Impacts of Complexity on Project Success

Commentary: This is the relevant portions of an extensive paper written in my Masters of Information Technology coursework.  The paper highlights a common concern among many project managers. That is the lack of quality information early in a project especially in complex projects.  The overall paper proposed research into project complexity and early planning efforts.

Impacts of Complexity on Project Success

by

JT Bogden, PMP

Introduction

Project management practice and principles have been maturing and continue to mature. The general paradigm to plan well applies to early project planning and has a significant influence on the success or failure of a project. This research is in support of identifying the key relationships between influential factors affecting scope and risk in complex projects during early project planning. Attention to the complexity is important since the nature of information technology, IT, projects are complex. Complexity tends to increases risk. "Project abandonment will continue to occur -- the risks of technology implementation and the imperfect nature of our IT development practices make it inevitable" (Iacovou and Dexter, 2005, 84). Therefore, this study is focused on the early information technology project planning practices when the project is vague and the outcomes are unknown and unforeseen. The purpose is to better manage scope gap early.

Problem Statement. Poor scope formulation and risk identification in complex projects during the early planning have lead to lower project performance and weakened viability. Therefore, project managers are challenged to manage these issues early in order to increase the project's viability and success.

Argument.  Project complexity influences performance just as taking shortcuts in a rush for results causes an outcome with complexity like characteristics. Lower performance outcomes may result from project essential factors relating to scope and risk objectives that are overlooked or not properly managed resulting in increased cost, delays, and/or quality issues that jeopardize the projects viability and success. 

Body of Works Review

This effort intends to explore the significant body of works that has emerged to date. Literature research was conducted across a diversity of project types in support of the research problem statement that poor scope formulation and risk identification of a complex project during the early planning affect project performance and project viability in relationship to complexity of the project. This is by no means the first time research of this nature has been explored in these three areas; scope definition, risk identification, and project complexity. 

The common threads in the body of works that has emerged spans decades to include project management as a whole, risk and scope factors that affect project success, information and communications challenges, and complexity impacts on scope and risk. The works researched in other disciplines provide many transferrable lessons learned. For example, construction and engineering projects have in common to information technology projects complexity issues as well as information reporting and sharing concerns. Other works from supporting disciplines contribute to factors on education, intellect, and learning in support of competency influences on risk. A 2001 trade publication article indicated that causes for failed projects tend to be universal.  The article's author, John Murray, concludes that information technology projects fail for a small set of problems rather than exotic causes (Murray, 2001, p 26-29).

In a 2008 construction project study, the researchers discussed the construction industries front end planning which is explained as the same as the project charter process. The works details a study of fourteen companies and their project planning processes then presents a model process. The study results are summarized into critical criterion of success. In conclusion, fifty percent of the projects did not have required information for front-end planning activities. Problem areas were identified in a follow on study to include weak scope and risk identification as well as other basic issues (Bell and Back, 2008).

The problems of scope definition researched in the body of works indicates that cooperative planning and information sharing have been key factors in developing scope. A 2007 study on concurrent design addressed the complexities and risk of concurrent design projects. The researchers posed a model of interdependent project variables. The linkages illustrate the direction of the communications or information sharing between the variables. In the researcher's analysis they conclude that through cooperative planning in the form of coupling and cross-functional involvement significantly reduce rework risk. Early uncertainty resolution depends on cross-functional participation (Mitchell and Nault, 2007).

The Technology Analysis and Strategic Management Journal published an article in 2003 discussing outsourcing as a means of risk mitigation. The outcome of the case under review was project failure due to a lack of clear requirements and poor project management. This was attributed to conflict and a loss of mutual trust between the outsourced vendor and the information technology client. The result was one vendor cutting losses due to weak commitment when compared to in house project support. The researcher suggested that shared risk may be effective in a partnership such as outsourcing but requires strong communication and some level of  ownership (Natovich, 2009, p 416).  This article's case study illustrates that cooperation is critical in information technology projects. A 1997 study discussed mobilizing the partnering process in engineering and construction projects during complex multinational projects. Researchers argued developing project charters fostered stronger partnerships and reduced risk. In general, the article promotes a shared purpose supported by a method based on vision, key thrusts, actions, and communication. The works offers management practices and predictors for conflict resolution and successful projects. One of the best predictors of success in high performance project managers is the ability to reconcile views rather than differentiate; influence through knowledge; and consider views over logic or preferences (Brooke and Litwin, 1997).

