Why is Healthcare Architecture so Difficult to do?
Some random thoughts trying to think through why Health-care Architecture is unique or, maybe, not. Maybe architecture is very difficult because of the many elements needed for an architecture are not in place in the health care domain or maybe the complexity or maybe the politics or….
The difficulty in knowledge management modeling the health domain is caused partially by using a closed world assumption (closed data model) instead of an open world assumption (open data model). More on this later.
The health care economic model is different than many other domains. There is an insured patient who is indirectly the payer for the service; or if not an insured payer, the patient pays directly or the government/charity pays. The service provider, (e.g. clinician, hospital, the clinical support staff) provides a service where they are paid for each provided-service or pro bono, or in some cases (e.g. Mayo, Cleveland Clinic or …) in salary. There is the Payor who is trying to make a profit while acting as a middle-man between the patient and the provider. There is the supplier of a device or a medication that also has a profit motive. There is the Pharmacist who is the interpreter of the prescription interactions. There is the state and Federal govement agencies such as Medicare, FDA. The prospect of being sued creates problems. The role of professional groups impacts on the situation.
That potentially a human life that can be impacted in some why by a decision or something that impacts a decision is a major concern. Reliability is a major factor. Performance in real time is a major factor in many situations.
Privacy and security of the decision impacting data is a more immediate issue for the patient than in day to day actions, or what may impact on his job. But is the security of health information more critical than a saving’s account pin #? It of course depends on the context. If the health breach causes health harm to the patient this is a critical breach.
The complexity of the context (system of systems, emergent behavior, competing entities, conflicting economic motives) which provides services to the the patient. The role of the provider is based on helping the patient and still making a reasonable profit.
The politics of supply and demand, payment and turf issues.
The inconsistency and conflicting views of data across domains adds complexity. The priority of needs across disciplines. Technically, interoperability is a hard problem.
So is healthcare architecture just harder than other domains because of complexity or is the orientation so different?
