Launching

In healthcare IT I sometimes feel we see governance best practices as a way to "customer as king". Combined with tight budgets and multiple priorities this gives us a good way to align with the patients, physicians and other customers that we support. It also keeps us in a supporting actor role. We don't often have the lead role. The times are a changing though.

I've been spending a lot of time thinking about architecture lately, and not the baroque kind. I've watched our HIS applications evolve from monolithic mainframe apps (PCS on a Tandem) to open n-tier architectures that separate the data, business logic and presentation layers. It's exciting to watch. One of my favorites is an emergency room app by Picis. I remember standing up an old version and being excited to see that it was built out of Apache and Perl. It's architecture lent itself to our ability to deploy it with load balanced redundancy for the presentation layer and clustering for the data layer. This opportunity allowed us to deploy it across several emergency rooms without having to purchase totally separate infrastructure.

That is the kind of opportunity that a well considered architecture will provide for you. Yesterday I attended a meeting where an extremely complex report specification was being worked out. Part of the report requires the aggregation of data that is easy to extract at a point in time but not pull retrospectively. Fortunately our DBA team and our report writers have agreed to a set of best practices that include the development of stored procedures behind the crystal reports. Again architecture comes to the rescue because the aggregation of the snapshot data is easy to accomplish by modifying the stored procedure to save the results in a timestamped custom table.

Many of the vendors we work with still consider their architectures proprietary (even though they are built on open systems) or the separation between development and implementation is stark enough that their support can't answer questions about how the app is built.

The punchline is that good architecture can make or break new opportunities. It can launch IS out of the supporting actor role into the emmy winning lead spot. Architecture can accelerate service delivery and new architecture is being developed every day. I think there are two challenges to unlocking it. First, choosing the right elements so that they create rather than restrain opportunities. Second, capturing and selling the value of nuts and bolts that can make the delivery of service so much easier and faster. A third just occurred to me. That is making sure that we have the right organization and processes in place to deliver.

We have the right talent in place to help us with the first and most of the third. The second is vexing to me at times. Initiatives get off the ground with the help of a lot of players. Launching the right projects is the key to a better life through architecture.