Ahead IT Curve Case Study Review

Before reading the commentary

Peachtree in its IT planning process has lost clarity regarding their strategic goal for what they intent to accomplish with their systems along with a roadmap for achieving that goal. This should be the starting point of any large-sized institution going for an IT overhaul. The organization’s acquisition over the years has brought diverse medical institutions under its fold, each unique in terms of its workflow patterns. Ranging from large and midsized institutions, trauma centers, nursing systems to rehabilitation facilities, each has its own set of unique work processes, overlaps between them. This poses inherent challenges to devise an integrated Information System — IS. Development of an integrated IS at Peachtree has to translate into increased efficiency which would seamlessly function across its distributed facilities in a hassle-free manner. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Paul Lefler, the Board Chairman, Peachtree insists to go ahead on standards, systems and processes — which are the bedrock of any IS. According to him, common systems and broad standardization has to be the backbone for competitive realism and long-term progress. But this appears far-fetched, as healthcare is a different ball-game altogether where major challenges lay in standardizing various components on a workflow model from diagnosing ailments to prescribing medicines, adopting surgical procedures i.e the complete lifecycle from diagnosis to cure. At this juncture, Max Brendt, the CEO of Peachtree is right in justifying that standardizing medical treatment protocol is still a far cry from reality due to inherent nature of medical treatment procedures. Standardization will also have an effect of robbing physicians of their clinical judgments that has been of critical importance in the medical profession until now. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Besides, blanket standardization poses the likelihood of increased patient safety issues. Dependence of physicians on using IT as a primary tool in delivering care will make them dependent to work on it reliably. Any disruption or failure of IT systems will make the entire clinical procedure go haywire as IT system downtime due to capacity problems or otherwise can crop up unaware. The failure of the IT facility at Wallis brings to light the practical situation wherein talented and hardworking physicians were at the mercy of the failure of IT systems that had become an indispensable tool. As has been rightly stated by Cadence, CIO, Wallis Hospital, massive spending in IT infrastructure was using up substantial maintenance energy to such an extent that additional technology innovation was becoming increasingly unaffordable. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

The crux of the problem lay in sheer size of Peachtree which poses a challenge to run massive systems to operate ambitious software. Service-Oriented Architecture — SOA presents a solution in the form of a selective standardization, but the larger problem lies in the fact that piecemeal standardization would create watertight standalones which might create problems. There remains an uncertainty whether anything can be gained from standardization as the entire issue revolves around the hospital’s flexibility to respond to constant change and whether SOA has a solution to these problems or not. SOA is yet to test healthcare waters to prove its success. This poses a greater challenge in its implementation but is it a worthwhile migration path to a novel way of building technology capability? The answer is still nebulous. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

After reading the commentary:

The larger picture is gradually emerging wherein the scope and realm of IT has been grossly underestimated especially by George C. Halvorson to some extent and John A. Castor completely. Over the years it has been acknowledged that IT has revolutionized almost every perceivable business enterprise and bringing business solutions by closely understanding their processes and transforming them to function efficiently, reducing wastage and making them more profitable. The gigantic span of IT, its processes and diversity is so huge and still evolving that any business with whatever complexity and processes can find a justifiable solution and the business of healthcare is no exception to that. In the case study, primarily John A. Kastor who is a doctor by profession is trying to protect the physician’s professional turf by not bringing Peachtree into the IT fold leave alone any specialized IT system like Service Oriented Architecture — SOA. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Admittedly, a Doctor’s psyche of independence must not interfere with the larger interest that standardized systems offer through computer technology. Underestimating the diverse prowess of IT in the emerging healthcare arena, Kastor is limiting his understanding within a narrow confine and preventing the future scope of growth of the world of healthcare through his compartmental thinking. He seems to live in ‘practice plan’ era when the world of healthcare is fast moving towards advanced computer-aided procedures like telemedicine wherein treatment procedures are administered over distances. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

