NEWS AT SEI
This library item is related to the following area(s) of work:General Interest
This article was originally published in News at SEI on: January 1, 2007
U.S. military agencies depend on accurate information to determine quickly where, when, and how to respond to threats. A complex array of data, fed from a variety of sources, must be automatically shared, analyzed, and filtered. Only then can the military receive the precise details needed to make rapid, informed decisions.
The U.S. Army is refining its net-centric capabilities, an effort that has been supported by the SEI. Since 1985, the SEI's research has refined and improved many of the software-intensive systems that support an extensive U.S. Department of Defense (DoD) IT infrastructure, which must allow underlying systems and applications to work together flawlessly.
"We were struck by the interesting similarities in some health-care situations and some military situations," says Suzanne Garcia, a senior member of the SEI's technical staff. "Logistics management offers one example. Getting supplies, parts, and people to the right place at the right time within a military context correlates to the logistics challenges that large health systems with multiple facilities, departments, and medical disciplines also face."
"Just as a war fighter bases decisions on complex data that are fed from multiple sources, an emergency-room or intensive-care clinician also makes rapid patient-care decisions based on complex data that are fed from multiple sources," says Garcia.
The DoD saw improvement when it began to tear down communication barriers among its IT systems; likewise, improved communication is a key challenge for the health care industry. How can the IT systems that support doctors, nurses, emergency-room clinicians, laboratories, insurance providers, and patients provide real-time access to accurate and complete patient data?
To date, the SEI has conducted assessments and research for the U.S. Department of Veterans Affairs and the University of Pittsburgh Medical Center. The SEI recently chaired an International Process Research Consortium (IPRC) workshop that focused on process challenges in health care. "In the course of these activities, leaders in health care and health IT are identifying challenges that can be addressed with SEI capability," says Eileen Forrester, senior member of the technical staff at the SEI and co-chair of the IPRC. "Obviously, the SEI capability in process improvement is relevant, but there are other challenges that match our capabilities too." Those challenges include the following:
Interoperability—The power of the Internet has dramatically improved interoperability across the military. The SEI has helped the DoD and other organizations use the Internet, among other tools, to rapidly transfer and share information among IT systems that previously had not been able to communicate.
"The question is, how do we apply these interoperability principles to health care?" says Forrester. "How do we ensure that an intensive-care clinician is able to access the same test results during a weekend emergency as that patient's doctor would during a standard office visit?"
To foster interoperability in IT systems, the SEI established the Integration of Software-Intensive Systems (ISIS) initiative. The SEI has found that achieving interoperability is much more than an engineering problem. ISIS is pursuing several projects that deal with the multiple dimensions of interoperability challenges. A common issue they all face is stakeholder management and coordination.
"In health care, all the stakeholders of an IT system, especially the end users, need to have a strong voice early in the development process, and throughout that process, to help identify and address interoperability issues," says Garcia. "Likewise, clinical users of health-care systems must be actively involved with the vendors and IT personnel who are making decisions about their systems. This helps ensure that the systems are not overly constrained—that interoperability will be more easily accomplished as new systems are added in the future."
Security—In the military, preventing information from getting into the wrong hands could be a matter of life or death. As health-care providers begin to make medical records widely available over the Internet, one challengeis to protect data from malicious users while allowing legitimate users quick and easy access.
"Standards such as the HIPAA Privacy Rule mandate that entities receiving health care information from consumers adequately protect the data," says Garcia. The HIPAA Privacy Rule is a regulation of the federal Health Insurance Portability and Accountability Act (HIPAA). "The SEI has developed techniques for assessing security risks for the DoD that are helping to identify and mitigate weaknesses within the health-care domain. The early pilots of security risk assessment were performed in the DoD health system environment."
Adoption—One of the larger challenges with technology in any domain is not the technology itself, but getting stakeholders to apply it and use it. Working with the DoD and its suppliers, the SEI developed a set of techniques that support comprehensive organizational change when adopting new processes and technologies.
"The SEI has a strong history and experience in understanding the adoption of new practices, such as using a new logistics-management tool or using a new protocol for making decisions of a particular type," says Garcia. "Our adoption techniques apply equally well to clinicians adopting a new electronic medical-record system or a logistics specialist adopting a new commercial scheduling package for vehicle-maintenance management."
Adoption challenges are similar among domains, and the SEI has identified some of the acute challenges in health care. "For example, in every domain, our adoption processes must account for the fact staff members have competing commitments for their time," says Forrester. "In health care, it's hard for doctors, nurses, or lab technicians to justify setting aside the time to learn a new software application when patient-care activities are waiting for their attention."
When possible, the SEI looks for opportunities to mitigate such a challenge in ways that are specific to that context. One of the challenges in electronic medical record systems is how to represent the tremendous amount of information that is present in a patient's chart. Some users want to see the electronic format mimic the paper chart they are already familiar with—but this may introduce problems and miss opportunities. So should the electronic system try to mimic a paper chart to win over some users, or should it try to find ways to represent the information that take advantage of computer-user interface strengths that go beyond the paper-chart approach? "We've found that, predictably, some clinicians adapt most easily to an electronic record that mimics a paper chart, and others adapt fairly easily to novel information designs," says Garcia. "One of our adoption techniques can help organizations determine which approach is likely to be most successful with their clinicians."
During the past 20 years, the SEI has served as a neutral advocate of the best software engineering practices—an objective voice that has helped the DoD establish parameters and standards that get a wide variety of stakeholders to improve their results in acquiring, developing, and operating IT systems. The SEI and DoD are currently working for dramatic improvement in interoperability across diverse IT systems in DoD and industry.
Today, health care faces similar challenges—it also requires a neutral advocate to get all the stakeholders in concert. "The process of incorporating and adopting new ideas around health-care challenges will not only help deliver robust practices to the health care community," says Garcia, "but it will help us further enrich our understanding of a broad range of issues that we can then transfer back to the DoD and the other domains we support."
The International Process Research Consortium (IPRC) is dedicated to projecting future needs and trends in process research over the longer term (five to 10 years in the future). IPRC members include internationally recognized experts from all over the world as well as organizations in such divergent domains as manufacturing, consulting, research and health care. During the first week of November 2006, the SEI led an IPRC workshop among health care stakeholders to address the unique process needs and challenges faced by the health care domain.
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