Ten-Second Coherence Test — Where Does Coherence Break Most Often in Your Patient-Care Flow
- Sunil Dutt Jha
- Nov 11
- 3 min read
Ten-Second Coherence Test — Where does coherence break most often in your patient-care flow?
Hospitals digitized rapidly — yet care, billing, and compliance still
ICMG Enterprise Anatomy™ exposes where those gates lose alignment.
Diagnostics Question:
Where does coherence break most often in your patient-care flow?
P1 — Strategy (Care model, compliance goals)
P2 — Process (Admission, discharge, claims)
P3 — Systems / Logic (EHR, billing, labs)
P4 — Component Specs (HL7 APIs, schema fields)
P5 — Implementation Tasks
P6 — Operations
Which Gate Disrupts Care Flow?
Vote P1–P6 -Trace the anatomy of delay.
Executive Context (P1–P2)
Hospitals digitized fast—EHR, lab automation, claims platforms—but care still slows where departments meet.The root isn’t capacity; it’s coherence. Somewhere between P1 (Strategy) and P2 (Process), intent fragments before it reaches the bedside.
Leadership sets “patient-centric” goals, while each unit (clinical, billing, compliance) designs its own workflows.
The six-gate (perspectives) spine of Enterprise Anatomy™—Strategy → Process → Systems → Specs → Implementation → Operations—shows how those divisions silently derail integrated care.
Hidden Anatomy (P3)
The most frequent drift emerges at P3 (Systems / Logic). EHR, billing, and insurance platforms each encode different care-rule logic.
For example: a patient discharged at 9 a.m. in EHR remains “admitted” in billing until midnight, triggering excess-stay costs and audit exceptions.
To IT, it looks like a “data-sync issue.”
To enterprise anatomists, it’s logic misalignment—the nervous system misfiring inside the healthcare body.
Component & Implementation (P4–P5)
P4 (Component Specs): HL7 fields, API mappings, and data dictionaries rarely mirror one another. Each vendor maintains its own parameter list.
Result: one field labeled Diagnosis Code on screen A equals Primary Condition ID on system B.
P5 (Implementation Tasks): Integrators test for interface success, not semantic alignment. Every “pass” hides a drift.
In one diagnostic, 40 % of billing delays stemmed from mismatched discharge codes between EHR and claims modules—each technically correct, but anatomically incoherent.
Operations & Impact (P6)
Operations staff bridge the gap manually—re-entering data, calling departments, or correcting claims after submission. Over time, these compensations create invisible cost centers.
Measured effects across three hospital networks:
Average discharge-to-billing delay ↑ 3-4 hours
Manual reconciliation workload ↑
Claim rejection due to logic mismatch ↑
Patient satisfaction score ↓
Every mismatch drains both margin and morale.
Diagnostic Map
Perspective | Anatomy Meaning | Common Failure in Healthcare | Observable Symptom |
P1 – Strategy | Care-model & financial alignment | Digital plan built without clinical workflow input | Disconnected KPIs across departments |
P2 – Process | Admission → Discharge → Claims sequence | Manual or redundant steps | Extended patient cycle time |
P3 – Systems / Logic | EHR, Billing, Lab rules | Different rule engines | Duplicate or missing transactions |
P4 – Component Specs | HL7 fields, APIs, configs | Parameter mismatch across vendors | Interface “success” but data error |
P5 – Implementation | Build / deploy tasks | Passed UAT without logic traceability | Issues post-go-live |
P6 – Operations | Daily care and revenue cycle | Staff workarounds | Overtime and audit risk |
Pattern Recognition — Why the Drift Repeats
Departmental Autonomy ≠ Integration: Each function perfects its own process. None governs cross-gate coherence.
Vendor-Centric Ecosystem: Every system follows its vendor’s logic template, not the hospital’s anatomy.
Compliance Over Design: Accreditation drives documentation, not coherence.
Project Fatigue: Multiple digitization waves left fragmented remnants of earlier architectures.
The result: a hospital digitally rich but structurally disjointed.
Governance Implications — The Leadership Drift
Healthcare boards measure outcomes, costs, and compliance separately.
Anatomy governance demands a new question: Do our care, billing, and compliance systems think the same thought?
The Chief Enterprise Architect becomes the integrator of intent—bridging medical excellence with operational integrity.
From Diagnosis to Restoration of Coherence (Advisory Path)
Model the Hospital Anatomy (P1–P6 × D1–D15 departments).
Run Coherence Tests for admission, discharge, and claims flows.
Apply ICMG X-Ray Protocol to isolate rule and data conflicts.
Create Unified Gate Governance (Clinical + Finance + IT).
Rate and track progress through the Fast-Track Rating platform.
Turning Insight into Action
Join the Healthcare Enterprise Architecture & Anatomy Forum to share your gate results.
Request a Fast-Track Coherence Rating for your hospital or network.
One Healthcare. One Anatomy™ | ICMG Enterprise Anatomy™ Diagnostics