The literature has also indicated competencies of project members and conflict resolution have been key factors of interest. Northeastern University's explored strengthen information technology project competencies having conducted a survey of 190 employers finding that employers considered hands on experience, communications ability, and behavioral mannerism of the student among other attributes. The researcher makes a call for a mixture of improvements to student curriculum that involves project management skills both visionary and hand-on as well as group interaction (Kesner, 2008).  The efforts to strengthen competencies have not only been in traditional education institutions but also in professional organizations such as the American Institute of Certified Public Accountants (AICPA). A 2008 article discussed the accounting industry's approach to identifying and correctly placing information technology staff based on assessed competency levels. The AICPA is using a competency set that is found cross industry and levels of skill ("IT Competency", 2008).  Some dated literature is also indicating that in order to solve vague problem sets within complex project has centered on a willingness and ability to engage the vague circumstances, to think abstractly.  A 1999 psychology publication discussed the typical intellectual engagement involving a desire to engage and understand the world; interest in a wide variety of things; a preference for complete understandings of a complex problem; and a general need to know. The study associated intellect with the typical intellectual  engagement their environment in an intellectual manner, problem solve, believe they possess greater locust of control over the events in their lives (Ferguson, 1999, p 557-558).  Additional research is necessary in this area with this work being so dated.

In a 2006 article researchers sought to understand reporting to senior manager methodology regarding software development projects. The works discussed reporting and governance in an organization then break into four functional areas and further refine the best practices into a common view.  The researchers noted that little attention has been given to how senior managers and the board can be informed about project progress and offered several method of informing them. The researchers reported that senior managers need information grouped into three classes; support decisions, project management, and benefits realization assessments. The researcher then discusses a variety of reports and their attributes. The researchers concluded that senior managers and board members need effective reporting if they are to offer oversight to the software development project (Oliver and Walker, 2006).  Another 2006 study indicated that continuous reporting, information sharing, builds the case for compelling board member involvement based on four factors: cost overrun history, material expenditures, [software] complexity, and any adverse effects on the company (Oliver and Walker, 2006, p 58).

The challenges of project complexity management have utilized information technology governance as a key factor in project success.  Information technology governance has been sought as a framework to align organizational goals with project goals.  In a 2009 qualitative study, researchers sought to treat information technology governance, change management, and project management as closely related then stated a premise that information technology governance must be governed to ensure that problems due to weak governance are corrected.  They postulate the question how much information technology governance is a requirement. Then they organize information technology governance into three broad groups; corporate governance, scope economies, and absorptive capacity exploring these groupings. The researchers finally relate information technology governance to the enterprise at all levels discussing results of a survey given to numerous actors in the organization's CRM [Customer Relationship Management] projects. They also found that most companies surveyed had risk and problem management programs that were mature rather than given lip service. The problem areas that stood out were communicating with senior management as well as consultants and vendors. In conclusion, the researchers remark that information technology governance depends on senior management involvement and sound project management ability (Sharma, Stone, and Ekinci, 2009).

Given scope, risk and project complexity, information technology governance offers a framework for unifying organizational objectives.  Research completed in 2009 showed that information technology governance covers all the assets that may be involved in information technology, whether human, financial, and physical, data, or intellectual property (Sharma, Stone, Ekinci, 2009, p 30).  The same research has also shown that information technology governance required top down involvement stating that successful implementations of information technology governance depends on senior management involvement, constancy, and positive project management abilities (Sharma, Stone, and Ekinci, 2009, p 43).  Senior management requires information to be shared and a 2006 project journal publication supports remarking that continuous reporting builds the case for compelling board member involvement based on four factors: cost overrun history, material expenditures, [software] complexity, and any adverse effects on the company (Oliver and Walker, 2006, pp 50-58).

