From Good to Great – DNA of a Successful Leader (PART II)

Rajeswari S

Before you are a leader, success is all about growing yourself. When you become a leader, success is all about growing others” – Jack Welch

In my previous article, I wrote about a few qualities that make for a good leader. In this article, I discuss a few ways in which a leader can become great from good.

  1. Seek to understand and be understood: Seeking feedback and taking criticisms is not an easy task for anyone. When you are holding a leadership position and people look up to you, it is even more difficult. But a true leader does exactly that and does it HONESTLY. A good leader focuses on the needs of others. When you are open to feedback and constructive criticism, you have the right to give the same to others. Make genuine efforts to listen when your team speaks. Great leaders listen first, speak second.
  1. Be there: Being there is just not about being the center of attention. You need to be there for your people during critical times and help members across your organization find solutions to roadblocks. Mentorship is an art. Your people should accept you as their mentor and gaining that space is not as easy.
  1. Demonstrate empathy and compassion: This quality is an extension of the previous point. When you are laser-focused on your goals, it can be difficult to focus on the needs of others around. You need to know not only how your actions affect people, but what you need to do to show understanding and sympathy for others.
  1. Get curious: Leaders are often driven with an insatiable desire to learn; they push the limits of what’s possible and explore opportunities as a continuous process. Expanding your mind can often be as simple as reading and asking ‘why’ more often. Curiosity can help you to get to the root of a problem and promote better ideas and thoughts. Leaders think and embrace others’ ideas. A correctly asked question with the right intention could lead to many opportunities and achievements.
  1. Be in the know: Leaders go out of their way to stay educated and up-to-date. Intentional learning is a continuous process of acquiring, understanding information with the goal of making yourself more intelligent and prepared on a specific subject. People cannot always see your work, it is how you talk that creates the first impression. When you make an informed or up-to-date speech, you get the edge over others.
  1. Enjoy the ride: Smart leaders know that their journey is often more rewarding than their destination. Which is why they take the time to enjoy life and what they have already achieved because they know nothing can last forever. When you can enjoy the journey, you’ll be amazed by what you can learn. A great leader embraces each day as an experience. They grow every day!
  1. Celebrate and Connect: Leaders working toward a brighter future share their success with the people they care about – business partners and customers, family and friends, employees, and their families, etc. Great leaders celebrate other’s victory as their own; this creates a high-performing team and culture. A true captain takes time to know about the people around her and their lives. It goes a long way in running not only a successful business but a happy one too!
  1. Pursue new experiences: Mountains are interesting to watch and hike. Why? Because of its rugged terrain and unpredictable nature. Straight roads are boring, that is why we sleep on a highway drive! An intelligent leader is never complacent and constantly pushes himself out of his comfort zone. To stay prepared for any bumps along the road, leaders actively pursue new experiences that allow them to learn and grow. From starting a new venture to coaching a little league to diversifying the business.

Unique brands of Leadership

A quick look at successful CEOs, new-age entrepreneurs, and their unique leadership mantras:

Ø  Sundar Pichai, CEO, Alphabet Inc. and its subsidiary Google LLC

Leadership mantra:

  1. Never forget your roots
  2. Focus more on others’ success than your own
  3. Empower the youth
  4. Stay humble and keep learning

Ø  Bill Gates, Founder, Microsoft

Leadership mantra: 

  1. Knowledge is different from wisdom
  2. Take a step-by-step approach to make progress towards your vision
  3. Empower people to create new opportunities to explore ideas; Embrace creativity
  4. Be caring and passionate

Ø  Suchi Mukherjee, CEO, Limeroad, an Indian online marketplace
Leadership mantra: True leadership is about enabling the voice of the youngest team member.

Ø  Amit Agarwal, CEO, NoBroker, a real estate search portal
Leadership mantra: Leaders provide employees the opportunity to be leaders themselves.

References   

About the Author –

Rajeswari is part of the IP team at GAVS. She is involved in technical and creative content development for the past 13 years. She is passionate about music and writing and spends her free time watching movies or going for a highway drive.

 

Tuning Agile Delivery for Customer and Employee Success

Ashish Joseph

What is Agile?