The opinions that make the most sense and its reason:

In this case study, the commentaries of Randy Heffner makes the most business sense and also Monte Ford. If Monte Ford has given the introduction of choosing SOA as a tailor-made option, Randy Heffner takes it from there to offer more clarity regarding how to go ahead with the proposed SOA. Heffener has detailed the manner in which the thinking plan at Peachtree has to change from accepting SOA as a mere product category to visualizing it to get the larger picture as a methodology instead. Monte Ford has shared his success in implementing SOA at American Airlines which he rightly believes can be replicated at Peachtree. He has also given the option to choose between a monolithic system and SOA because rightly a SOA-based environment has to be functionally rich to reap its full benefits. When it is not, a monolithic system would work best. Randy Heffner has gone further and crystallized that the modularity of SOA delivers a range of standardization choices which is a ‘best of both worlds’ scenario. You have the twin benefit of SOA as also the standardization built into it. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Parts of recommendation to be used and those which are unique:

Heffner’s opinions are the most differentiated ones that offer a workable solution when he states that SOA’s reach within the industry is far deeper than is understood by Candace. Research reveals that nearly 60% of businesses across N. America, Europe and Asia-Pacific enterprises are using it or preparing themselves to migrate to it shortly. As a matter of fact, 40% of the SOA users admit that it is helping them to attain strategic business transformation. Its modules offer minute granularity termed as business service’. The best part being that SOA does not need web services, nevertheless their synergy offer strong potential for business integration and flexibility. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Heffner’s thinking is also unique when he foresees that SOA would permit Peachtree to replace just the disjointed components of its existing technology base. This will be a huge cost savings for Peachtree as retrofitting legacy systems with business service interface will be comparatively cheaper compared to replacement. From there onwards, Peachtree can progress with small but stand-alone projects within a gamut of improvement initiatives. This gives the leeway and the time for ‘course correction’ in the form of adjustments, redesign as the organization moves ahead in its functionality. Post SOA implementation, the enterprise is equipped with the liberty to enhance them. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

Explanation of my recommendations with justification:

From the above paragraphs and in the context of Peachtree’s problem, the solution that is most close if not ideal is implementation of SOA business design models which will enable the company not only to manage the business risks but technological obsolescence also. It is a fact that human beings in almost every sphere of work can commit errors. Errors can be prevented through proper design of systems that render it difficult for people to do the wrong things and easy for people to perform the right thing. At Peachtree, implementation of an e-Healthcare project based on the SOA is going to be the right solution. The SOA reinforces basic software architecture like abstraction, modularity, encapsulation and reuse of software. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

There will be a well defined interface that will separate the interfaces from their implementation and also allow service capabilities and interfaces to be implemented as a collection of process which is what Peachtree is looking for. Each process provides a service as a standalone basis with one that gives a specific capability. Since process is manifested through a standardized interface, the underlying implementation of the individual service is at liberty to charge without impacting the manner in which the service is availed. SOA not just encompasses the services from a technology perspective, but also policies and practices by which the services are delivered are availed. These are the concrete reasons for suggesting SOA as the appropriate model for developing a distributed e-healthcare system at Peachtree. A top level design for SOA is stated at Exhibit — I. (Glaser; Halvorson; Ford; Heffner; Kastor, 2007)

The topmost layer provides the web services interfaces. The bottom layer is for healthcare services. The services coordination within the middle layer is responsible for message flow in the system from the web services interfaces to the healthcare services to and fro. The present e-Healthcare system looks at relationship between patients, doctors, nurses and pharmacists. The system has in-built modularity to upscale it to cover other healthcare facilities and professionals like laboratory techniques are responsible for performing and reporting tests and detailed analysis statements ordered by doctors. Active exploration is on to examine whether clinic and pharmacy module are able to be interfaced to applications given by pharma companies who provide information regarding medicines and dosages and give alert regarding interactions between medicines. (Kart; Miao; Moser; Melliar-Smith, 2007)