The body of works while much broader than sampled and demonstrates support and strength in a number of areas of the problem statement.  The literature selected ranges in date from 1997 to 2010 with the greater portion of the works were more recent, 2007 or thereafter. Some of the areas of work are dated or sparse. This indicates a need additional research such as in the area of problem solving abilities in vague or unclear circumstances.  While much of the research was across several industries principally from industry and trade journals in information technology, general construction, or engineering the project management principles and findings transferrable between project types. The works were also with several academic studies and only two open source articles.  Most of the works were authoritative under peer review. The dated works were cited more frequently than the more current works as to be expected.

The compelling thread line in the body of works is that scope and risk concerns influenced by project complexity with cooperation, information sharing, conflict resolutions, and competencies as significant factors in project success.

Discussion

Technology projects are challenged with a variety of factors that contribute towards the performance of the project. The body of works indicates that risk and scope complicated by project complexity directly influence project success from the outset. Thus, early project planning is crucial toward success. The body of works relating to the elemental aspects of competencies, information, cooperation, and conflict management offers historical support to risk and scope formulation. The one point that seemed to standout is information sharing and flow at all levels.  Additional research is necessary into the body of knowledge behind successful project managers and the relationship to the ability to reason through complex and obscure project problem sets as related to project related competencies. Dated literature indicates a relationship between the positive locust of control and willingness to engage abstract problems.

Commentary: I suggest that compartmentalizing a complex project into smaller projects should strengthen the locust of control and improve problem solving challenges. In short, the smaller problem set is more easily grasp than an overwhelming large set of problems. Thus, reducing risk and strengthening scope definition.  In breaking a complex project into smaller achievable projects, the organization will gain greater control over the entire process and gain incremental successes towards the ultimate goal. Continuous improvement would characterize such an evolution.  The master project manager must assess the order in which the smaller projects are completed. Some may be completed simultaneously while others may be completed sequentially. 

A risk of scope creep may be introduced as an outcome of mitigating scope gap. To remain focused all the projects must align with the organizational strategic objectives as they take strategy-to-task. New ideas need to be vetted in meaningful ways for the organization and aligned with the overall objectives in a comprehensive change management plan. 


Communication is also essential in managing complex projects. The use of a Wiki as a point of  foundational policies and information is often a best practice. 

Large scale sudden disruptions of an organization are required under certain circumstances. However, in most circumstances complex projects need to be properly broken into smaller manageable efforts then become part of a continuous improvement effort within the organization. 

References

(2004). Skills shortage behind project failures. Manager: British Journal of Administrative Management, (39), 7. Retrieved from Business Source Complete database.

(2008). AICPA's IT competency tool takes you down the path to success!. CPA Technology Advisor, 18(6), 60. Retrieved from Business Source Complete database.

Brooke, K., & Litwin, G. (1997). Mobilizing the partnering process. Journal of Management in Engineering, 13(4), 42. Retrieved from Business Source Complete database.

Chua, A. (2009). Exhuming it projects from their graves: an analysis of eight failure cases and their risk factors. Journal of Computer Information Systems, 49(3), 31-39. Retrieved from Business Source Complete database.

Ferguson, E. (1999). A facet and factor analysis of typical intellectual engagement (tie): associations with locus of control and the five factor model of personality. Social Behavior & Personality: An International Journal, 27(6), 545. Retrieved from SocINDEX with Full Text database.

Bell, G.R. & Back, E.W. (2008). Critical Activities in the Front-End Planning Process. Journal of Management in Engineering, 24(2), 66-74. doi:10.1061/(ASCE)0742-597X(2008)24:2(66).

Iacovoc, C., & Dexter, A. (2005). Surviving it project cancellations. Communications of the ACM, 48(4), 83-86. Retrieved from Business Source Complete database.

Kesner, R. (2008). Business school undergraduate information management competencies: a study of employer expectations and associated curricular recommendations. Communications of AIS, 2008(23), 633-654. Retrieved from Business Source Complete database.

Kutsch, E., & Hall, M. (2009). The rational choice of not applying project risk management in information technology projects. Project Management Journal, 40(3), 72-81. doi:10.1002/pmj.20112.

Mitchell, V., & Nault, B. (2007). Cooperative planning, uncertainty, and managerial control in concurrent design. Management Science, 53(3), 375-389. Retrieved from Business Source Complete database.

