Director at The Open Group to learn how an expected
continued deluge of data and information about patients, providers, outcomes, and efficiencies is
pushing the healthcare industry to rapid change.
With that, please join me now in welcoming our guest. We're here with Jason Lee, Healthcare
and Security Forums Director at The Open Group. Welcome, Jason.
Jason Lee: Thank you so much, Dana. Good to be here.
Gardner: Great to have you. I'm looking forward to the Boston conference and want to remind
our listeners and readers that it's not too late to sign up. You can learn more at
www.opengroup.org.
Jason, 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.
Gardner

2. 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's the hurdle? What prevents a nice, seamless, easy flow and collaboration in information
that gets 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 an 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
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.
Lee

3. 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 and portion. 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 give 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.”

4. 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..

5. 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.
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 care 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.

6. 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 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. Because one of the big
question marks with many of the ailments in a modern society has to do with lifestyle and
behavior.

7. 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.
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.

8. The conference
Gardner: Well, great. I'm sure there will be a lot more about how to actually implement some
of those activities at the conference. Again, that’s going to be in Boston, beginning July 21, 2014.
We'll have to leave it there. We're about out of time. We've been talking with a new Director at
The Open Group to learn how an expected continued deluge of data and information about
patients and providers, outcomes and efficiencies are all working together to push the healthcare
industry to rapid change. And, as we've heard, that might very well spill over into other
industries as well.
So we've seen how innovation and adaptation around technology, enterprise architecture and
standards can improve the communication and collaboration among healthcare ecosystem
players.
This special BriefingsDirect discussion comes to you in conjunction with The Open Group,
Boston, 2014 beginning on July 21. It's not too late to register (http://www.opengroup.org/
boston2014) and join the conversation via Twitter #ogchat #ogBOS, where you will be able to
learn more about Boundaryless Information Flow, Open Platform 3.0, Healthcare and other
relevant topics.
So a big thank you to our guest. We've been joined by Jason Lee, Healthcare and Security
Forums Director at The Open Group. Thanks so much, Jason.
Lee: Thank you very much.
Gardner: This is Dana Gardner, Principal Analyst at Interarbor Solutions, your host and
moderator throughout these Thought Leadership Interviews. Thanks again for listening, and do
come back next time.
Listen to the podcast. Find it on iTunes. Sponsor: The Open Group
Transcript of a BriefingsDirect podcast on how new devices and practices have the potential to
expand the information available to healthcare providers and facilities. Copyright The Open
Group and Interarbor Solutions, LLC, 2005-2014. All rights reserved.
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