Agile has been very popular in the software development industry for empowering delivery to be more efficient and effective. It is a common misconception for Agile to be thought of as a framework or a process that follows a methodology for software development. But Agile is a set of values and principles. It is a collection of beliefs that teams can use for decision making and optimizing project deliveries. It is customer-centric and flexible, helping teams adapt accordingly. It doesn’t make the decision for the team. Instead, it gives a foundation for teams to make decisions that can result in a stellar execution of the project.

According to the Agile Manifesto, teams can deliver better by prioritizing the following over the other.

  • Individuals and Interactions over process and tools
  • Working Model over Comprehensive Documentation
  • Customer Collaboration over Contract Negotiation
  • Responding to Changes over following a Plan

With respect to Software Development, Agile is an iterative approach to project management which help teams deliver results with measurable customer value. The approach is designed to be faster and ensures the quality of delivery that is aided with periodic customer feedbacks. Agile aims to break down the requirement into smaller portions, results of which can be continuously evaluated with a natural mechanism to respond to changes quickly.

AIOps Artificial Intelligence for IT Operations

Why Agile?

The world is changing, and businesses must be ready to adapt to how the market demands change over time. When we look at the Fortune 500 companies from 1955, 88% of them perished. Nearly half of the S&P 500 companies is forecasted to be replaced every ten years. The only way for organizations to survive is to innovate continuously and understand the pulse of the market every step of the way. An innovative mindset helps organizations react to changes and discover new opportunities the market can offer them from time to time.

Agile helps organizations execute projects in an everchanging environment. The approach helps break down modules for continuous customer evaluation and implement changes swiftly.

The traditional approach to software project management uses the waterfall model, where we Plan, Build, Test, Review and Deploy. But this existing approach would result in iterations in the plan phase whenever there are deviations in the requirement with respect to the market. When teams choose agile, it helps them respond to changes in the marketplace and implement customer feedback without going off the plan. Agile plans are designed in such a manner to include continuous feedback and its corresponding changes. Organizations should imbibe the ability to adapt and respond fast to new and changing market demands. This foundation is imperative for modern software development and delivery.

Is Agile a right fit for my Customer? People who advocate Agile development claim that Agile projects succeed more often than waterfall delivery models. But this claim has not been validated by statistics. A paper titled “How Agile your Project should be?” by Dr. Kevin Thompson from Kevin Thompson Consulting, provides a perspective from a mathematical point of view for both Agile and Waterfall project management. Here both approaches were followed for the same requirements and were also affected by the same unanticipated variables. The paper focused on the statistical evidence to support the validity of both the options to evaluate the fit.

While assessing the right approach, the following questions need to be asked

  • Are the customer requirements for the project complete, clear and stable?
  • Can the project effort estimation be easily predicted?
  • Has a project with similar requirements been executed before?

If the answer to all the above questions are Yes, then Agile is not the approach to be followed.

The Agile approach provides a better return on investment and risk reduction when there is high uncertainty of different variables in the project. When the uncertainty is low, waterfall projects tend to be more cost effective than agile projects.

Optimizing Agile Customer Centricity

Customer centricity should be the foundation of all project deliveries. This help businesses align themselves to the customer’s mission and vision with respect to the project at hand. While we consider an Agile approach to a project in a dynamic and changing environment, the following are some principles that can help organizations align themselves better with their customer goals.

  • Prioritizing Customer Satisfaction through timely and continuous delivery of requirements.
  • Openness to changing requirements, regardless of the development phase, to enable customers to harness the change for their competitive advantage in the market.
  • Frequent delivery of modules with a preference towards shorter timelines.
  • Continuous collaboration between management and developers to understand the functional and non-functional requirements better.
  • Measuring progress through the number of working modules delivered.
  • Improving velocity and agility in delivery by concentrating on technical excellence and good design.
  • Periodic retrospection at the end of each sprint to improve delivery effectiveness and efficiency.
  • Trusting and supporting motivated individuals to lead projects on their own and allowing them to experiment.

Since Agile is a collection of principles and values, its real utility lies in giving teams a common foundation to make good decisions with actionable intelligence to deliver measurable value to their customers.