Murray, J. (2001). Recognizing the responsibility of a failed information technology project as a shared failure. Information Systems Management, 18(2), 25. Retrieved from Business Source Complete database.

Natovich, J. (2003). Vendor related risks in it development: a chronology of an outsourced project failure. Technology Analysis & Strategic Management, 15(4), 409-419. Retrieved from Business Source Complete database.

Oliver, G., & Walker, R. (2006). Reporting on software development projects to senior managers and the board. Abacus, 42(1), 43-65. doi:10.1111/j.1467-6281.2006.00188.x.

Seyedhoseini, S., Noori, S., & Hatefi, M. (2009). An integrated methodology for assessment and selection of the project risk response actions. Risk Analysis: An International Journal, 29(5), 752-763.

doi:10.1111/j.1539-6924.2008.01187.x.

Sharma, D., Stone, M., & Ekinci, Y. (2009). IT governance and project management: A qualitative study. Journal of Database Marketing and Customer Strategy Management, 16(1), 29-50. doi:10.1057/dbm.2009.6.

Skilton, P., & Dooley, K. (2010). The effects of repeat collaboration on creative abrasion. Academy of Management Review, 35(1), 118-134. Retrieved from Business Source Complete database.

Sutcliffe, N., Chan, S., & Nakayama, M. (2005). A competency based MSIS curriculum. Journal of Information Systems Education, 16(3), 301-310. Retrieved from Business Source Complete database.

Vermeulen, F., & Barkema, H. (2002). Pace, rhythm, and scope: process dependence in building a profitable multinational corporation. Strategic Management Journal, 23(7), 637. doi:10.1002/smj.243.

Project Complexity Perplexes Procurements

Comment: This is a paper I wrote for a course on procurements.  If you have followed my blog posts you may have realized that I am a proponent of complex adaptive systems (CAS). I have found that CAS reflects natural relationships such that organizational latency is reduced, collaboration and information sharing increase, and problem solving occurs at the point of origin. The business or operation must be properly structured in order to take advantage of CAS. Once again, I have applied this concept to complex projects and procurements.  

Project Complexity Perplexes Procurements

by

JT Bogden, PMP

Introduction

One of the greatest challenges in project management is complexity which is common to mega-projects but also common to smaller highly integrated projects. Complexity occurs in many dynamic forms such as in scalability, relationships, tempo of the project, and due to self-organization. Complexity affects project procurement costs due to uncertainty in quantity and timing. In some cases, the actual procurements required remains in question until conditions emerge such that a determination can be made as in progressive elaboration events. The greater challenge is not the actual procurements but instead the management of or adaptability to emergent conditions while maintaining optimal procurements otherwise known as innovative procurements or simply innovation. In complex projects, the project procurement practices of plan, conduct, administer, and closeout fall short of providing the requisite level of management. How does a project manager design and implement procurement systems or programs that assure optimal procurement processes in the face of uncertainty driven by complexity?

Clarifying Project Complexity

A formal definition of mega-projects does not exist among scholars but the United States government defines mega-projects as major infrastructure projects exceeding US $500 million or projects that attract a high level of public or political attention due to impacts on the community, environment, or budgets (Li, Yanfei, and Chaosheng, 2009). Regardless of the definition or whether a highly integrated or mega-project, complexity is present and best described as projects that have a high degree of uncertainty and dynamic relationships among the participants. A closer look at complexity reveals the nature of the project culture. Scalability relates to sizing or the scale of the effort indicating the type of management and controls. Relationships among the participants such as serial, parallel, or nonlinear indicates the participant’s collaborative interest and willingness to cooperate. Self-organization traits of the project participants relate to the ability adapt to emergent conditions in order to learn and solve problems. The project tempo relates to the rapidity with which decisions must be made and the effort progresses. Projects operating under a compressed time line must make reliable decisions sooner than projects under normal time constraints. Optimal procurement processes are adaptive to the emergent conditions, minimize legal claims in the end, promote quality, and correctly specify materials and services. The project manager must bring these objectives into succinct focus while managing complex projects.

Procurement Planning

Many managers are realizing that the control of overall complexity is a strategic issue for the company (Isk, 2010, pp. 3681-3682). The process begins before the scoping and work breakdown structure is considered by surveying the ground conditions such as the form of complexity, anticipated project tempo, and the nature of the expected procurements in order to begin formulation of the management method.

