Silos Are For Farms, Not Healthcare IT Departments


Years ago, an Indiana Jones-type archeologist came across an ancient text showing an ancient grain silo in Greece around the 8th century B.C.  The word comes from the Greek “Siros,” described as a pit for holding grain.  Flash forward almost 2900 years and some in the healthcare IT world would say that the word has taken on a new meaning.  Silos have become technology barriers to patient care.

Whether it be a large hospital or small independent practice, the refrain from clinicians is much the same; IT has become a necessary evil in patient care delivery. The Healthcare industry has made significant investments in software and infrastructure to comply with regulatory guidelines. With the prospects of Population Health shaping the industry’s future, IT departments must be prepared to embrace further infrastructure changes that will allow more flexible access to data and on-demand environments to create new services.

This is much easier said than done and requires IT leaders to take a strategic look at how IT organizations are structured to foster necessary innovation. That begins by taking down the silos.

“But We’ve Always Done it that Way”

Functional disciplines and the siloed walls that go with them have divided healthcare IT departments organically over time: the virtualization guys only talk to the storage guys when they’re carving up the capital expense budget pie or provisioning infrastructure. The folks in networking want little to do with the service desk, while security and application delivery stay focused on their functional disciplines. While this alignment may foster expertise in each area, it creates silos of communication and leadership. When new technologies emerge that blur the boundaries between the disciplines or require substantial changes across them, it can be extremely difficult to even explore those technologies, regardless of their value to improve physician satisfaction, patient care, or even reduce cost.

-Organizations built around technology disciplines create isolated functions and management that inhibit cross-functional communication and innovation. This is a significant barrier to the review and adoption of new solutions in Healthcare.

Disruptive technologies have extraordinary impact, but their very nature creates operational and political challenges. A pertinent example is virtualization itself. The value proposition was outstanding: compelling capital and operating savings, and the impact to availability and change management to support growth had a measurable impact on application availability. Despite these benefits, many organizations saw slow adoption due to challenges across technology disciplines (chiefly server, storage, and networking) who all had to learn new vocabularies and engage in a more collaborative fashion to design, build, and operate the platform. In many cases, this change was facilitated by changes in leadership and the creation of a Virtualization Team with expertise in the relevant disciplines.

Almost identical challenges exist today with several new capabilities and service delivery models: Mobility, Software-defined Networking and Security, Software-defined Storage, and Cloud strategies. Successful adoption requires substantial collaboration and new responsibilities for existing staff.

Solution: Build Cross-Functional Teams

For Software as a Service providers, the business and technology platform are inseparable, and long-term success requires that the infrastructure and operating platform evolve to leverage the best technologies that enable accessibility, availability, and security in the most efficient manner while controlling cost. These technology companies build innovation and operational excellence into their very structure.

-Organizations that are built to support application and infrastructure lifecycle management using cross-functional teams are better equipped to evaluate and implement new solutions that lead to greater return on capital, lower operating expense, and superior clinical experiences.

Instead of technical silos, evolving infrastructure groups leverage cross-functional teams focused on application lifecycle stages: Architecture and Engineering. Each team has experts in the traditional technical disciplines, but the structure requires collaboration and cross-education to succeed: experts in individual areas educate the rest to evaluate new solutions and develop new infrastructure and application models. As new technologies are selected and new designs chosen, there is tight collaboration with the Engineering team to build the infrastructure ensure intelligent monitoring and feedback are part of the design.

Architecture is the single most important high level concept in an IT Organization today. The primary purpose of the architecture team in total is to innovate: to evaluate solutions that might better serve the delivery of care and the efficient operation of clinicians regardless of the technical discipline. They review technologies through evaluation and small pilots in close collaboration with clinicians and other stakeholders.

They answer important questions: How can we better serve clinicians and address their mobility needs? How can we enable service delivery to patients on their own devices? How can we effectively deliver applications as a service to affiliates and partners? What new security capabilities are required to address a complex communications and regulatory environment? What is the right solution for newly acquired clinics and remote users? How do we handle multiple-os clients and user-owned devices? What is the value of Business Continuity, and how can it best be made available to application owners? What does the next generation of our infrastructure look like? When should we select Software as a Service over on-premises operations?

Engineering builds next generation infrastructure, owns change management, and break-fix. The Engineering team works with Architecture on pilots to begin operationalization of new solutions and ensure necessary infrastructure changes are implemented smoothly. When composed of members who are experts in a broad range of technical disciplines, the team as a whole can develop a more comprehensive understanding of the operating environment, which improves design and reduces time to overcome complex challenges that continually encompass more of the traditional technical disciplines.

Operational Excellence is achieved here through break-fix, monitoring, support, and feedback to Architecture to resolve issues in the platform and application stack. The support function is essential to the feedback loop: understanding the clinical challenges as a function of training, infrastructure, or application issues so the solutions can be quickly developed and implemented. This team needs an integrated understanding of the entire environment and access to sophisticated and comprehensive monitoring solutions to ensure that problems with infrastructure and applications can be observed and mitigated before affecting a service delivery. In the event of service interruptions, their multi-disciplined structure expedites restoration with feedback to Architecture and Engineering for relevant design changes.

Don’t Lose Focus

Those of us in healthcare IT need no primer on the need for continual innovation. Cross functional teams tasked with designing, building, and running the next generation infrastructure will build platforms for success and ensure the continued advancement of care delivery and new services to support it. Creating an organization of dedicated innovators and multi-talented staff makes better use of resources and will realize next generation solutions sooner, rather than later.

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