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CIOs tasked to make healthcare infrastructure composable

Healthcare is already on the path to becoming composable. The next steps, however, will present challenges and require good stewardship from CIOs, according to Gartner.

To Gartner, the future of healthcare is composable -- not just from an infrastructure perspective, although that's part of it, but from a business and cultural perspective as well.

At a high level, the intent behind a composable healthcare organization is to make infrastructure, business capabilities and thinking as modular as possible so that healthcare organizations can quickly adjust -- or recompose -- their business and organizational models to keep pace with market changes.

A composable healthcare infrastructure will mean giving up monolithic IT applications such as claims processing systems or the mega suite of EHRs healthcare organizations have invested in and grown accustomed to, according to Jeff Cribbs, research vice president of Gartner's healthcare strategy group.

They'll trade them in for packaged business capabilities (PBCs), "collections of APIs that accomplish a business or clinical function that's recognizable as such by a nontechnical user," Cribbs said during his talk at the virtual 2020 Gartner IT Symposium/Xpo.

Jeff Cribbs, research vice president, Gartner's healthcare strategy groupJeff Cribbs

The good news for CIOs is that healthcare infrastructure is already on its way to becoming composable -- Cribbs pointed to their growing adoption of cloud computing as one indicator. The not-so good news is that CIOs will face challenges, which include breaking down the silos of traditional, monolithic applications and creating closer relationships with business partners.

In this Q&A, Cribbs talks about composability, PBCs and the necessary influence of the healthcare CIO.

What is the composable healthcare organization?

Jeff Cribbs: The composable healthcare organization is a healthcare organization that can reconfigure its capabilities -- both its business and operating model -- at the pace of market change.

We have lived in a world and in an industry where there's been stable business and operational models. If you're a provider organization or a payer organization or a life sciences company, those heritage business models have been pretty stable. That's in terms of how organizations think, their culture, the way their business is architected -- so the organizational structures, the way they collaborate, all the way down to the way we've architected technology. They've really done that in service of a relatively stable business and operating model.

What we're marking here are three main points. On a very simple level it's this: Adaptability is more important than ever, adaptability is more possible than ever, adaptability can be done by the people who you and I are speaking to -- the people you're reporting for and the people we work with on the Gartner health team.

Composability is not a new concept. What's different here?

Cribbs: The idea of adaptability is nothing new to CIOs, in general. If you go back to when many of today's CIOs were in high school or even in college, there was reusable code, object-oriented programming -- we've just gone through a decade-and-a-half of more data services and agile development. All of those techniques and tools were important in making organizations more adaptable.

One difference right now is that we're looking at making entire organizations more adaptable. We're not just talking about the technology layer, but how do we change the way collaboration works, the way organizations think and take advantage of the adaptability of the technology.

You talked about PBCs at Symposium. Can you explain what PBCs are and provide an example?

Cribbs: You're looking for places where there is an urgent business need for adaptability, where there are multiple back-end systems or applications that generally cross functions or domains, where you need to bring those things together for this new capability.

Look at concierge service models for U.S. healthcare payers. This has been an application space that's been a challenge for payers. It requires the integration of call center technology, care center, care management technology and, in some cases, quality engines, marketing, and other things.

The point is to become the single front door for the experience of any given member. That's been very challenging to do with point-to-point integrations or even when you have vendors that have expensive API libraries. The APIs are a level of granularity that the business can't really do anything with.

What you can do with a packaged business capability is publish something like 'member next best action.' That is a capability that could look across the next best action having to do with acquisition and growth: We may want them to take an assessment; we may want them to learn to use our digital tools so they stop using a call center; we may want them to enroll in a clinical care program; we may want them to see their doctor so they get documentation for the full amount of risk that they need for risk-adjusted programs. Those are many different applications but just one piece of information we need for that concierge, which is what is the next most important thing to do with this individual.

That's a perfect use case for a packaged business capability. That same 'member next best action' could go to any number of functions within the organization, which is what makes it composable.

In your presentation, you talked about two additional elements of a PBC -- a data fabric mediator and an orchestration layer. How do those two pieces fit into this healthcare infrastructure?

Cribbs: The data fabric mediator is the way we talk about the enrichment of what we've conventionally had in our data management technology -- enterprise data warehouses, data lakes, data hubs -- and putting those things together with master data management, meta data management and data services in a way that's highly reusable across use cases. And so that's the data fabric piece.

The APIs, then, are the individual calls for getting or setting data and then you orchestrate a number of APIs or methods together and that's when you have a PBC. You know it's a PBC when the business can recognize it as a business function and can make use of it in multiple applications. Composed experiences is what they would be called in the new world.

Will everything, including things like HR, be a PBC? 

Cribbs: We will be in the process of fleshing out what the logical PBCs are for healthcare organizations and then in what order a healthcare organization should roll them out. This isn't going to be a design or model that you sort of snap your fingers and make happen. There is going to be some ordering to bringing composability to the most important things first.

In your talk, you also mentioned CIOs will need to forge closer relationships with the business, which could be a challenge.

Cribbs: That's right. And I would give, in general, some encouraging news: There was already a growing level influence by CIOs within healthcare organizations as it stood. We've seen more clients with strategic influence, with a positive and proactive voice in business and strategic planning processes. The next level of that is making it more continuous than what we see today. It is the rule rather than the exception that the CIO has a seat in strategic planning today.

Showing real leadership around what emerging technology and what composable business can do for the organization throughout the cycle of strategic planning -- that's what we're saying needs to happen next.

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