How to evolve your IT infrastructure for healthcare’s digital transformation
Shelly Lucas
Creative Director, Redox
Contents
In the race for digital transformation, you may not be thinking about redesigning your infrastructure. But you should be.
Modernizing your IT is good, but it’s not enough to support healthcare’s data-driven, interconnected future.
The quantity, velocity, and diversity of health data continues to climb. Can your current infrastructure keep up?
One-off integrations are costly, stop-gap measures that won’t transform your underlying infrastructure.
Examine the projected costs, resource investment, and expected outcomes for your composable initiative.
Now is the time to revamp your infrastructure for agility, adaptability, and speed.
Follow these industry analyst recommendations to prepare, build, and scale your composable future.
Digital technology alone won’t transform your organization, but redesigning your IT infrastructure will.
Introduction
COVID-19 pushed healthcare organizations onto the digital train. Today, many are still on the train, with some riding a few railcars ahead from where they started. But now, their goal is more than digitizing care. They want to use digital technology to transform their organizations—all the better to traverse what could be a bumpy ride ahead.
Most healthcare organizations are staring down a set of fairly grim realities: A burned-out, vastly reduced workforce; enormous financial pressures; consumer demands that race forward at full tilt. These challenges are high on their priority list. But redesigning their IT infrastructure? Not so much.
This mindset has far more serious consequences than healthcare organizations may realize. Those who choose not to take steps toward a more flexible infrastructure now are stalling their organization’s progress toward healthcare’s interconnected future. At best, they’re gambling with their competitive edge. At worst, they’re pushing their market survival to the side.
In this guide, you’ll learn how digital transformation and the health data explosion are intensifying the need for a more flexible healthcare IT (HIT) infrastructure. You’ll also discover why one-off integrations are costly stop-gap measures that fall short of more agile healthcare delivery. Finally, you’ll get a detailed look at composable architecture—why it’s an ideal model to digitally transform organizations and how you can best implement it.
The pressure of digital transformation
Perhaps the biggest trend that is pushing healthcare HIT to operate beyond its brittle, legacy infrastructure is digital transformation.
During the pandemic, healthcare organizations experienced the benefits of digitized care. Now, during an economic downturn, digital technologies have become even more important as healthcare organizations struggle to do more with less. Equipped with digital health solutions, providers can enhance care quality, improve operational efficiency, and expand care access.
With an eye on these outcomes, 53% of U.S. providers have declared digital transformation as their top organizational goal.1 Finance leaders are following suit, planning to spend more on IT and digital transformation,2 even as they tighten their grip on cash.
Healthcare organizations must do more than modernize their IT to truly transform their business. They must embrace data-driven, responsive care delivery.
However, for this initiative to gain traction, healthcare organizations must do more than digitize care. Granted, digital health solutions can relieve a variety of pain points, including labor shortages, administrative burdens, and operational waste. But in themselves, they will not fundamentally change—i.e., transform—the way healthcare organizations do business.
Healthcare organizations must do more than modernize their IT to truly transform their business. They must embrace data-driven, responsive care delivery, which industry leaders call patient-centric or whole-person care. Ideally, this care is informed and activated by multiple players in the healthcare ecosystem. Together, clinicians, caregivers, payers, therapists, social workers, and other healthcare professionals join forces to participate in a patient’s everyday health and well-being.
In this vision, the healthcare organization’s operational focus shifts from achieving their institutional goals to focus primarily the needs of the patient. This is a positive, and necessary, change. However, to truly deliver patient-centric care, an expanding number of healthcare professionals will collaborate, sharing different datasets at different points in a patient’s health journey.
Health data’s explosive growth
Not only are HIT teams challenged to deliver meaningful data to more players in the healthcare ecosystem, but they’re also charged with wrangling rapidly ballooning data volumes.
Today, about 30% of the world’s data volume is generated by healthcare. By 2025, the compound annual growth rate of healthcare data will reach 36%. This is six percent faster than manufacturing, 10% faster than financial services, and 11% faster than media and entertainment.3
Current healthcare IT (HIT) infrastructures aren’t designed to support this future data growth. As it stands now, clinicians have more data than they act on. This can happen when a patient’s data is spread across disparate sources, which makes it difficult to access and piece together. To access patient-specific insights, clinicians report accessing six to 20 or more solutions outside of their EHR. Often, they don’t access these insights because they say doing so is too time-consuming (43%), not intuitive (39%), or they forget (31%).4
97% of healthcare data goes unused by hospitals.5
Most likely, C-suite executives at your organization know they need to harness data to fortify their analytics and train AI models. After all, only 16% of providers describe their organizations as mature in their data-driven decision making.6 However, your senior leadership may not understand the underlying infrastructure that’s required to support data-driven decisions.
