From a technical standpoint, my job falls into a number of classifications. I am an application, business, data, technical, and solution architect. The previous diagram in Figure 1 represents a small portion of an overall solution architecture. The picture below, Figure 2, represents the other models.
In the simplest example, imagine that Hospital A and B use different business processes, applications, and data at every layer of Figure 2. In this case, even if the two hospitals were across the street from one another, a single patient would have to carry his patient file with him to receive care in both cases. There would be no economy of scale without some level of technology integration.
One could replace all of the systems. However, the costs would be in the millions of dollars. There would also be significant interruptions in service, hiring of temporary backfill employees, and there could be some risk to patient care.
Before engaging in the technical build, it is important to define the benefits and costs of such an enterprise. It is my job to provide financial analysis, a technical fit summary, and an organizational assessment. Hospital Executives take the business case, and determine the direction that is best suited for their organization.
I have worked at hospitals where they decided to not replace applications, but rather to build a large connectivity and then normalization and translation layer. The common element across all systems is data. All hospital applications use the same types of clinical, patient, and physician attributes. In this case, it is my job to create a 'Normalization and Translation Layer,' standardize the database elements, and to create a tool to analyze and monitor data consistency, business process and patient care efficiency.
|Inner city ambulances at the ready|
Hospitals exist wherever people live. Because the USA is so large, there are more rural hospitals than urban hospitals. Even with today's communication technology, it is expensive to connect many locations.
Large software companies do not generally develop applications for hospitals. A global company such as SAP can sell billions of dollars of software to large multi-national companies such as Citibank and Daimler-Benz. The hospital market is larger than any other industry vertical. However, if global software companies were to sell to hospitals, they need to redesign their software for this niche market. Even then, they would collect <1% of the big company price, and salespeople and engineers would need to visit over 6000 facilities evenly distributed across the country.
Given this picture, I have had the good fortune to work with organizations that serve large numbers of hospitals, clinics, and long-term care facilities. As they had an economy of scale, I had an opportunity to develop custom applications and solutions. I have worked with Ascential, i2 Technologies, and Oracle to develop industry specific software for general acceptance release. In these cases, we developed use cases, programmed at almost every level and layer, linked business processes across a common data layer, and created a repeatable and sustainable solution.