Thursday, March 24, 2011

A Foundation for eHealthcare:
The Center of Excellence

March 27, 2011 8:45PM
Needham Heights, MA, USA
Bernard P. Wess, Jr. mail



Like all new technologies, eHealthcare needs a raison d'être. The Center of Excellence provides a reason to implement eHealthcare solutions and a method of payment for eHealthcare.  We also discuss both a model IT architecture and building an organization for success.

Note: This blog is a very brief executive summary of a new white paper by Perseid Software on justifying, funding and operating advanced eHealthcare applications supporting mobile healthcare and the Medical Home. 1

Executive Summary

As electronic information systems begin to become more widely adopted into a broad spectrum of healthcare uses in group, personal, occupational and disability lines of business, it's time to take a look at the methods to justify, finance and operate the organizations that are essential to design, create and operate complex eHealthcare solutions, particularly those that support Medical Home and mobile health solutions.

Organizations designed to implement Continuous Quality Improvement solutions developed in manufacturing have begun to appear in healthcare.  These organizations are modeled on the high performance organization built around small teams of focused and trained professionals driven by the rigors of a scientific approach to service delivery and manufacturing pioneered by NASA in the 1960s and the Japanese in automotive manufacturing.

They build on incremental improvements in processes and fund themselves and their growth through continuous improvements in financial results and clinical outcomes using a statistical approach to organizational development and care delivery.   These organizations, the High Performance Organization and its associated Centers of Excellence, are self-sustaining and can be highly successful financial models of healthcare delivery. 

The Center of Excellence

The high performance organization implements a culture of quality and its organization applies that culture to the Center of Excellence model of eHealthcare delivery.
Figure 1 The High Performance Organization

The Center of Excellence is a diagnostic or treatment focused (as opposed to general) healthcare delivery process that implement healthcare solutions that depend on continuous incremental quality improvement of clinical and financial results using a formal methodology and fully integrated information systems to improve:
  • Healthcare diagnostic and treatment outcomes for one condition at a time
  • Costs of Care (productivity and financial)
  • The rate of reduction in the absolute number of healthcare procedures
  • Quality of Care of a cohort of patients
  • Patient/employee/family satisfaction
  • The Center of Excellence processes themselves
in a cycle of quality improvement over time.
This approach—total total quality management and with data integration—is the foundation of integrated care and case management for watch groups of patients in a Center of Excellence and it is an important step forward in creating true patient- and family-centered care; regardless of the person's role as an employee, patient or family-member in society.


Figure 2 The Center of Excellence Continuous Quality Improvement Process

A Systems Solution
The continuous quality improvement cycle in Figure 2 above and its supporting data architecture (in the pyramid) result in a uniform and clearly defined cycle of service delivery and measurement that allows for non-stop 7x24 operation if required and ease of rapid (sometimes real-time) reporting for both clinical, financial results and other center of excellence metrics.

Its overall clinical and financial success enables the high performance organization to rapidly develop additional integrated and continuously improving applications in more lines of business and care, creating additional opportunities in:
  • Group Health
    • Mobile health
    • The Medical Home
    • Disease Management
    • Care and Case Management
  • Worker's Compensation & Disability
  • Occupational Health & Safety.
Systems Architecture

The Life Sciences Universe product is enabled to design, build and operate simple or complex insurance, clinical and financial applications for many lines of business and risk and to create and monitor patient- and family-centered Centers of Excellence.

The data architecture supports tiers of information, increasingly condensed and summarized to improve the ability of Center of Excellence managers and clinicians to rapidly evaluate the data flowing into a Center of Excellence with the intent to automate the processes as much as is technically feasible and to bring the Center of Excellence systems into the home and workplace of the patient, if not even into the patient's pocket (in the form of the PDA or cell phone).

Information Model

Figure 3 The Data Architecture of the Center of Excellence

To enable enterprise-scale systems implementation, the entire product is written in Oracle and supports Oracle cluster processing, 64-bit architecture and full, secure Internet Web 2.0 cloud processing using Oracle Sun Web Services.

Advanced transaction processing, audit and control is implemented using Oracle Advanced Queues for clinical, administrative and financial transaction processing that guarantees delivery of web transactions to secure queues for immediate or deferred processing.

Information Network Model

The Center of Excellence, being a high performance organization, is in continuous operation and as such requires a network architecture that can support not only 7x24 use but also multiple Centers of Excellence that are secure, auditable and easy-to-use.

Model Architecture
Figure 4 A Model Architecture in Support of the Center of Excellence 

The information model in Figure 3 is matched with a flexible Internet 2.0 network architecture in Figure 4 that enables mobile healthcare and also large-scale commercial transaction processing with guaranteed delivery and auditing so no transactions are lost, even under excessive transactions loads and intense background analytical processing.

The Center of Excellence is established as a global resource, available to users, patients, clinicians and others anywhere in the world.  Many large corporations operate in many countries and now some insurers do also.

Also, the Center of Excellence design and implementation encourages and enables the patient to participate regularly and safely in the monitoring and delivery of their own care as a full and equal participant in the process.


1For more details on designing and using Centers of Excellence to pay for advanced eHealthcare applications, see the Center of Excellence white paper released with this blog article.

keywords: center of excellence, integrated care, medical home, life sciences universe, medicare, medicaid, group health, disability, medical home, mobile health

perseid software limited
needham heights, massachusetts

at +1-617-517-6314 or perseid software limited