HIT infrastructures aren’t built to securely house, distribute, and exchange the petabytes of data that will be involved in delivering personalized, anytime, anywhere care. Nevertheless, the quantity, velocity, and diversity of health data will continue to climb without pausing for infrastructures to catch up.
For this reason, healthcare organizations are migrating technologies to the cloud. Doing so has also equipped organizations to streamline processes, improve security, and maintain business continuity. Still, providers have the most systems on premises, including 60% of their applications.7
Despite the proliferation of on-prem apps, legacy systems, and looming technical debt, it’s critical for you to start designing a robust, reliable, and flexible tech stack now. Your HIT team will need to keep pace with the explosive growth of health data as it moves securely within your organization and beyond, to other health systems, care partners, payers, and patients’ homes as well as within their communities.
The shortcomings of one-off integrations
While data volume and complexity present their own infrastructure challenges, delivering only useful data to individual users’ workflows is quite another. Without this capability, users won’t be able to act on the data.
HIT teams acutely feel this gap as they strive to support advanced analytics across their organization. More than 80% of healthcare organizations report leveraging some form of advanced analytics.8 However, their ability to use these technologies doesn’t always translate into full adoption, primarily because they lack the infrastructure to effectively bring data sources together. This is why unified data and integrated systems are linchpins for digital transformation.
Only 38% of healthcare and life science organizations are currently executing on, or have achieved, full integration of all systems and data.
Typically, to connect diverse systems and data formats, HIT leaders use proprietary APIs or interoperability standards like HL7® and HL7® Fast Healthcare Interoperability Resources (FHIR®). Due to the complexity of these projects, providers often rely on integration vendors or consultants to make one-off connections for them.
In many cases, this case-by-case approach to integration has produced disappointing results. The most common culprits are extended implementation timelines and added costs, which have slowed providers’ integration efforts. In fact, only 38% of healthcare and life science organizations are currently executing on, or have achieved, full integration of all systems and data.9
For HIT teams, the costs of solving integration problems are steep. One estimate finds that data integration problems collectively cost government healthcare organizations more than $300B each year. Another market report estimates that businesses can lose up to $500,000 or more annually due to integration issues.10
Integration headaches have bred an existing vendor bias among HIT leaders; the majority would rather buy solutions from their existing vendor roster, even if the functionality is less effective than that offered by third-party technologies.
The risk of disrupting daily processes and workflows with slower, integration-laden deployments can be too great for HIT teams to shoulder. Often, there’s too much at stake. For example, updating one function in an EHR requires changes to the codebase—a resource-intensive task that usually requires system downtime. There’s also the danger of coding errors, which can cause cascading issues across the system, leading to lower-quality care or patient safety risks. Finding and fixing a single coding error can take days or weeks.11
The flexibility and responsiveness of a…business are severely hampered if those traits aren’t also reflected in the tech foundation layer.12
Because of these risks, many HIT teams tend to avoid integration projects whenever possible, opting to purchase technologies that are compatible with their EHR and enterprise systems. However, when external solutions must be onboarded and integration is not in scope, HIT teams have bolted them on, sometimes creating clunky workarounds, resulting in inefficient processes and fragmented workflows. These experiences intensify clinician and staff burnout.
In these situations, data becomes the exhaust, not the fuel, for your digital transformation.
This is just a glimpse into the struggles you or your team may have experienced when attempting to connect with technologies that your organization needs to exchange data with today. But what about the professionals, institutions, and other healthcare entities to which you’ll need to deliver data in the future?
One-off tool integrations, while they embed data in clinical workflows, aren’t extensible or adaptable for other users. As your data-sharing network expands and data users diversify, your integration efforts start again at square one, unable to build on the intensive work your team has done previously.
You can end this recurring frustration by reimagining your infrastructure. How can you revamp your technical landscape to quickly and easily deliver meaningful data tailored to the needs of specific users? You’ll need to package data into easily consumable units, delivering it to individual users in a personalized, self-service experience.13 And you’ll need to scale the delivery of instantly customized, pertinent, and usable data experience to clinicians, patients, labs, payers, caregivers, and other healthcare stakeholders at all points of care—wherever they are.