Agile Empowered Employee Success

A truly Agile team makes their decisions based on Agile values and principles. The values and principles have enough flexibility to allow teams to develop software in the ways that work best for their market situation while providing enough direction to help them to continually move towards their full potential. The team and employee empowerment through these values and principles aid in the overall performance.

Agile not only improves the team but also the environment around which it is established by helping employees to be compliant with respect to audit and governance.  It reduces the overall project cost for dynamic requirements and focuses on technical excellence along with an optimized process for its delivery. The 14th Annual State of Agile Report 2020 published by StateofAgile.com surveyed 40,000 Agile executives to get insights into the application of Agile across different areas of enterprises. The report surveyed different Agile techniques that contributed most towards the employee success of the organization. The following are some of the most preferred Agile techniques that helped enhance the employee and team performances.

Best AI Auto Discovery Tools

All the above Agile techniques help teams and individuals to introspect their actions and understand areas of improvement in real time with periodic qualitative and quantitative feedback. Each deliverable from multiple cross functional teams can be monitored, tracked and assessed under a single roof. All these techniques collectively bring together an enhanced form of delivery and empower each team to realize their full potential.
Above all, Agile techniques help teams to feel the pulse of the customer every step of the way. The openness to change regardless of the phase, helps them to map all the requirements leading to an overall customer satisfaction coupled with employee success.

Top 5 Agile Approaches

Best AIOps Platforms Software

A Truly Agile Organization

Majority of the Agile approach has been concentrated towards development, IT, and Operations. However, organizations should strive towards effective alignment and coordination across all departments. Organizations today are aiming for greater expansion of agility into areas beyond building, deploying, and maintaining software. At the end of the day, Agile is not about the framework. It is all about the Agile values and principles the organizations believe in for achieving their mission and vision in the long run.

About the Author –

Ashish Joseph is a Lead Consultant at GAVS working for a healthcare client in the Product Management space. His areas of expertise lie in branding and outbound product management. He runs a series called #BizPective on LinkedIn and Instagram focusing on contemporary business trends from a different perspective. Outside work, he is very passionate about basketball, music, and food.

Happy Birthday MLK – My ode to the Free Thinkers, Disruptors, and Iconoclasts

Sumit Ganguli

CEO, GAVS Technologies

While we were gearing up for the weekend, I noticed that Monday, January 18, is Rev. Martin Luther King Jr.’s birth anniversary. This coupled with the overcast sky and cool winter day all conspired to make me sit back and reminisce about the events of the past few months.

Working from home, I have become accustomed to keeping my TV on mute, alternating between CNN and Fox News while I go through my emails, video conferences and other work routines. And that is when I saw the traumatic video of George Floyd’s death in Minneapolis and the massive demonstrations that ensued across the US and in other parts of the world. The Black Lives Matter movement rightfully gained immense momentum and soon #BlackLivesMatter became one of the most trending of all hashtags.

An avid tennis fan, I got to watch the US Open on TV this year, being played without any spectators.  But I was most inspired by the young Japanese tennis player, Naomi Osaka who went on to win the US Open and decided to draw attention to the #BLM by wearing the names of seven black victims who were being memorialized by the BLM movement. She succeeded in persuading me to read more about the movement and many of the victims.    

Cut to the present, we now have our first Black Vice President elect Kamala Harris who is of Jamaican and Indian heritage. Just the other day, my 90-year-old mother who is in Bangalore and is quite a political junkie, challenged me to name the Indian lady who was announced to be a member of Mr. Joe Biden’s economic committee. Convinced that my Mother was mistaken, I told her that Janet Yellen was not Indian. But she insisted and then I recalled that Ms. Neera Tanden has been nominated to head the Office of Management and Budget.

The Indian diaspora has been deservedly proud of the achievements of the Indian leaders in America – Satya Nadella, Microsoft; Arvind Krishna, IBM; Ajay Banga, Mastercard; Nandita Bakshi, Bank of the West & Federal Reserve Bank; Sanat Chattopadhyay, Merck; Niren Chaudhury, Panera Bread – and with Reverend Martin Luther King’s birth anniversary round the corner, I think it is  opportune for us to celebrate the avantgarde Free thinkers, Disruptors, and Iconoclasts, who made this possible for some of this happen.  

