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A Conversation with Jason Uppal About Enterprise Architecture in the Healthcare Industry We recently spoke to Uppal about the role of enterprise architecture in the health care industry, the problems that have surrounded the launch of the Obamacare website in the U.S. and how enterprise architecture can help with healthcare reform.


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EA in Practice – A Conversation with Jason Uppal About Enterprise Architecture in the Healthcare Industry

Posted By Birgit Hartje, Friday, March 14, 2014

EA in Practice – A Conversation with Jason Uppal About Enterprise Architecture in the Healthcare Industry


AEA member Jason Uppal is Chief Architect at clinicalMessage, Inc. and CEO of QRS, a company focused on Business Transformation. A division of QRS, clinicalMessage uses the business transformation methods developed by QRS to create a culture of quality and safety in healthcare organizations. Over the past three years, Uppal has worked extensively in healthcare settings researching, learning and listening to everyone from nurses, doctors and surgeons to administrators and senior management in hospitals, health authorities and at universities. This work has allowed Uppal and his team to apply EA and develop solutions that fit the particular needs of healthcare settings and environments. In 2012, the clinicalMessage capability was awarded the Edison Award for being an innovative health care application.. Uppal is also the Vice Chair of The Open Group’s newly launched Healthcare Forum. He divides his time between his home base in Toronto and Philadelphia.


We recently spoke to Uppal about the role of enterprise architecture in the health care industry, the problems that have surrounded the launch of the Obamacare website in the U.S. and how enterprise architecture can help with healthcare reform.


The rollout of Obamacare has been a bit of a fiasco. From the standpoint of Enterprise Architecture, what could they have done better?

Enterprise architecture (EA) could have helped them understand you don’t have to solve 100 percent of the problem. You solve the problems that are most important and leave the remaining for the next iteration —there are some opportunities to be had there, and that’s the focus of healthcare reform.


From the enterprise architecture point of view, they did some parts right, but I don’t think they thought about the transition plan well enough. They relied on a transition plan from consultants and lobbyists that said they could do it fast. The transition plan was not practical for two reasons. First, healthcare has not ever changed at this speed. If you have a whole industry that hasn’t had to change and you put the hammer on them, they don’t know how to do it…had they thought about it from an enterprise architecture standpoint they wouldn’t have done that. You just can’t do things fast because you want to. It doesn’t happen. Technology is not perfect from day one.


There’s nothing wrong with the architecture, it’s the transition plan. Transition is 99 percent of the problem that enterprise architecture addresses. We all know where we are and where we want to go, the problem is how do you get there, with minimum disruption to current operations while staying true to disruptive change.


The other part where EA could have helped was instead of solving every problem from every stakeholder’s point of view, they could have prioritized and tackled this one first, then the next. If you approach things from every stakeholder’s point of view, then every problem has to be done right away. From an EA standpoint, it could have been incrementally instead of a big bang where everything has to be done at once.


Are there problems that are specific to the healthcare industry that should be addressed up front to make projects like this run more smoothly? How can EA help healthcare?

One thing they could have done, they could have looked at the industry as a whole to see what they’re prepared to accept and what needs to change. It’s easy to think about at the 25,000-ft. level, but to bring it to the ground level where hospitals have to change while taking care of patients, this is a live world and you only have to make one mistake and you’re on the firing line. That’s a lot of change in an industry where there’s not a lot of change. You could be in a boardroom where nobody can say ‘yes’ and anyone can say ‘no.’ That’s unique to healthcare…everybody’s right and nobody’s wrong. They are very consensus-driven organizations on the inside. Command and control is not in that culture.


Change has to be delivered with command and control. One reason that systems like Kaiser Permanente or the Cleveland Clinic are much more productive and much faster at changing is because they have a CEO. At the end of the day they have a CEO that makes decisions…Those organizations are powerful enough to make changes fast, but in a lot of the healthcare system, it’s very consensus driven and change is next to impossible. The unfortunate thing is they think they have changed a lot, but in the scheme of things, they have changed very little. When compared to telecom, they haven’t seen an iota of change—nothing of that magnitude has happened in healthcare, but it’s coming.


EA can help in understanding an organizations’ preparedness to change. The second thing is to create a model that fits that organization and then get that change ready—where do you need to go, how fast and what do we need to augment that change.


What kind of architecture and security concerns need to be addressed when putting together a project of this scale that needs to be able to support many thousands of users simultaneously?

Some fundamental issues that we need to be concerned about are: Are there rules in place? For data ownership, who owns your health records? Is it the hospital? And also where it is—if they move it to the cloud, who owns it? There are all kinds of practical concerns around that. A concerted effort needs to be put in place—you need rules and regulations around that. Security and privacy are not an impediment; they’re the constraints that we need to deal with. It’s a red herring to think we don’t know how to handle those things…if you put in clearly defined rules; it’s not a problem. It doesn’t increase costs or anything, security and privacy management is just good business.


On a project such as Obamacare that combines government and private contracting resources, where ideally should the architecture sit?

They both have roles in it. At the big picture level, architecture needs to be done, and at the solutions level, there needs to be architecture. They need to sing from the same song sheet. The strategic needs to be at the governance level, solutions at the implementation level, but the solutions level needs to inherit from the enterprise architecture. It needs to be, otherwise it’s a waste of time and money. They need to work from the same set of principles.


Government IT projects are notorious for being over deadline, over budget and often for not working. How can enterprise architects help improve public infrastructure projects?

This is more of a problem of the healthcare industry as a whole, not a public infrastructure issue. In the healthcare industry, they still don’t know what a good architecture is. They don’t know what the costs and benefits are like in other industries. How do you measure the benefit of good healthcare? They’ve tried to apply private industry rules to healthcare and it’s not working very well. That’s why healthcare costs in the U.S. are twice that of other countries. The U.S. GDP spend is 18 percent on healthcare. Canada, Germany and Britain spend 8 percent, and it’s not that people are more healthy. You spend less but get better quality from a Canadian perspective.


That’s partially because it’s been thought of as a private business. You can’t have a private business when costs and benefits are not the same currency. The benefit in other industries is money. How do you quantify a $75,000 hip replacement for someone who is 92 years old? Is that a good investment? Those are the fundamental problems in healthcare that need to be dealt with. So, if you’re rich you can afford it, but if you’re not, you can’t? Is that an acceptable way to make decisions?


In Canada, they look at your need more than whether you can afford it or not, the physician decides what the treatment will be. In the U.S., the patient or insurance company decides what procedures you have and decides what you get—there’s  fragmentation. In the private sector, everybody makes their own deal with somebody. A procedure that costs $10 in Canada can cost $150 in the U.S. The hospital system is negotiating with insurance companies what they’ll get paid for something.


The new Obamacare site had a deadline of Dec. 1. How realistic is it to put deadlines on projects that need fixing on a scale like this?

From an architect’s point of view, deadlines are absolutely necessary. Bucketizing things and putting a wrapper around things are absolutely necessary. If you don’t, things have a nasty habit of staying around forever. I’m a big proponent of deadlines. They’re a must and limiting costs are a must, then you come up with a creative way of getting it done. Deadlines are not artificial—they’re real and they’re necessary.


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