Your HIT team must deliver on this vision, and it will come sooner than you think. But here’s the good news: You can achieve all of this with a composable architecture.
Shifting to composable architecture
Traditional HIT is brittle. Its components are tightly interconnected and interdependent. As your team knows all too well, all components must be rewritten when one element needs an update. This is not the best technology foundation for digitized care—let alone for introducing new smart devices, data streams, business models, or ecosystem partners. Most healthcare organizations (and their HIT) are designed for reliability, repeatability, and control—not for agility, adaptability, and speed.14 This must change.
Your tech infrastructure must be flexible enough to accommodate the evolution of health data itself. Digital transformation begins with data. Changes in data types and formats are continuous, spurred by organic business growth, new data exchange partners, evolving technologies, or new regulatory requirements. Your HIT needs to be able to adapt to these changes, integrate with incompatible systems, and deliver a reliable, meaningful data experience that clinicians, staff, and their trusted collaborators can interact with to formulate smart decisions.
The move to a flexible, data-powered infrastructure
Your infrastructure needs to support the co-creation of new and improved provider services. In the future, your healthcare organization won’t compete solely on cost, quality, and market share. It will compete on network effects,15 relying on the expertise of partners to fill capability gaps as it strives to deliver value to consumers and staff across the care, health, and wellness spectrum. Most likely, this will involve introducing new business models and aggregating services to improve care quality, reduce costs, and personalize the consumer health experience.
To increase HIT flexibility, leading healthcare organizations are architecting their infrastructure based on Gartner’s “composable business” model.16 In this model, HIT can address a specific organizational need at a specific time by assembling, disassembling, and reassembling independent modular components or packaged business capabilities (PBC) consisting of both technology and people.17
Healthcare organizations using a composable approach build their tech stack on cloud services and capabilities. The front-end presentation (what the user sees) is decoupled from the back-end logic (how it works), with an API communicating between legacy and new technologies. The API, which can be reused and recycled, accesses diverse data from a vendor-neutral, centralized clinical data repository or FHIR store. The advantage here: Applications are speaking to the same data without being tied to a predetermined use case or purpose.
As health and care data is for life, it needs to outlive applications, so there is a clear need to separate the two.18
A composable architecture equips frontline workers to compose applications by incorporating formerly separate functions (e.g., RPM, care management, outcomes reporting, and decision support) into a unified PBC that can be customizable as needs change.
A composable architecture creates a win-win for both users and HIT teams. Users across lines of business can access the applications needed to manage individual patients using a similar user experience. HIT teams working with this architecture can implement solutions easily and quickly, regardless of the technology vendor. By reducing compatibility concerns, composable architecture gives HIT teams the freedom to choose the best solutions for individual lines of business at any time.
With composable, you can deliver content and assets to any platform or device, regardless of channel, programming language, or framework. Your HIT team can also activate the user experience in only one organizational area or expand it to impact operations across your entire organization.
Weighing practical considerations
Maybe a composable tech architecture sounds great in theory, but what about the practical considerations, like costs and resources? How can you know whether it’s beyond your reach or not?
The cost of a composable implementation depends on the complexity of your business requirements.19 If you need to integrate multiple components and manage API connections across various services, additional development effort and specialized skill will be required, which will add to your upfront implementation costs. However, you can shorten your time-to-value by partnering with a strategic integration partner who can reuse previous configurations to scale quickly.
According to Forrester, companies that have migrated to composable are spending 50% less on ongoing maintenance.
According to Forrester, companies that have migrated to composable are spending 50% less on ongoing maintenance.
If you decide to start small and focus on incremental progress (vs. tackling a large replatforming project), you may not need a throng of technical experts. Some B2B commerce companies taking this route have achieved it with less than 10 developers.20
When estimating costs, it’s important to also consider composable’s impact on the total cost of ownership (TCO). According to Forrester, companies that have migrated to composable are spending 50% less on ongoing maintenance.21 Because components can be modified and replaced individually (vs. having to make changes to the entire system), composable architecture makes it easier to fix problems, make updates, and implement improvements.
Gartner estimates that organizations adopting composable will outpace their competition by 80% in the speed of new feature implementations.22
You’ll need to make strategic decisions on whether to modify or extend existing HIT assets, introduce new modular resources to complement the existing core, or invest in creating a new ecosystem from the ground up.23
Plotting your composable path
Your path to a composable tech architecture may slightly different from that of other providers, depending on your organization’s digital maturity. Regardless, industry analysts recommend taking the steps below24 to prepare, build, and scale a composable future.
