Prescriptions: Lawmakers Detail Obama’s Pitch

New York Time:  Lawmakers Detail Obama’s Pitch

By Jackie Calmes

In an odd coincidence, the House debate on Saturday to overhaul health care took place on the third anniversary of the 2006 election that gave Democrats majority control after 12 years of Republican dominance. It fell to President Obama and to Congressional leaders to persuade those Democrats still sweating the final vote that it would not prove the party’s undoing in next November’s midterm elections.

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CMIO Magazine

Can we build an Enhanced Healthcare Operations Map–e-HOM?

Contributing editor: Paul Roemer – – Can we build an Enhanced Healthcare Operations Map–e-HOM to create a standard for processes within the healthcare industry? 

Please click on the link below to view the e-TOM diagram used in Telecommunication Industry:

CMIO Magazine – e-TOM Diagram

Without such a map, knowing which processes are involved with which systems and knowing where to apply change management is like shooting in the dark. I’ve asked and searched, and there does not appear to be anything like e-HOM. 

The telecommunications industry has such a model, e-TOM.  It serves as their global standard for process development and process interaction.

 The e-TOM model consists of Level-0, Level-1, Level-2 and Level-3 processes. Each level drills down to the more specific processes.  The graphic representation of an e-TOM model consists of rows and columns. The intersections of these rows and columns point to specific high level processes within the model. The topmost row denotes the customer facing activity i.e. marketing while the bottom most row indicates the supplier facing activity and the support activities.  In this manner the e-TOM map indicates the whole value chain. The map also gives a good indication of the interaction between the processes.

I know we can build our own healthcare operations map. Please take a look at the telecommunications industry model and let me know your thoughts as to how we can edit that diagram to create our own. What word would you change, what would you add, what relationships would you add or delete? For example, we would change “customer” to patient. Where would you add “EHR”, registration, etc? 

How would healthcare benefit from having such a map?  Here are my thoughts to that question.   I’ve used it a lot with my clients. I use it to help people in one part of the organization see how they relate to the entire organization.  It is used to show the boundaries served by various systems and the major business functions with which they interface.  It can be used to show where processes and/or systems are duplicated. 

I mostly use it to define major processes and functions that will be affected by adding or changing large it systems.  For example, what is the impact to the provider of adding EHR, of replacing an ERP system, of eliminating a redundant billing department?  The diagram is used for As-Is and To-Be models. This is considered a Level 0 diagram. I take this down at least three levels, or to a level where processes (work flows) have been decomposed to a level where one can define inputs, outputs, and interactions. 

From there I define business rules for each process. At the end of this effort I have an N x M map of business rules and processes. I know that if I change a business rule exactly what processes must be changed, and if I change a process which rules must be changed. I use this information to parameterize the systems, determine where change management and training must be applied. 

It is also a very good tool to use when implementing shared services, telling which processes will be affected by removing duplicated parts of the practice. 

for further maps and questions, please contact Tracy Carroll at

Author: Paul Roemer