If you think solving Y2K problems will put an end to technology upheaval at your facility, you may be in for an unpleasant surprise. New modular software programs based on object-oriented programming principles are about to shake up the healthcare industry. Variously known as object technologies or componentization, depending on how strict you are about definitions (see "Component Speak," page 68), this trend is forcing a Who’s Who list of healthcare software vendors to work feverishly behind the scenes to develop new standards and architectures. When the smoke clears, the healthcare industry could see the end of large, monolithic applications that you update with unwieldy revisions every few years.
Replacing tradition will be software chunks that you plug in like building blocks to an umbrella architecture whenever you need to revise a program or add a new capability. If you haven’t gotten a heads up from a software rep yet, you’ll soon be hearing promises like, "Get over one more installation hump, and revising software will become as easy as popping in a new videotape in your VCR."
When will software Nirvana arrive? Starting now and hitting full force in the next 12 to 24 months--if you believe marketing brochures. Support for componentized applications comes from heavy hitters like HBOC, HealthVISION, IDX and SMS, plus component software pioneers like CareFlowNet. But before the promise becomes a reality, software vendors and standards organizations have to solve knotty interoperability problems that have long kept competing applications from working together. In part, the solutions revolve around burying some proprietary technologies, which, it’s important to remember, have helped today’s big companies get big.
However, technological prudence demands an object-oriented approach by software vendors for the future. "No [vendor] in its right mind wouldn’t be working on an object-oriented architecture today," says Tom Hurley, vice president of First Consulting Group, Phoenix.
But how should healthcare organizations respond to the components craze? For now, components are mainly for pioneering hospitals that are trying to solve unique problems. For others, today’s challenge is to understand the new way of building software, what it can and cannot do, and how to prepare for the brave modular world.
Tuning in to components
Not unlike other technology areas, such as Y2K deployment, the healthcare industry lags finance, manufacturing and other industries in its adoption of component technologies. Since the early part of the decade, corporations in these sectors have been buying and building early componentized software to help them adjust information systems to fast-changing business needs and to build applications with best-of-breed software from a variety of vendors, rather than relying on a single software supplier.
Despite progress in developing standards, healthcare software vendors so far have been hard pressed to deliver componentized applications. "Everyone is talking about components, but there’s a very short list of people who have actually delivered," says Jim Klein, a research director for GartnerGroup IT Healthcare, Great Falls, Va.
Part of the reason for delays is that many hospitals aren’t demanding components yet. "Healthcare professionals make decisions on patient care features. Unless [componentization] criteria are brought to the front end of the buying process, it won’t happen," says LaDonna Shedor, chief information officer for Centra Health, Lynchburg, Va.
But that doesn’t mean the healthcare industry doesn’t understand the potential of components. "Healthcare is anxious to get better plug and play of packaged applications" and components are the latest best hope for achieving this, says Klein. The average 350-bed community hospital doesn’t develop its own applications, so being able to pop in a software module purchased from a third-party component vendor is almost like unleashing a programming staff to write a custom application, he adds.
To make components interoperable among applications from different vendors, the industry needs backbone standards like Object Management Group’s CORBA and Microsoft’s COM specifications, which define ways for components to travel and interact across organizations.
In a sense, CORBA and COM take up where HL7, a universal format for describing and exchanging medical data, leaves off. Instead of replicating data for each application, as HL7 does, CORBA and COM maintain a single copy of the data and provide interfaces that let applications tap into the database. Because only one data copy exists, doctors, nurses and administrators don’t have to wonder if they’re dealing with the latest information.