July 2009

There was a time when vendors and enterprise customers touted the technical and business benefits of best-of-breed (i.e., picking the best of the best and integrating them into a coherent solution tailored to a company’s needs). Recently I started hearing vendors talk about the value of single-source vendor solution (whether it is hardware or software).

Is this a reaction to a rise in the number of failed (or expensive) integration exercises? Or is it as a result of vendor consolidation – with some of the bigger vendors now capable of offering one-stop-shop. For example, EMC can now offer security (RSA), server virtualization (VMware), Data Deduplication (Quantum, Avamar and now Data Domain).

I raised this question within the Storage Group community of Linkedin and got a couple of interesting responses one of which has specifically asked not to be made public in case he gets into hot water because of his opinion.

My own observation is that it depends in part on the customer. I spoke to the head of IT at Bossini and he said that best of breed works for them.

In the instances where I’ve seen best of breed fail, it is rooted around compatibility and accountability issues that no one anticipated at the beginning of the acquisition trail. Consider the case at a large Philippine-based conglomerate. The company upgraded their storage hardrware, deployed a SAN, and installed a new backup software. Pre-production testing was good. A few weeks after going into production one of the database applications started to issue error messages. Initial investigation by the data admin pointed to the new storage system as the culprit. This was validated by the database vendor. Two weeks of research on the part of the storage vendor revealed the problem was not inherent in the storage system. The storage vendor showed postings on several user groups showing the same problems but with different storage platforms. So whose fault was it? Worst of all, the problem took three weeks to solve.

The point of the story is that throughout the first two weeks of problem solving, no one wanted to take accountability. When the bulication is not working and the organization is losing money because it is unable to take in orders, who is at fault? Who should be responsible?

What is your view of this?


When the US Congress convenes for business, after the July 4 Independence Day celebrations, the Obama administration will come face to face with its biggest challenge – getting Congress to approve its massive health care reform package [7].

Governments in Asia have varying degrees of success when it comes to health care provision to the citizens. According to Aparnaa Somanathan of the Institute of Policy Studies, Equity in Asia-Pacific Health Systems, universal access to healthcare is the goal for many governments in Asia. How governments reach this goal is the subject of much study and debate. Somanathan lauds Hong Kong and Sri Lanka for leading the charge in the provision of universal healthcare service regardless of social status.

Market research firm, Frost and Sullivan, estimates that IT spending among healthcare organizations will reach US$10 billion by 2012. “Healthcare providers no longer consider IT solutions and services an unnecessary cost burden, but a critical value provider,” says Frost & Sullivan consultant Dr. Pawel Suwinski. “In public and private hospitals, IT budgets are expected to increase from the year 2009 to 2011.”

That said, IT spending proposals will undergo tougher reviews as CIOs and IT managers feel the same budget and operational pressures as their peers in other industries.

Dr. Suwinski notes that lack of standards has remained a stumbling block for the adoption of healthcare IT solutions in many parts of Asia including China and India. In more developed markets like Australia and Southeast Asian countries, the focus appears to be around adopting clinical information systems and electronic medical records solutions.

Recently a friend was admitted at The Medical City [8](TMC), a private hospital in the Philippines. He arrived at 11:25pm to be admitted as per instruction of his doctor, an attending physician at the hospital. He purposely timed it so late in the evening to speed admission process. And yet it took him almost 20 minutes to get processed despite the fact that there were only two other persons in the room waiting to be admitted.

According to Gerard Anthony Dass, healthcare solutions leader at Nortel Asia, patient admissions and discharges. “The process often requires hours of staff time, coordination of multiple departments and rarely seems to run smoothly. And every step of the process costs hospitals money and time and generally leaves patients wondering why everything is taking so long,” notes Daas.

Indeed, my friend is not new to TMC and yet each visit requires him to fill exactly the same form. In the 25 years I’ve known him, he hasn’t changed his name, date of birth, and other personal details since becoming a TMC customer in 2000.

The good news is that private hospitals across Asia are discovering the financial windfall that health tourism brings. The tax revenue to be gained from the industry has also caught governments with many supporting the local hospital industry efforts to upgrade infrastructure to cater to the growing influx of foreigners searching for low-cost but good quality health services.

One technology that is seeing an upsurge in interest is unified communication (UC). How else would a hospital like TMC manage 40,000 in-patient and 380,000 out-patient customers annually? UC helps lare hospitals with very mobile doctors, nurse and supporting staff move about quickly and efficiently to serve its customers.

Daas claims that UC combined with new applications such as automated patient discharge solutions will allow hospitals to discharge a patient 50% faster than previously possible.

However all is not smooth sailing. Limited IT resources and shrinking budgets are hampering adoption of new technologies.

“Public hospitals need solutions that meet their forward-looking plans, while affordably addressing current needs without sacrificing application performance in any way. They need solutions to deliver the advanced technologies, services and communications-enabled clinical applications that will allow them to do much more with limited resources, faster, and with fewer errors; facilitating clinician mobility and effective communication,” said Daas.

Whether in the public or private hospitals, improving the quality and speed of patient care is of paramount importance to healthcare professionals. Hospitals like Thailand’s Bumrungrad and Hong Kong’s Matilda Hospital are leading the charge in improve patient care through technology.

Communication-enabled applications are helping hospitals empower staff with access to up-to-date patient information. “UC-powered solutions enable hospitals to mobilize clinicians and staff, unify multimedia communications and make the most of standardized digital health records. The ability to share digital files securely – even over large distances and in new treatment regimes – is made possible thanks to wireless technologies,” Daas adds.

