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July-August 2007 HBR Case Study: Monolithic Enterprise Software or SOA

The HBR Case Study in July-August 2007 issue Too Far Ahead of the IT Curve, authored by John P. Glaser, CIO of Partners Healthcare Systems and co-author of Managing Health Care Information Systems, presents the case of failing IT infrastructure of Peachtree Healthcare, "a federation of 11 hospitals of assorted sizes and special purposes, each with its own proud history and culture, and each with its own weird mishmash of IT systems of various vintages and vendor pedigrees".

The main problems with the existing system and goals for the future system identified in the study are:

  • 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 allow sufficient flexibility to individual hospitals and professionals in other areas.

Of course, these points are not so neatly laid out but are embedded within the story in a typical HBR case study style. I had to read it twice.

Two options are presented to address the current problems and meet future objectives:

  • Deploy a monolithic enterprise software system that will be much more manageable but will also standardize the business processes across the network. Peachtree Healthcare CEO Max Berndt does not like the brute force homogenization across the network hospitals, especially for non-routine stuff.
  • Adopt Service Oriented Architecture (SOA) which will enable selective standardization. Though the details are somewhat hazy -- are they talking about (a) integrating existing IT systems within various hospitals using SOA; or (b) completely replace the existing systems and build the equivalent functionality on top of SOA building blocks such as SOA capable App servers, registries, business process engines and so on. (a) will not address the up-time and performance problems being faced by individual hospitals. (b) will require a costly redesign and rewrite of systems, but will provide the desired flexibility and agility.

As usual, the expert opinions on this case are varied: George C. Halvorson, the chairman and CEO of Kaiser Permanente, is concerned that the CIO of Peachtree is not enthusiastic about about SOA and recommends more work around defining the vision and identifying the objectives. Typical CEO speak, but it might help the CIO in better understanding the pros and cons of the two options. Monte Ford, senior VP and CIO at American Airlines, recommends SOA based on his experience in adopting SOA. Randy Heffner, a VP at Forrester Research, makes the comment that "by goofing around SOA as a product category instead of looking at it as a methodology, the CIO has missed key perspectives" and recommends SOA. John A Kastor, a professor of medicine at the Univ. of Maryland School of Medicine, agrees with Peachtree CEO Max that indiscriminate standardization of all medical processes is not the right thing to do, but offers no choice for IT infrastructure modernization.

The interesting thing to note is that none of the experts recommend a monolithic enterprise software system.

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