Example of a responsibilities driven business architecture alignment effort
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This document uses the Microsoft Connected Health Framework (CHF) to illustrate a Responsibilities Driven Business Architecture Alignment effort conducted by a fictional Healthcare organization that ...

This document uses the Microsoft Connected Health Framework (CHF) to illustrate a Responsibilities Driven Business Architecture Alignment effort conducted by a fictional Healthcare organization that wants to adopt the CHF.

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Example of a responsibilities driven business architecture alignment effort Presentation Transcript

  • 1. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 1 of 60 EBMM-TRIADS™ Responsibilities Driven Business Architecture Alignment Case Study: The Microsoft CHF
  • 2. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 2 of 60 Table of Contents 1-Introduction ........................................................................................................................................................................6 2-The EBMM-TRIADS...........................................................................................................................................................6 3-EBMM-TRIADS Shared Relationships...............................................................................................................................8 4-Responsibilities-Driven Business Architecture Alignment ................................................................................................12 4.1 Business Responsibilities and Motivation Alignment: WHO-WHY Relationships .............................................12 4.1.1. Market Segments Generate Customer Demands and Relationships .............................................................12 4.1.2. Influencing Organizations are Sources of Influence .......................................................................................13 4.1.3. Stakeholders are accountable for Business Strategies and Objectives..........................................................13 4.1.4. Stakeholders can be a type of Driver..............................................................................................................13 4.1.5. Governance Body enforces Business Policies ...............................................................................................14 4.2 Business Responsibilities and Strategy Alignment: WHY-WHAT Relationships ..............................................14 4.2.1. Business Capability Roadmaps describe Changes to Business Capabilities .................................................14 4.2.2. Business Strategies and Objectives drive changes to Business Capabilities .................................................14 4.2.3. Business Initiatives and Programs drive changes to Business Capabilities....................................................14 4.2.4. Customer Demands and Relationships drive Products and Services.............................................................14 4.2.5. Value Proposition drives Required Competencies..........................................................................................15 4.2.6. Directives govern the use of Assets ...............................................................................................................15 4.3 Business Responsibilities and Operation Alignment: WHAT-WHO Relationships............................................15 4.3.1. Business Units are responsible for Business Capabilities ..............................................................................15 4.3.2. Business Units are responsible for Assets......................................................................................................16 4.3.3. Business Units provide Products and Services ..............................................................................................16 4.3.4. Business Units consume Products and Services............................................................................................16 5-Responsibilities-Driven Business Architecture Alignment and the Microsoft CHF ...........................................................17 5.1-BUSINESS POLICIES .............................................................................................................................................20 5.2-CAPABILITY ROAD MAP........................................................................................................................................20 5.3-CHF BUSINESS CAPABILITIES .............................................................................................................................21 5.4-CUSTOMERS’ DEMANDS and RELATIONSHIPS..................................................................................................22 5.5-MARKET SEGMENTS.............................................................................................................................................23 5.6-PRODUCTS and SERVICES...................................................................................................................................24 5.7-REQUIRED COMPETENCIES ................................................................................................................................25 5.8-VALUE PROPOSITION...........................................................................................................................................25
  • 3. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 3 of 60 5.9-YOUR ORGANIZATION'S ASSETS........................................................................................................................26 5.10-YOUR ORGANIZATION'S BUSINESS INITIATIVES & PROGRAMS ...................................................................27 5.11-YOUR ORGANIZATION'S BUSINESS STRATEGIES & OBJECTIVES................................................................28 5.12-YOUR ORGANIZATION'S BUSINESS UNITS ......................................................................................................29 5.13-YOUR ORGANIZATION'S GOVERNANCE BODY................................................................................................30 5.14-YOUR ORGANIZATION'S STAKEHOLDERS .......................................................................................................31 5.15-WHO-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES......................................................................32 INFLUENCING ORGANIZATIONS .............................................................................................................................32 ITU............................................................................................................................................................................32 MARKET SEGMENTS ................................................................................................................................................32 CARE PROFESSIONALS (D) ..................................................................................................................................32 CARE PROVIDERS (P)............................................................................................................................................33 FUNDING ORGANIZATION (F) ...............................................................................................................................33 PERSONS (C)..........................................................................................................................................................33 POLICY MAKERS and LEGISLATORS (G) .............................................................................................................34 RESEARCHERS and ANALYSTS (R)......................................................................................................................34 5.16-WHY-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES ......................................................................34 BUSINESS POLICIES.................................................................................................................................................34 Using Cloud Computing............................................................................................................................................34 Using Portals ............................................................................................................................................................35 Using SOA................................................................................................................................................................35 CAPABILITY ROADMAPS..........................................................................................................................................36 Maturity Model for e-Health and e-Care ...................................................................................................................36 CUSTOMER DEMANDS AND RELATIONSHIPS.......................................................................................................36 C2C ..........................................................................................................................................................................36 C2P ..........................................................................................................................................................................37 D2C ..........................................................................................................................................................................37 D2D ..........................................................................................................................................................................38 F2C...........................................................................................................................................................................38 F2F...........................................................................................................................................................................39 F2P...........................................................................................................................................................................40 G2C..........................................................................................................................................................................40 G2D..........................................................................................................................................................................41
  • 4. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 4 of 60 G2F ..........................................................................................................................................................................41 G2G..........................................................................................................................................................................42 G2P ..........................................................................................................................................................................42 P2D ..........................................................................................................................................................................43 P2P...........................................................................................................................................................................43 R2F...........................................................................................................................................................................44 R2G..........................................................................................................................................................................44 R2R ..........................................................................................................................................................................45 VALUE PROPOSITIONS ............................................................................................................................................45 Microsoft Value Proposition for Health and Social Care ...........................................................................................45 5.17-WHAT-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES....................................................................47 BUSINESS CAPABILITIES.........................................................................................................................................47 ASSESSMENTS AND CARE PLANS ......................................................................................................................47 CARE FACILITIES AND SCHEDULES ....................................................................................................................47 CARE PATHWAYS ..................................................................................................................................................48 CARE PROFESSIONALS ........................................................................................................................................48 CLINICAL AND CARE DATA MANAGEMENT.........................................................................................................48 CLINICAL CODING AND DATASETS......................................................................................................................49 COSTS AND PRICES ..............................................................................................................................................49 CURRENT CLIENTS, PATIENTS AND CARE RELATIONSHIPS ...........................................................................49 HEALTH AND CARE CLASSIFICATIONS ...............................................................................................................50 INVESTIGATIONS, ORDERS, TESTS AND RESULTS...........................................................................................50 MEDICATIONS AND TREATMENTS.......................................................................................................................51 ORGANIZATIONS, CARE PROVIDERS AND SERVICES ......................................................................................51 PATIENT AND CLIENT GROUPS............................................................................................................................52 PATIENT AND CLIENT JOURNEY..........................................................................................................................52 PATIENT AND CLIENT MANAGEMENT .................................................................................................................53 PERSONAL AFFILIATIONS AND ENTITLEMENTS ................................................................................................53 PERSONAL CARE RECORDS ................................................................................................................................54 PERSONAL CONSENTS .........................................................................................................................................54 PERSONAL HEALTH AND CARE STATUS ............................................................................................................55 PERSONS AND IDENTITIES...................................................................................................................................55 PROCESSES AND PROTOCOLS ...........................................................................................................................56