Project managers reel over uncertainty and the lack of structure. Complexity is typically wrought with uncertainty causing project managers an uneasy sensibility. Somehow, project managers must apply structure to complex projects in order to stabilize the core focus areas and, in particularly, the project procurements. Complex environments rely on several key activities; information sharing, transparency, communications, and autonomy. These activities are necessary for the project participants operating under complex circumstances to adapt to emergent conditions otherwise known as the ability to innovate. Complex adaptive systems are the structure of complex environments that can facilitate the key activities. Complex adaptive systems, Figure 1, are composed of autonomous nodes and communication pipes between the nodes reflecting a molecular lattice. In this case, the autonomous nodes represent suppliers, work centers, stakeholders, and other project participants. The communication pipes between the nodes pass Information Exchange Requirements, IERs, over the pipes and possess the self-organizing capability of dynamically connecting and disconnecting from nodes as necessary. With this architecture in mind, project managers can begin to overlay policies and practices to manage the complex environment. "Owing to the inherent complexity, it is a challenge to coordinate the actions of entities across organizational boundaries so that they perform in a coherent manner (Surana, A., Kumara, S., Greaves, M., & Raghavan, U. 2005, p. 4241)."

Figure 1: Complex Adaptive Systems exchange information and self-organize

Supply Networks

Supply networks can be ‘dyadic’ to multi-firm groupings (Brady, 2011). The variety and uncertainty of a supply chain might be extremely high and cause complexity. A typical supply chain can often be complex as a large mesh having members with competing objectives in other supply chains that dynamically reform (Isik, 2010, p.3685). At the most basic level, supply networks vary in structure based on the predictability of demand and complexity of the finished goods. Regardless of the supply network’s detail, the complex adaptive construct can be mapped to it. The greatest concern for a project manager is the supply network’s ability to be responsive and solve problems autonomously or to be innovative. Supplier competitive and self-interest factors detract from the desirable traits of collaboration and innovation. The project manager must put all the traits into balance in order to keep cost low and innovation high.

The more complex, high technology, and high cost the product becomes the more significant systems integration becomes to the productive activity of the organization (Brady, 2011, p. 471). Complex adaptive constructs combined with program management provide such integration through teaming.

Procurement Management Program

Cost overruns of 50% are common; overruns of 100% are not uncommon. Project management is of enormous value to the success of mega-projects (Li, Yanfei, and Chaosheng, 2009, p. 100). The source of the cost overruns is uncertainty or risk. There are five main sources of risk; (1) Lack of buyer understanding of the requirements, (2) Language shortcomings, (3) Behavior of the parties, (4) Haste, and (5) Deception (Garrett, 2010, p. 50).

A procurement management program frames and provides guidance in order to address risk factors and strengthen the project procurement process such that cost overruns are reduced to acceptable levels. The underpinnings of a procurement program can be addressed in a structured manner the complex adaptive systems as the underpinnings. As indicated prior, optimal procurement processes are innovative and adaptive to the emergent conditions, minimize litigations or claims in the end, promote quality, and correctly specify materials and services. The objective of managing procurements in this manner is to derive value for the project.

The British Airport Authority was confronted with supplier conflict, poor information sharing, unwillingness to accept risk, and the lack of a consistent process among other issues. The solution embodied two main principles; the client always bears the risk and the work was to be carried out by integrated project teams. The British Airport Authority took on the role replacing the lead firm as systems integrator creating a framework of agreements that led to a value-creating supplier network (Brady, 2011, pp. 475-479).

The centerpiece of a program is the type of contracts and agreements made between the contractors or suppliers that leverage the complex adaptive systems traits. These agreements may be viewed as a teaming arrangement which is an agreement between two or more firms to form an alliance for their mutual benefit in a project (Fleming, 2003, pp. 36-37).