Evaluate your current technology base. Can you support a gradual transition from monolithic technologies to collections of PBCs? What are the lifecycle stages of your legacy systems? Take inventory of your existing deployments and contractual obligations. Prepare to address tech gaps for supporting integration, low-code development, API management, event processing, and security and governance.
Assess the way you currently deliver new business capabilities. What’s your current mix of approaches (e.g. iterative, waterfall, and agile)? What are the delivery timelines and success rates for each? Based on your evaluation, do you need to shift more toward agile delivery?
Take stock of your team’s technical and business skills. What is your digital ambition? Is it technology optimization or business model transformation (or both)? Does your team have the talent and know-how to support your composable journey? What’s your plan for enhancing and/or extending the skills of current team members?
Say no to new monolithic solutions. Plan to revamp or replace legacy systems to progress towards assembled, composable user experiences.
Expedite product-style delivery over traditional methods. Package independent technology components as reusable building blocks so you can deliver the functionality continuously, by installments, as PBCs.
Modernize your application portfolio. Favor tech vendors that understand the assembly-based model of delivering user experiences. Isolate the discrete business capabilities of older applications. Incorporate APIs and event streams everywhere.
Identify role-centric user experiences. These experiences—shaped by individual objectives, priorities, and best practices—should drive technical design, not the other way around.
Aim for eventual self-service. Ultimately, you want users to be able to compose PBCs themselves without developer skills. In pursuit of this goal, implement democratized, low-code tools and well-designed PBCs.
Conclusion
When digitally transforming healthcare organizations, there’s no single path for HIT teams to follow. Regardless of whichever team structure, processes, or applications you decide to adopt, your progress will be limited without a flexible infrastructure. The smartest way to achieve this is to build a composable architecture.
When you shift to a composable architecture, you’ll be able to accelerate your organization’s digital transformation. Your HIT team will be able to deliver always-adaptable data flows powered by an adaptable tech infrastructure—one that’s repeatable, modular, and scalable. You’ll be able to easily handle the volume, velocity, and variety of healthcare data. You’ll also avoid the costs and constraints of resource-intensive, one-off integrations.
By all means, hop on that digital train. Lean in to digital technology. Weigh its ability to solve your healthcare organization’s pressing challenges.
Just don’t overlook what your tech infrastructure needs to support your organization as it hurtles forward. Otherwise, your digital train may run out of railway.
HL7® is a registered trademark of Health Level Seven International. The use of this trademark does not constitute an endorsement by HL7.
FHIR® is a registered trademark of Health Level Seven (HL7) and is used with the permission of HL7. Use of this trademark does not constitute an endorsement of products/services by HL7®.
Resources
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13Cramer, Richard. Healthcare Revolution: Bold Predictions for 2024. Healthcare Innovation, 4 Dec. 2023. Webinar.
14“Enabling Healthcare Organizations to Thrive with Business Agility.” RGP, 12 Mar. 2022.
15Gisby, Simon et al. “New Business Models in Health Care: Building Platform-Enabled Ecosystems.” The Deloitte Center for Health Solutions, 2022.
16Ambasna-Jones, Marc. “Is Composable Business the Most Essential Technology Trend to Meet Challenges of 2023 and Beyond?” ComputerWeekly.com, 23 Jan. 2023.
17Fonseca, Hugo. “How to Reach Peak Agility with Composable Tech Architecture.” CEO Digital, 22 June 2022.
18Gornik, Tomaz. “Re-Thinking the Architecture of Healthcare IT.” The Journal of mHealth, 5 Mar. 2021.
19Tahoe, Manuela. “Myth or Reality: Does Composable Only Work for Digitally Mature B2B Firms?” commercetools, 06 July 2023.
20Ibid.
21Ibid.
22Gartner, Inc. “2022 Gartner Magic Quadrant for Digital Experience Platforms.” Accessed via Sitecore. https://www.sitecore.com/resources/index/analyst-reports/gartner-mq-for-dxps
23McBride, Aloha. “How Will You Design Information Architecture to Unlock the Power of Data?” EY, 8 June 2020.
24Natis, Yefim et al. “2021 Strategic Roadmap for the Composable Future of Applications.” Gartner, Inc. 3962036.