At one point in its operation, Kyushu University Hospital in southern Japan’s Kyushu region needed better access to x-rays, diagnosis data, ultrasound imaging, real-time patient vital signs and operating theater monitoring. The hospital recently deployed a new medical information network, based on Nortel’s clinical-grade Healthcare Solutions, enabling information to be more efficiently stored, managed, retrieved and shared to help physicians, specialists and medical staff collaborate to improve the outcomes of patients.

Another example showing the benefits of having better communications is Taiwan Mobile Healthcare Services. It provides high-bandwidth links for doctors treating patients at Taipei Medical University Hospital, Tri-Service General Hospital and Taipei City-Wan Fang Hospital. As part of the government’s M-Taiwan initiative, a wireless solution gives doctors virtual access to patient medical records, monitors the condition of long-term sufferers of chronic diseases, provides high-quality diagnostic images and video, and provides remote outpatient registration to improve healthcare services.

The King Fahad Medical City hospital, one of the largest healthcare providers in the Middle East is using UC to enhance care and manage costs across its four hospitals and 269 primary clinics. It uses a UC-enabled solution to integrate IP telephony, enhance call answering, contact center and interactive voice response (IVR) capabilities with legacy voice systems, and promptly connect patients with the right clinicians for responsive and personalized care.

If you have ever recently visited a hospital as a in-patient, how long did it take for you to get discharged by hospital administrators after your attending doctor gives you a clean bill of health? My friend waited for three hours to get his discharged paper. After several inquiries at the nurse’s station and frustration showing in his voice and face, it took him over 2.5 hours to get his bill so he could pay up and get out. It took him less than five minutes to settle his bill.

Hospitals, like any other business, are constantly on the lookout to trim the fat in their operations while satisfying the urgency of improving patient care. Hospitals like Bumrungrad, Kyushu University Hospital, King Fahad Medical City hospital and Taiwan Mobile Healthcare Services have shown that information technology has enough innovation to meet the business needs of hospital – improve patient care.

[1] http://egovasia.enterpriseinnovation.net/content/improving-patient-care-asias-healthcare-industry#comment
[2] http://www.facebook.com/share.php?u=http://crm.enterpriseinnovation.net/content/improving-patient-care-asias-healthcare-industry
[3] http://del.icio.us/post?url=http://crm.enterpriseinnovation.net/content/improving-patient-care-asias-healthcare-industry&title=Improving patient care in Asia’s healthcare industry
[4] http://www.digg.com/submit?url=http://crm.enterpriseinnovation.net/content/improving-patient-care-asias-healthcare-industry
[5] http://egovasia.enterpriseinnovation.net/forward?path=node/3509
[6] http://egovasia.enterpriseinnovation.net/print/3509
[7] http://www.nytimes.com/2009/06/19/us/politics/19reform.html
[8] http://www.themedicalcity.com/

While the US ponder who will be appointed as the cyber czar of the Obama administration, a number of US government websites were reportedly hacked over the July 4 holidays.

The US Treasury Department, Secret Service, Federal Trade Commission and Transportation Department sites were all shut down for as much as two days after unknown parties carried out denial-of-service (DoS) attacks.

The Homeland Security Department’s Computer Emergency Readiness Team later issued a notice to federal departments and other partner organizations about the problems and the appropriate steps to take to help mitigate against such attacks.

Thousands of miles away, a number of South Korean government agency sites, banks and Internet sites were hit as well. A spokesperson for the Korea Information Security Agency said that the US and Korean incidents appeared to be linked.

Cyber attacks on government websites are growing in frequency with perpetrators becoming bold with each successful attack. According to Professor Fang Binxing, a cyber security scientist and former director of the national computer network emergency response team in China between 2002 and 2006, as many as 60,000 hacks targeting the government are attempted each year.

In case you think only government and very large organizations are targets, you could never be more wrong.

Richard Moss, eBorders Director, believes no computer is safe, whether public or private. “There are well understood tactics and techniques for protecting systems which should be deployed, regularly tested and updated but lets face it – what more evidence is needed that any system, anywhere in the world, is vulnerable? if a system is connected to something else then its vulnerable, end of story! (and if a system’s not connected its value to an organization diminishes rapidly).”

“Furthermore, how vulnerable a system is can be pretty dynamic, public or private. witness the cyber attacks in Estonia – the simple act of moving a stone statue brought a virtual barrage of cyber attacks crippling both public and private systems – the systems themselves hadn’t changed overnight but the motivation (the threat) of attack had. So public and private organizations need to perform regular and holistic risk assessments (see my Blog on Cyber terrorism for a list of motivations for attacks),” said Ross.

While no system will ever be 100% foolproof from cyber attacks, “organizations can developed the necessary risk profiles, plan defenses appropriately, make the correct investments and establish and enforce the security policy appropriate for the business you are in, the threats you face and the risk appetite your investors want you to hold. Best Practice is to invest in real time security monitoring alerting you in real-time to threats as they occur,” advices Ross.

But real mitigation of such risks can only occur when true international government co-operation between nation states is achieved. “This would help establish effective and homogeneous computer crimes laws backed by consistent and fair punishments, establishes a framework for effective law-enforcement cooperation (similar to Interpol in the real world fight against crime) and has effective measures to “lock-out” nations that fail to cooperate. But we are years away from this nirvana … so, its still a case of individuals and organizations out running that Tiger!,” quips Ross.

Ross can be melodramatic at times – maybe because he is British. But then aain we are coming to a full week since the July 4 attacks on US government websites and they are still under attack.

So word of caution, if you think you need to be connected to the Internet, err on the side of caution. You never know who is watching you.