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Governing Through Architecture

Explore the impact of architectural governance on inter-organizational systems in health care evolution, focusing on information flow, ICT architecture, and regulatory modalities. Case studies and critical questions shed light on architecture's role in governing and evolving these systems.

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Governing Through Architecture

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  1. Governing Through Architecture Ole Hanseth Department of Informatics University of Oslo, Norway

  2. Inter-organizational Systems/Information Infrastructures • Logistics chains • Banking and finance • …… • Health care • Between hospitals, GPs, labs, pharmacies, .. • Orders and reports, prescriptions, admission and discharge letters, .. • Telemedicine • Internet of Things/Wellfare technologies

  3. Regulatory modalities (Lessig)“Governance modalities” • Law • Social norms • Market (prices), organizing • Architecture/technology

  4. Critical question • What kind of architectures supports II (IOS) governance? • Governing IIs = II evolution = governing • Bootstrapping • Scaling • Adoption • Innovation • Restructuring

  5. Architecture - governance • Mirroring • Product – producer • Product – users • Implications: “conway’s law,” big companies => NOT( disruptive or architectural innovations) • Architectural control points • Platform/apps • Internet: End-2-end (+ open source licenses , flat network, ..)

  6. Health Care IIs: The EDI Paradigm Information flow ICT architecture Project organization Hospital systems VendorsofGPs’ EPR systems Vendors of hospital syst. GP offices Hospitals GPs’ EPR systems NAV systems NAV’s dev. org. Vendor of the Pharmacies’ system NAV Lab systems Vendors of Lab systems Pharmacies Labs Pharmacy systems

  7. ePrescription

  8. ePrescription • Several failed initiatives during the 90-ies • Started 2004 – after report from the Office of the Auditor General => solid funding • Profdoc joined – new EPR • Pilot 2008 – disaster • New pilot 2010 – successful • Crisis => Generic module for old Profdoc systems

  9. ….. continued … • GM deployment, “rollout” from 2012 • GM + DIPS 2012 in Bergen – rollout • DIPS and Profdoc integrated module • Siemens and other adopt GM • 2014 - : • Adding multi-dose dispencing • Messages v2.5

  10. A few other projects • Fürst • Lab report transfer solution, 1987, 3 man weeks + 1 evening • Lab ordering solution • Edimed, Northern Norwegian Health Network • Well/Dips Interactor • Interactive admission letters • BlueFox, Prescription register • MyJournal

  11. An alternative architecture GP GP office GP computer GP’s computer Client module GP’s EPR system Project org. Communication system/network Lab/hospital ICT architecture Project organization Server module Lab/hospital Lab system

  12. Two architectures Non-communicating applications INA Architecture SPA Architecture

  13. Two architectures • Application Centric/Institutional Interface Architecture (AC/INA) • Communication System Centric/Service Provider Architecture (CSC/SPA)

  14. The SPA Paradigm Hospital systems GPs’ EPR systems GP offices Hospitals Welfare Agency Systems National Welfare Agency Lab systems Pharmacy systems Pharma- cies Labs Project organization Information flow ICT architecture Vendors of hospital systems Vendorsof GPs’ EPR systems Project ASP Services ASP Welfare Agencydevel. org. Vendors Phar- macy system Vendors of Lab systems

  15. Summary Care Record Systems • Scotland: • 3 MGBP (4M Euros, 4 M USD) • Denmark: • Official, top-down • 10 M Euros, • Faded out after about 4 years, officially cancelled after 8 • Unofficial, bottom-up • Great success • Norway (ePrescription) • 500 MNOK, currently piloted in one GP office • UK • Started 2004, early adoption 2007, further deployment is frozen • Spent 240 MGBP

  16. Conclusion • Org – arch mirroring! • Different architectures for different evolutionary processes • CSCA: bootstrapping, innovation, restructuring • ACA: scaling and adoption

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