A system of agreements should be developed as part of the procurement management program that frame the level of collaboration and empowerment in a way to reduce destructive competition or conflict, properly assign risk, and solve procurement problems as they emerge. This was a success in the Heathrow terminal project where the approach consisted of four main components in the agreement; a single model environment, the use of preassembly, prefabrications, off-site testing, and just-in-time logistics (Brady, 2011, p. 477). One agreement should frame the project procurement structure as did the Heathrow project. Another agreement should frame guidance for cross-functional teams that strengthen collaboration, information sharing, and problem solving. This approach was a success in the SHRBC construction project where long term strategic cooperative partnerships yielded a high satisfaction with collaboration and looked forward to future cooperation projects (Li, Yanfei, and Chaosheng, 2009, p. 107). Other agreements with the procurement participants can be developed on an as needed basis. Once the framework for the procurement program is in place then the project procurement practices of plan, conduct, administer, and closeout, can be integrated into the overall management effort.

The project procurement practices will follow the Project Management Institutes model as closely as possible. This involves the Request for Information, Request for Quotes, and Request for Proposals as well as contract type selections. The procurement management program could have agreements that provide guidance to the participants in the procurement process regarding the project procurement practices in these areas. For example, several contract types could be utilized during the project in a strategic manner. Cost plus fixed fee could be used to reduce cost and manage high uncertainty as the risk management on the buyer and not a lead vendor who may pass the risk around. Firm fixed price contracts are ideal when uncertainty is low and places the risk on the contractor. Time and material contracts should be sparingly used but serve well in augment labor situations where the buyer has direct control and oversight of hours.

In the end, the agreements provide the necessary structure promoting a successful procurement management program.

Conclusion

Leveraging complex adaptive systems as the structural underpinning of complexity creates a framework for innovation that solves problems and increases value to the project. Layered on top of the complex adaptive systems framework is a system of agreements that frame the communications, information sharing, and collaboration as well as any other structures necessary for the management of the procurements in complex projects. Actors in the procurement process need adequate guidance to collaborate, share information, and communicate. In the Heathrow Terminal project, the British Airport Authority took on the role of systems integrator rather than allowing the prime contractor or lead supplier to perform this task. In doing so, a strategic supply network was created where the level of innovation had been considered low (Brady, 2011, p. 470). The system of complex adaptive framework, agreements, and the Project Management Institutes project procurement practices can provide the program management levels necessary to reduce cost overruns in complex projects.

References:

Brady, T. (2011). Creating and sustaining a supply network to deliver routine and complex one-off airport infrastructure projects. International Journal of Innovation & Technology Management, 8(3), 469-481.

Defense Systems Management College. (2008). Comparison of major contract types. [PowerPoint slides]. Retrieved from http://www.dau.mil/sites/locations/dsmc/default.aspx.

Flemming, Q. (2003). Project procurement management: contracting, subcontracting, teaming. (1st e.d.). FMC Press. California.

Garret, G. (2010). World class contracting (5th ed.). CCH, inc. USA. Isik, F. (2010). An entropy-based approach for measuring complexity in supply chains. International Journal Of Production Research, 48(12), 3681-3696.

Li, Z., Yanfei, X., & Chaosheng, C. (2009). Understanding the value of project management from a stakeholder's perspective: Case study of mega-project management. Project Management Journal, 40(1), 99-109. doi:10.1002/pmj.20099

Lind, D. (2012). Integrated project delivery for building new airport facilities. Journal Of Airport Management, 6(3), 207-216.

Project Management Institute. (2008). A Guide to the project management body of knowledge (PMBOK Guide). (4th ed.). Newtown Square, PA: PMI.

Surana, A., Kumara, S., Greaves, M., & Raghavan, U. (2005). Supply-chain networks: a complex adaptive systems perspective. International Journal Of Production Research, 43(20), 4235-4265. doi:10.1080/00207540500142274

Yeow, J., & Edler, J. (2012). Innovation procurement as projects. Journal Of Public Procurement, 12(4), 472-504.

Healthcare Information Virtual Environment System (HIVES)

Comment:  This post was an outcropping of a project we worked in my Master's Program. The problem set was complex and required the project team to scope, identify, then management risks, objectives, and the projects necessary to implement the overarching project. 