In the morning, I bathe my intellect in the stupendous and cosmogonal philosophy of the Bhagvat Geeta, since whose composition years of the Gods have elapsed, and in comparison with which our modern world and its literature seem puny and trivial…The pure Walden water is mingled with the sacred water of the Ganges” (Thoreau, Walden).

In 1854’s Boston, Henry David Thoreau and Ralph Waldo Emerson, derived a lot of their concept of Transcendentalism, Non-Violence, and Civil Disobedience from the concepts of Ahimsa and Dharma from the ancient Indian scriptures, the Upanishads and the Gita. They read this at the Harvard Library and wrote extensively about it.

In 1893, a man got thrown out of a train in South Africa, which led him to take on the mighty British and launch his Satyagraha movement to fight for India’s independence. His movement in turn was highly influenced by Thoreau’s Civil Disobedience. That man, of course is known around the world as Mahatma Gandhi. 

From 1954 to 1968, Rev. Martin Luther King Jr. and other activists launched the Civil Rights Movement in America. He drew inspiration from Gandhi’s philosophy who has been immortalized as the Father of the Nation in India. This is truly a circle of ideas that traversed oceans and continents.

Today, we are all beneficiaries of largesse of the thoughts and visions of these great luminaries. On MLK’s birthday, Monday, January 18, I believe we will be well served to pay our ode to the Reverend and his fellow free thinkers John Lewis, Rosa Parks, and many others for their audacious vision, temerity, and currency of ideas and ideals –  for these disruptors, iconoclasts made it possible for us to live the life of our dreams in America, a country that we have come to love and cherish.  

Vision for 2021

Sumit Ganguli

CEO, GAVS Technologies

God, grant me the serenity to accept things, I cannot change,

Courage to change the things I can,

And the wisdom to know the difference.

The events of 2020 have reaffirmed in me the ethos conveyed by this stanza, from the Serenity Prayer.

For us, COVID has been up close and personal. One of our key clients, Bronx Care Hospital has been an epicenter of the pandemic in New York City. The doctors, staff and support staff, including GAVS’ IT support engineers have experienced the devastating effect of this pandemic, up close and personal. GAVS’ technical team supported the ICUs and patient care units at the hospitals during the peak of pandemic.

“Every day we witness these heroic acts: one example out of many this week was our own Kishore going into our ICU to move a computer without full PPE (we have a PPE shortage). The GAVS technicians who come into our hospital every day are, like our doctors and healthcare workers, the true heroes of our time.”

Ivan Durbak, CIO, BronxCare Health System

“GAVS Team was instrumental in assisting the deployment of digital contact less care solutions and remote patient monitoring solutions during the peak of COVID. Their ability to react in quick time really helped us save more lives than what we could have, with technology at the fore-front.”

Dr. Sridhar Chilimuri, Chairman, Dept. of Medicine, BronxCare Health System

The alacrity with which our colleagues in India addressed the remote working situation and the initiative that they have demonstrated in maintaining business continuity for the clients in the US have inspired us at GAVS and  have reaffirmed our belief that we are on the way to create a purposeful company.  

The biggest learning from 2020, is that we need to be mindful of the fragility of life and truly make every day count. At GAVS, we are committed to use technology and service for the betterment of our clients and our stakeholders; and anchor this with our values of Respect, Integrity, Trust and Empathy.

The year was not without some positives. Thanks to some new client acquisitions and renewed contracts we have been able to significantly expand the GAVS family and have registered a 40% growth in revenue. 

We have formed Long 80, A GAVS & Premier, Inc. JV and have started reaching out to Healthcare providers in the US. We are reaching out to some of the largest hospitals in North America offering our AI-based Infrastructure Managed Services, Cybersecurity solutions, Prescriptive and Predictive Healthcare Solutions based on Analytics.

“Moving from a vendor-only model with GAVS to a collaborative model through Long 80 expands Premier’s current technology portfolio, enabling us to offer GAVS’ technology, digital transformation and data security services and solutions to US healthcare organizations. We are extremely excited about this opportunity and look forward to our new relationship with GAVS.”

Leigh Anderson, President, Performance Services, Premier, Inc.