At Peachtree the transition of technology will be controlled through the interaction of four factors. The first is the cost/risk factor which usually decreases in course of time while the other is the benefit factor. When the technology benefits offset the cost/risk factor, it is pointer that the adoption of that particular technology may be desirable for the business enterprise. The other two factors are competitive pressure and regulatory compliance. From a business process and strategy perspective benefits of SOA will accrue at a time when its key projects and the enterprise in its entirety incorporate through SOA components and services vital information needs. The application of shared services for lowering costs is required to be examined for an accurate SOA impact assessment that is dependent heavily on close mapping and configuration of business processes on underlying SOA services with the corresponding logical view characteristics. (Vasilescu, 2006)

However, inherent to any technology, the primary risk factors are linked to precise assessment of SOA components and services maturity. It is here that managing technical risk factors may be carried out through a classification of services as well as components based on the five SOA as discussed above. An initial (low) beginning stage might be a pre-SOA component which is not necessarily fulfilling any of the SOA attributes which might nevertheless possess the benefit of being operational and scope for modularity/partitioning. It will only through mature services as well as components that massive enterprises like Peachtree will achieve SOA-based architecture benefits. The advantages come from enhanced layering and flexibility since characteristics like platform neutrality, message orientation, description orientation permit loose coupling of components across heterogeneous platforms, simplicity of maintenance and integration, utilization and assimilation of services and components. (Vasilescu, 2006)

It is important to note that transitioning to SOA at Peachtree might create atypical organizational pressure since the organization is not armed to account for shared services that might differ rapidly in regard to content, complexity and application across the enterprise. As is inherent with any large-sized, healthcare enterprise traditional divisions and barriers among some departments and services exist and at higher levels also between functional areas and administrative elements. These barriers are unable to be suitably bridged, particularly in an environment that gives due importance to specialization. At Peachtree the acquisition and development of novel IT systems will be project oriented as also the software development methodologies, supporting tools, plus the continuing operational processes and practices. (Vasilescu, 2006)

Interoperability is also a major issue in healthcare which will be addressed at Peachtree that includes a plethora of technical and organizational issues like the diversity of applications and systems spread over Departments and the divergent mentalities and perceptions prevailing across various stakeholders. The application of SOA will be able to address those requirements and offer a modern application perspective for the interaction of available and new applications at Peachtree. A ‘Virtual Patient Record — VPR’ paradigm is required to be implemented. Within the context of present implementation, the application of business process execution language — BPEL is also required to be exploited so as to formulate business and technical processes definitions for interaction situations among the participating applications. (Daskalakis, Mantras, 2009)

Exhibit — I — SOA Architecture at Peachtree

Retrieved from: Kart, Firat; Miao, Gengxin; Moser, L. E; Melliar-Smith, P.M. (2007) “A distributed e-Healthcare System Based on the Service Oriented Architecture” IEEE International Conference on Services Computing, pp: 652 — 659.

References

Daskalakis S, Mantras J. (2009) “The impact of SOA for Achieving Healthcare

Interoperability” Methods Inf Med, vol. 48, no. 2, pp: 190-195.

Glaser, John P; Halvorson, George C; Ford, Monte; Heffner, Randy; Kastor, John A. (2007)

“Too Far Ahead of the IT Curve?” Harvard Business Review, vol. 85, no. 7/8, pp: 29-39.

Kart, Firat; Miao, Gengxin; Moser, L. E; Melliar-Smith, P.M. (2007) “A distributed e-

Healthcare System Based on the Service Oriented Architecture” IEEE International Conference on Services Computing, pp: 652 — 659.

Vasilescu, Eugen. (2006) “Service Oriented Architecture (SOA) Implications for Large Scale

Distributed Health Care Enterprises” 1st Transdisciplinary Conference on Distributed Diagnosis and Home Healthcare, pp: 91 — 94.

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