Healthcare Information Virtual Environment System (HIVES)

by

JT Bogden, PMP

Healthcare information systems have a vast array of various equipment, clinics, labs, governmental agencies, manufacturers, doctor offices, and innumerable other organizations providing, collecting, and processing information. Classic issues of stove piping or 'Silos' have emerged causing inefficiencies in the industry such as multiple lab test and/or diagnostics being prescribed. The advent of a nationalized health records system increases the complexity of these networks as well. In order to gain management and control over these information systems, the American National Standards Institute (ANSI) hosts the Healthcare Information Technology Standards Panel, (HITSP). This is one of several cooperative efforts, between industry and government to create standards. However, all too often the standards result in a highly complex architecture and system design to the chagrin of efficienies. This is because early standards and architectures often focus on resolving major issues with little forethought into the broader architecture. Many argue that little information is known or that the project is far too complex. Years later, this results in an effort to simplify and streamline the system again.

Allowing a Frankenstein architecture to emerge would be a travesty when our initial objectives are to streamline the healthcare processes removing redundancies and latencies in the current system. The planners should design the system for streamlined performance early. Large scale projects like these are not new and history tells us many good things. The evolution of complex systems such as the computer, the car, and the internet have emerged out of a democratization of design. Literally, tens of thousands of people have contributed to these systems and those models are one approach to resolving the large scale complex information systems involved in healthcare. What we have seen emerge out of the democratization of design is a standardization of interfaces in a virtualized environment. For example, the headlamps are nearly identical for every car with standard connectors and mounts even though the headlight assemblies are artfully different on each car. The computer has standard hardware and software interfaces even though the cards and software perform different functions. The virtual computer is independent of vendor product specifications. Instead, the vendor performs to a virtual computer standard in order for their products and services to function properly.

Let us take a moment to explain that virtualization is the creation of a concept, thing, or object as an intangible structure for the purpose of study, order, and/or management. The practice is used in across a breadth of disciplines to include particle physics and information science. Within the information realm, there are several different virtualization domains to include software, hardware, training, and management virtualization. My interest is not in the use of any specific virtualized technology but instead in exploring healthcare virtualization management as a practice.

I propose a need for a Healthcare Information Virtual Environment System (HIVES), Figure 1, which is essential to reducing complexity and establishing a standard for all those participating in the healthcare industry. The virtual environment is not a technological system. Instead it is a management system or space in which medical information is exchanged by participating objects within the virtual environment. Real things like clinics, offices, data centers, and equipment sit on the virtualized backplane or space.  HIVES would have a set of standards for participating equipment, clinics, hospitals, insurance agencies, data centers, etc... connecting to the environment in order to exchange information. Many may remark that these standards exist. I am able to locate dozens of vendor products and services supporting hardware, software and even service virtualization which are not a standard virtualized management of the overarching healthcare environment that is what the nationalized healthcare system is attempting to manage. I have reviewed HITSP and noted there is no clear delineation of a virtualized managed environment.

Figure 1: HIVES

In such an environment, I envision data being placed into the environment would have addressing and security headers attached. In this way, data is limited to those listening and who have authorization to gather, store, and review specific information. For example, a doctor prescribes a diagnostic test. An announcement is made in the environment of the doctors request addressed to testing centers. Scheduling software at a testing facility participating in the environment picks up the request then schedules the appointment. It announces the appointment in the virtualized environment in which the doctor's office software is listening to receive the appointment data. Once the patient arrives the machines perform the diagnostics placing the patient's data back in the environment. A analyst picks up the record reviews it and posts the assessment in the environment. In the meantime, a data center participating in the environment that holds the patient's record is listening and collects all new information posted in the environment regarding the patient then serves those records to authenticated requests. The patient returns to the doctors office which request the patient's record from the data center through the environment.

The advantages to having such an environment whether called HIVES or something else are astronomical. The patient's records are available to all participating in the environment, security levels and access can be administered in the environment efficiently to ensure HIPPA and other security compliance standards, bio-surveillance data is more readily available with higher accuracy in the data centers, the environment can be an industry driven standard and managed through a consortium, and the government could be an equal participant in the environment.  

Moreover, to be a participant, the manufacturer, clinic, lab, hospital, doctor office, data center or any others have to meet the clearly defined standards and become a consortium participant at some level. Thus, complexity of the architecture and systems interfacing can be tremendously reduced achieving the stated objectives of healthcare reform and streamlining.