This year, we see the Premier team growing by an additional 120 persons to continue to support their initiative to reduce costs, improve efficiency, enhance productivity and faster time to market.

We aim to hit some milestones in our journey of enabling AI-driven Digital Transformation in the Healthcare space. We have constituted a team dedicated to achieving that.

We are contemplating on establishing the GAVS Healthcare Institute in partnership leading institutions in India and US to develop competency within GAVS in the latest technologies for the healthcare space.

GAVS is committed to being a company focused on AI, and newer technologies and promote GAVS’ AI led Technology Operations, Zero Incident Framework. In 2021, we will work on increasing our ZIF sites around the US and India.  

Based on inputs from our Customer Advisory Board, we at GAVS would like to build a competency around Client Relationship and empower our Client Success Managers to evolve as true partners of our Clients and support their aspirations and visions.  

GAVS is also making strong progress in the BFS sector and we would like to leverage our expertise in AI, Blockchain, Service Reliability and other digital technologies.

GAVS has the competency to support multiyear contracts and there will be a push to reach out to Sourcing Companies, Influencers and partners to garner these long-term predictable business.

We will continue to build competency and expertise around Innovation, and there are some initiatives that we will be putting in place to promote a Culture of Innovation and have measurable successes under Novelty of Innovation.

Our experience of 2020 has inspired us to once again remind ourselves that we should make GAVS an aspirational company, a firm that is purposeful and anchored with our values.

Why is AIOps an Industrial Benchmark for Organizations to Scale in this Economy?

Ashish Joseph

Business Environment Overview

In this pandemic economy, the topmost priorities for most companies are to make sure the operations costs and business processes are optimized and streamlined. Organizations must be more proactive than ever and identify gaps that need to be acted upon at the earliest.

The industry has been striving towards efficiency and effectivity in its operations day in and day out. As a reliability check to ensure operational standards, many organizations consider the following levers:

  1. High Application Availability & Reliability
  2. Optimized Performance Tuning & Monitoring
  3. Operational gains & Cost Optimization
  4. Generation of Actionable Insights for Efficiency
  5. Workforce Productivity Improvement

Organizations that have prioritized the above levers in their daily operations require dedicated teams to analyze different silos and implement solutions that provide the result. Running projects of this complexity affects the scalability and monitoring of these systems. This is where AIOps platforms come in to provide customized solutions for the growing needs of all organizations, regardless of the size.

Deep Dive into AIOps

Artificial Intelligence for IT Operations (AIOps) is a platform that provides multilayers of functionalities that leverage machine learning and analytics.  Gartner defines AIOps as a combination of big data and machine learning functionalities that empower IT functions, enabling scalability and robustness of its entire ecosystem.

These systems transform the existing landscape to analyze and correlate historical and real-time data to provide actionable intelligence in an automated fashion.

Data Center Migration Planning Tools

AIOps platforms are designed to handle large volumes of data. The tools offer various data collection methods, integration of multiple data sources, and generate visual analytical intelligence. These tools are centralized and flexible across directly and indirectly coupled IT operations for data insights.

The platform aims to bring an organization’s infrastructure monitoring, application performance monitoring, and IT systems management process under a single roof to enable big data analytics that give correlation and causality insights across all domains. These functionalities open different avenues for system engineers to proactively determine how to optimize application performance, quickly find the potential root causes, and design preventive steps to avoid issues from ever happening.

AIOps has transformed the culture of IT war rooms from reactive to proactive firefighting.

Industrial Inclination to Transformation

The pandemic economy has challenged the traditional way companies choose their transformational strategies. Machine learning-powered automations for creating an autonomous IT environment is no longer a luxury. The usage of mathematical and logical algorithms to derive solutions and forecasts for issues have a direct correlation with the overall customer experience. In this pandemic economy, customer attrition has a serious impact on the annual recurring revenue. Hence, organizations must reposition their strategies to be more customer-centric in everything they do. Thus, providing customers with the best-in-class service coupled with continuous availability and enhanced reliability has become an industry standard.

As reliability and scalability are crucial factors for any company’s growth, cloud technologies have seen a growing demand. This shift of demand for cloud premises for core businesses has made AIOps platforms more accessible and easier to integrate. With the handshake between analytics and automation, AIOps has become a transformative technology investment that any organization can make.

