I recently proposed that organizations looking to build or participate in risk-delegated delivery models (like ACOs) would be well served to look at the discipline of enterprise architecture (EA).
For those not familiar with enterprise architecture, you can think of it as a management framework for an effective, efficient, agile, and durable technology portfolio aligned to business process needs. Various definitions of enterprise architecture abound, but my favorite comes from the MIT Center for Information Systems Research:
Enterprise Architecture is the organizing logic for business processes and IT infrastructure reflecting the integration and standardization requirements of the company’s operating model.
Looking at that definition, anyone familiar with emerging care models should immediately see three important terms in this definition:
processes — ACOs design and implement management processes (clinical, financial, and administrative), including associated health analytics
standardization — ACO management processes are created as standards of practice with critical metrics and measures
integration — ACOs require process and data integration across organizational boundaries in order to operate, monitor, and manage the processes, metrics, measures, and analytics
In short, ACOs need health analytics, and health analytics need an enterprise architecture.
Enterprise architecture is one of the concepts that underpin the health analytics strategies I’ve written about over the years. Why is enterprise architecture important for health analytics and ACOs? Here are my top 7 reasons that enterprise architecture deserves attention:
Organizational planning. EA establishes a common framework for defining the to-be state of business processes, what technology is needed, when, and how. Whether you are building a parallel ACO infrastructure from scratch or transitioning existing practices onto one way of handling patients, EA gives a mechanism for capturing, formalizing, and planning that trip.
Security. American security guru Bruce Schneier (among others) has been quoted as stating “complexity is the enemy of security.” With lots of moving people, facilities, and contracts involved in ACO formation and operation, security concerns can mount fairly quickly. EA reduces security exposure through infrastructure and service standardization and simplification.
Data interchange. ACOs need to share a lot of information: medical records, claims, referrals, care protocols, etc. EA defines the standard, universal method(s) for sharing data within and across the enterprise. That data is the fuel by which health analytics provide insights; the better the octane, the higher the performance of your ACO.
Communication. Sharing the data is not enough; people actually need to communicate and collaborate around patients. Though sharing EMRs or HL7 documents may be important, many practitioners gain real benefits from more simple things like having a simple way to contact other care team members. EA provides the common enterprise services associated with care coordination, communication and collaboration across corporate boundaries.
Onboarding. Would you rather teach the new guy one way of doing something, or five ways of doing part of it. Through standardization, common service offerings, and simplification, EA facilitates speed and quality in bringing on new practitioners, facilities, and technologists.
Standardized measurement. If you are going to be contractually bound and compensated on a set of performance measures, doesn’t it make sense to have a single definition and calculation of those measures that everyone — regardless of where they sit organizationally — can depend on? EA creates a lingua francafor consistent and reliable performance measurement and management.
Cost efficiency. If you want to avoid “system creep” (the unmanaged purchasing of new hardware and software) and get more value from the investments you have already made, EA increases returns on assets while lowering operating costs.
There are probably more than 7 good arguements for EA (safety, for example, is enhanced through the standardization that EA enables), but hopefully this list is enough to get you started down the path of building a more capable infrastructure to support your ACO.