Doug Felton is the manager of enterprise architecture for the Departments of Defense and Veterans Affairs – a role that gives him insight into inter-organizational space, otherwise known as IOS.

At the GHIT 2011 show on June 14-15 in Washington D.C., Felton will lead a session in which he'll share some insights about common governance between the two agencies, mediating engineering processes and practical applications of such inter-organizational practices.

Felton spoke with Government Health IT Editor Tom Sullivan about those topics, and how the political and policy landscape between the DoD and VA “are nicely aligned” for a project such as the joint EHR the agencies are building.

Q: The title of your session at GHIT 2011 is "Applying Systems Engineering Process for Inter-organizational Exchanges." What are the main points you plan to share?

A: The three basic points are found by parsing the title of the presentation: "Applying Systems Engineering Process for Inter-organizational Exchanges." First, there needs to be a basic understanding of what systems engineering practices are before they are applied. Next, an understanding has to exist on how to not only best apply them, but how to apply them consistently and effectively (aka appropriately). I could go on at length on what ‘appropriately’ means, but let’s just say that most IT pros recognize that the way SE practices are applied can result in the success or failure of a project. The last point is that there is another set of dimensions added when exchanges have to occur across organizations. Different cultures, terminologies, technologies, missions, policies, etc., between organizations all create complexities far greater than just dealing with different operational layers existing within a single organization. As a result, establishing an agreed set of practices that will bridge these differences becomes even more critical.

Q: How do you mediate these systems engineering practices between the DoD and VA?

A: We focused primarily on what affects the inter-organizational space (IOS) and the critical path interdependencies between the two organizations. Just as technical solutions may use mediation software to establish a common exchange of data between organizations (as exampled by the NwHIN Gateway/Adapter paradigm), we established a very basic set of common systems engineering practices and products that ‘mediated’ the practices and products that were unique to each department. This allowed each department to retain their own methodologies and proven practices. We also established a governance structure to address risks and issues related to critical path interdependencies and a virtual collaboration site for all project participants to use as a shared meeting space and document library.

Q: What is the value of these practices?

A: The predominant application of these inter-organizational practices occurred as part of the IPO’s support of the VLER (Virtual Lifetime Electronic Record) initiative and each of the pilots for the exchange of health data. Just as the technical solutions for VLER were being piloted, the standards and practices for DOD, VA and private sector partners were also, in many ways, being piloted. As a result, as each pilot moved toward the exchange of patient data in a live environment, the lessons learned and practices from the previous pilots were applied and the pilot that was underway could be developed with decreasing risks and issues. In other words, not only did the interorganizational systems engineering practices mature with each pilot, but the adoption of these practices became more institutionalized among DoD, VA and the private sector partners.

[Also leading up to the GHIT 2011 Conference next week, Q&A: CMS shares early EHR, HIE lessons learned.]

Additionally, from a more general perspective, ensuring that better shared systems engineering practices are instituted and that communications across organizations at all levels – managers, engineers and users – are correspondingly made more effective, IT products can be brought to market quicker and be of a higher quality. As a result, these products can better meet the clinician's requirements for treating the patient ... and better patient care is where the true value lies.

Q: For health IT organizations smaller than the VA/DoD, how can they apply what you’ve learned to their own practices?

A: Good systems engineering practices are critical to effective intra- and inter-communications regardless of size of a particular organization or the number of organizations involved. And, as the presentation addresses, the documentation produced as a result of these practices effectively become contracts across all layers of a single or multiple organizations. The question then becomes not ‘How can they apply,' but ‘If they are willing to apply.'

Q: Now, when you look at a long-term project like the joint EHR, how do you facilitate that inter-organizational exchange?

A: As covered in my presentation, the political and policy landscapes are very nicely aligned toward DoD and VA working effectively together on the iEHR effort. They already have had initial joint meetings and working groups to discuss not only the capabilities and technologies that will be shared parts of the iEHR, but also the governance structure and application of a common architectural framework – DODAF 2.0. In meshing these shared technologies and capabilities with a common governance structure and architectural framework, most of the problems that arise with inter-organizational efforts can be avoided and a successful effort greatly facilitated.

As far as a completion date is concerned, I’m not in a position to comment on that. I’ll defer to the two Departments on schedules since the iEHR is still on the planning stage by them and many details are still being worked out.