As organizations scale in size, so does the workforce and the complexity of the processes. The increase in size often burdens organizations with time-pressed teams having high pressure on delivery and reactive housekeeping strategies. An organization must be ready to meet the present and future demands with systems and processes that scale seamlessly. This why AIOps platforms serve as a multilayered functional solution that integrates the existing systems to manage and automate tasks with efficiency and effectivity. When scaling results in process complexity, AIOps platforms convert the complexity to effort savings and productivity enhancements.

Across the industry, many organizations have implemented AIOps platforms as transformative solutions to help them embrace their present and future demand. Various studies have been conducted by different research groups that have quantified the effort savings and productivity improvements.

The AIOps Organizational Vision

As the digital transformation race has been in full throttle during the pandemic, AIOps platforms have also evolved. The industry did venture upon traditional event correlation and operations analytical tools that helped organizations reduce incidents and the overall MTTR. AIOps has been relatively new in the market as Gartner had coined the phrase in 2016.  Today, AIOps has attracted a lot of attention from multiple industries to analyze its feasibility of implementation and the return of investment from the overall transformation. Google trends show a significant increase in user search results for AIOps during the last couple of years.

Data Center Consolidation Initiative Services

While taking a well-informed decision to include AIOps into the organization’s vision of growth, we must analyze the following:

  1. Understanding the feasibility and concerns for its future adoption
  2. Classification of business processes and use cases for AIOps intervention
  3. Quantification of operational gains from incident management using the functional AIOps tools

AIOps is truly visioned to provide tools that transform system engineers to reliability engineers to bring a system that trends towards zero incidents.

Because above all, Zero is the New Normal.

About the Author –

Ashish Joseph is a Lead Consultant at GAVS working for a healthcare client in the Product Management space. His areas of expertise lie in branding and outbound product management. He runs a series called #BizPective on LinkedIn and Instagram focusing on contemporary business trends from a different perspective. Outside work, he is very passionate about basketball, music, and food.

Health Information Exchanges in Post-Pandemic Healthcare

Srinivasan Sundararajan

Electronic Health Information Exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically – improving the speed, quality, safety, and cost of patient care.

HIE enables electronical movement of clinical information among different healthcare information systems. The goal is to facilitate access to and retrieval of clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care.

While the importance of HIE is clearly visible, now the important question is how hospitals can collaborate to form an HIE and how the HIE will consolidate data from disparate patient information sources. This brings us to the important discussion of HIE data models.

HIE Data Models 

There are multiple ways in which an HIE can get its data, each influencing the way in which the interoperability goals are achieved, how easily an HIE platform is built and how to sustain in the long run especially if the number of hospitals in the ecosystem increases. The two models are

  • Centralized
  • De-centralized

Centralized HIE Data Model

ehr modernization services with healthcare data

This is a pictorial representation of centralized HIE data model.

As evident, in the centralized model, all the stakeholders send their data to a centralized location and typically a ETL (Extraction, Transformation, and Loading) process ensures that all the data is synced with the centralized server.

Advantages

  • From the query performance perspective, this model is one of the most efficient, because the DBAs have complete control of the data and with the techniques like partitioning, indexing they could ensure that the query can be done in the best possible manner. Since the hardware is fully owned by a single organization (which is the HIE itself), this can be scaled out or scaled up to meet the demands of the business.
  • This model is fairly self-sufficient once the mechanism for the data transfers are established, as the need to connect to individual hospitals are no longer there.
  • Smaller hospitals in the ecosystem need not take the burden of maintaining their data and interoperability needs and can just send their data to the centralized repository.
  • Better scope for performing population predictive and prescriptive analytics as the data resides in one place and easier to create models based on the historical data.

