Too Far Ahead of the IT Curve

Peachtree Healthcare (PH)’s mission are ensures quality, provide consistency and continuity of care across the entire network, to deliver care with the highest levels of efficiency and economy, and maintain respect for patients and staff. The objective of PH is to offer all kinds of treatments so patients’ care would be continued without any disruption. PH’s patchwork IT infrastructure is in critical condition, so it has major IT infrastructure problems. CEO of PH Max Berndt is trying to find the right solution. He has an option to go with monolithic system that will provide consistency across PH’s facilities but may not give doctors enough flexibility or he can choose service-oriented architecture (SOA), a modular design that will allow PH to standardize incrementally and selectively but poses certain risks as a newer technology. Evaluating pros and cons of both SOA and monolithic system, SOA seems less expensive in the long run than the monolithic system.

CEO Max Berndt does not like the basic force to make homogeneous across the network hospitals, especially for non-routine stuff. So, he considers applying SOA as a new information system. Monte Ford, Sr. VP/CIO of American Airlines, recommends SOA and mentioned as “the company doesn’t have the luxury of waiting for a lot more certainty; its infrastructure needs a solutions now”. Likewise Randy Heffner, a VP at Forrester Research also recommends SOA. The interesting thing to note is that none of the experts recommend a monolithic system on case commentary. It is recommended PH to apply SOA because of low costs, easy to use, flexible and low time consuming. CURRENT SITUATION

Peachtree Healthcare (PH) is a network of eleven large and midsize institutions and has 4,000 employed and affiliated physicians who treated every imaginable injury and disease to one million patients range from new born to nonagenarian with all races, ethnicities, lifestyles and economic conditions annually. PH focused on ensures quality, provide consistency and continuity of care across the entire network, to deliver care with the highest levels of efficiency and economy, and maintain respect for patients and staff. PH’s patchwork IT infrastructure is in critical condition, so it has major IT infrastructure problems. CEO of PH Max Berndt is trying to find the right solution. He has an option to go with a single set of systems and applications (Monolithic System) that will provide consistency across PH’s facilities but may not give doctors enough flexibility or he can choose service-oriented architecture (SOA), a modular design that will allow PH to standardize incrementally and selectively but poses certain risks as a newer technology. Current challenges for PH are:

* Pressure to standardize processes/practices
* Incompatible current technology with future goals
* High maintenance costs for current IT system/Recent meltdown of clinical information system
* Seeking competitive advantage
* Conflicted support for IT-based innovation
* Several institutions with unique doctor-oriented identities CRITERIA:

The main problems with the existing system and goals for the future system identified as below: * Keeping all the different systems running with acceptable up-time and performance is a strain on the IT department: “the IT infrastructure was consuming so much maintenance energy that further innovation was becoming a luxury”. * Sharing of patient records, ensuring quality, consistency, and continuity of care across the entire network of hospitals and physicians. * Selective standardization of certain medical procedures across the network but allows sufficient flexibility to individual hospitals and professionals in other areas. The objective of PH is to offer all kinds of treatments (i.e. ancillary clinics, physician practices, rehabilitation facilities, trauma centers, and nursing homes) so patients’ care would be continued without any disruption. Nowadays healthcare’s trend is to have a network of clinics instead specialization ones. PH should focus on ensures quality, provide consistency and continuity of care across the entire network, to deliver care with the highest levels of efficiency and economy, and maintain respect for patients and staff. So these are important to the stakeholders of PH: employees, patients and their family, business partners, and board of directors. ALTERNATIVES AND RECOMMENDATION

There are two options to address the current problems and meet future objectives: * Arrange a monolithic system that will be much more
manageable but will also standardize the business processes across the network * Apply Service Oriented Architecture (SOA) which will enable selective standardization Proposed IT Systems for PH: SOA Vs Monolithic Systems

Pros of SOA:
* Easy to use Web services
* Quickness/replace old system overtime
* Flexibility to go after selective standardization
* Can attempt on a limited scale/move slowly to reduce risk
* Full advantage of the legacy system’s functionality
Cons of SOA:
* Immature SOA market/New to market/no industry track record
* Risk of becoming victim of ongoing learning curve
* No one else is aggressively adopting SOA
* Difficult to estimate time to achieve progress

Pros of Monolithic System
* Gets the job done
* Creates new consistent infrastructure
* Single set of systems that unifies every thing
* PH can become a single institution with multiple sites

Cons of Monolithic System
* High cost:500 million to a billion dollars
* Difficult to estimate true cost
* Require redesign of every business process

Evaluating pros and cons of both SOA and monolithic system, SOA seems less expensive in the long run than the monolithic system. CEO Max Berndt does not like the basic force to make homogeneous across the network hospitals, especially for non-routine stuff. So, he considers applying SOA as a new information system. Monte Ford, Sr. VP/CIO of American Airlines, recommends SOA and mentioned as “the company doesn’t have the luxury of waiting for a lot more certainty; its infrastructure needs a solutions now”. Likewise Randy Heffner, a VP at Forrester Research also recommends SOA. The interesting thing to note is that none of the experts recommend a monolithic system on case commentary. It is recommended PH to apply SOA because of low costs, easy to use, flexible and low time consuming. RISK MANAGEMENT PLAN

While applying SOA, there is a risk of uncertainty whether it works properly or not. So, we can say “it might work”. Since SOA is untested in a health care environment, the cost is undetermined, and the benefits are uncertain. PH management must clarify its overall IT strategy and they should be closely involved in developing and finalizing that strategy in order to minimize risk of uncertainty. PH should gradually replace its old systems with SOA, dividing the transformation into calculated, well-prioritized portions. This incremental approach would both minimize risk and enhance flexibility and control, allowing IT to shift priorities along the way. SOA’s modular approach to business design would best meet PH’s need for flexibility. SOA-based design doesn’t require Web services; together they their benefits provide strong potential for business integration and flexibility. Since SOA is a new product category, it is better viewed as a methodology. There is a risk of brutal standardization but SOA’s modularity provides a range of standardization choices, allowing PH to replace only the most broken parts of its existing technology base.