Limitations

  • This model needs to have highest level of security built in, because any breach in the system will compromise the data of entire ecosystem. Also considering that individual hospitals send their data to this model, all the responsibility lies with a single agency (HIE) which is highly prone to lawsuits related to data privacy and confidentiality.
  • There is no control for patients in managing their own records and right to provide consent for data access, even though this information can be collected there is no easy way to implement them.
  • The system is prone to a single point of failure and hence require efforts for high availability of the platform.
  • This model will face scalability challenges as the network grows beyond a point, unless the platform is modernized with latest big data databases, the system will have scalability issues.
  • Lot of coordination required to monitor the individual ETL jobs for their success, failure, and record synchronization details, so this model will have a huge allocation of IT resources and will increase the total cost of ownership.
  • The model of expense sharing between the HIE, data producers, data consumers will be difficult and needs to have a strong governance model.
  • Difficult to match the patient information across hospitals, unless the both the hospitals use deterministic matching attributes like SSN, otherwise it would be difficult to match between patients who have misspelt names, different addresses, etc.
  • This model may suffer data integrity issues when the participant hospitals merge with each other, such that the IT systems of the two hospitals need to take care the internal details of the ETL jobs.

De-centralized HIE Data Model

ehr modernization with health data management platforms

The above is the pictorial representation of decentralized HIE data model.

As evident, in this model individual hospitals, continue to own all their data, however, the centralized database keeps a pointer – MPI (Master Patient Index), which serves as a unifying factor for consolidating data for that patient. While some books also suggest a variant called Hybrid model which combines centralized and decentralized data models, we believe that pure play decentralized model itself is a hybrid (i.e. centralized + decentralized) because there needs to be a centralized repository to keep the master patient index along with all the access rights and related information.

Advantages

  • It is much easier to implement as no huge investment is required from a centralized provider perspective. The HIEs in this model can start low and grow on demand basis
  • Less expensive as no single organization owns all the data, but only a pointer to the data, and the respective hospitals continue to own the data.
  • Much easier to provide patients the control of their own data and patient’s consent can be a key in accessing information from the respective hospitals.
  • No need to worry about broken ETL jobs and the latency between source and destination. All the data is always current.
  • No need to worry about single point of failure, as the individual sub systems will continue to exist even if one link to a particular hospital is broken. Maintaining the high availability of this light-weight platform is much easier than a monolithic large database as part of a centralized data model.
  • A data breach into the centralized repository still will not compromise all the data, as the individual hospitals are likely to have some more additional controls which prevent a free flow for hackers. This also prevents one organization from facing all the legal issues resulting from patient data breach.

Limitations

  • This model will have a query performance problem when it comes to aggregating a patient information across multiple hospitals because each has to be obtained with a separate API call and a facade has to group multiple datasets.
  • Difficult to establish common standards in terms of data formats and APIs across multiple hospitals, this may result in each hospital having their own methods.
  • Bringing all the stakeholders including the patients to agree on a MPI (Master Patient Index) will have governance challenges and needs to be implemented carefully.
  • Providing analytics for a large set of population will have challenges due to the difficulties in consolidating the data.

GAVS Point of View & Role of Blockchain

While no model can be 100% perfect for building an HIE, GAVS’ analysis point to that fact decentralized model of building and operating HIE is better than centralized model.  The COVID pandemic has changed the world and the boundaries of healthcare no longer exist within a smaller geography or neighbourhood as it used to. More the participants and bigger the network size, the better it is for population health improvement initiatives. Also, in high population countries where there are initiatives like national healthcare for all, these larger initiatives cannot be done using a pure play centralized model.

From an implementation perspective, the Healthcare IT world has been curiously watching the role of Blockchain in data interoperability and in the implementation of decentralized HIE. Blockchain which is a distributed database has decentralization built-in as part of its core architecture. It would be easier to implement decentralized HIE using blockchain.

GAVS Reference Implementation Rhodium to cater to Healthcare Data Management and Interoperability has positioned Blockchain as a core mechanism for patient data sharing, we will share more of our thoughts and details of reference implementation in the coming articles in this series.

About the Author –

Srini is the Technology Advisor for GAVS. He is currently focused on Healthcare Data Management Solutions for the post-pandemic Healthcare era, using the combination of Multi Modal databases, Blockchain and Data Mining. The solutions aim at Patient data sharing within Hospitals as well as across Hospitals (Healthcare Interoprability), while bringing more trust and transparency into the healthcare process using patient consent management, credentialing and zero knowledge proofs.