  • 5. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 5 of 60 PROFESSIONAL ROLES AND TEAMS...................................................................................................................56 RULES ENGINE.......................................................................................................................................................56 SOCIAL CARE CODING AND DATASETS..............................................................................................................57 WAITING LISTS .......................................................................................................................................................57 PRODUCTS AND SERVICES ....................................................................................................................................58 CARE PROFESSIONAL SERVICES........................................................................................................................58 CARE PROVIDER SERVICES.................................................................................................................................58 FUNDING ORG SERVICES.....................................................................................................................................58 PERSON SERVICES ...............................................................................................................................................59 POLICY MAKER SERVICES....................................................................................................................................59 RESEARCHER and ANALYST SERVICES .............................................................................................................59 REQUIRED COMPETENCIES....................................................................................................................................59 Connected – Interoperable by Design ......................................................................................................................59 Dependable – Proven and Robust............................................................................................................................59 Extensive Partner Ecosystem...................................................................................................................................59 Productive – Familiar Tools to Automate the Way Users Work ................................................................................59 REFERENCES....................................................................................................................................................................60
  • 6. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 6 of 60 1-Introduction We present an approach that tackles the number one issue faced by most organizations: Aligning Business and IT. We do so by presenting a Business Architecture meta-model called the EBMM-TRIADS and its practical application to aligning an organization's Business Motivation, Business Strategy, Business Responsibilities, and Business Operation. Each one of the four EBMM-TRIADs shares three sets of relationships with the other TRIADs. The relationships contained in each one of those sets impose alignment constraints on the types of Business Architecture elements hosted by the TRIADs. So each set of constraints represents a dimension of alignment between two TRIADs. The number of relationships contained in each set indicates the strength of alignment between the two TRIADs that share the set. Therefore the EBMM-TRIADs can provide a solid reference for a qualitative and quantitative characterization of the alignment achieved by an organization through its existing and targeted Business Architectures. We illustrate our approach with a case study of a Business Architecture Alignment effort conducted by a healthcare organization that wants to adopt the Microsoft Connected Health Framework (CHF). 2-The EBMM-TRIADS The EBMM-TRIADs are a conceptual meta-model of a business architecture and as such they model the types of elements and their associated relationships involved in the definition of an actual business architecture. The four EBMM-TRIADs elegantly break down the complexity found in Nick Malik's initial EBMM [1] by showing how its business architecture elements participate in four very common views of any Business Architecture: Strategy, Motivation, Responsibilities, and Operation. Each TRIAD combines three fundamental interrogatives taken from the following set: WHY, WHAT, WHO, and HOW. Each interrogative group contains several types of Business model elements that
  • 7. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 7 of 60 entertain relationships with each other (e.g Success Metrics and Measures [WHY] set Performance Criteria for Business Strategies and Objectives [WHY]). The EBMM-TRIADs are an attempt at integrating fundamental interrogatives similar to the purpose of the Zachman Framework’ s (ZF) Integration Relationships between any two cells of the same perspective (ZF Row) [2,3]. Each TRIAD lists relevant types of business model elements and their respective relationships. Those relationships are between elements that belong to different interrogative groups (e.g. Business Strategies and Objectives [WHY] drive changes to Business Capabilities [WHAT]). Figure 1 – The EBMM-TRIADS Figure 1 is a high level view of the EBMM-TRIADs. These are the interrogatives that define each
  • 8. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 8 of 60 TRIAD:  Business Strategy TRIAD: HOW does WHAT fulfil WHY  Business Motivation TRIAD: HOW does WHO influence WHY  Business Responsibilities TRIAD: WHY does WHO do WHAT  Business Operation TRIAD: HOW does WHO do WHAT The EBMM-TRIADS have practical applications to Business Architecture Alignment. The approach that we present can be used to guide an organization through the steps required to achieve a strong alignment between Business Motivation, Business Strategy, Business Responsibilities, and Business Operation. Our approach is valuable because it tackles the number one issue faced by most organizations: Aligning Business and IT [4]. A practical definition of alignment is given by Henderson and Venkatraman as “Alignment between business and IT is the degree of fit and integration between business strategy, IT strategy, business infrastructure, and IT infrastructure”[5]. The EBMM-TRIADs allow a precise characterization, both qualitative and quantitative, of the degree of fit and integration between Business and IT. 3-EBMM-TRIADS Shared Relationships Each EBMM-TRIAD shares three sets of relationships with the other TRIADs as shown in Figure 2. The relationships contained in each one of those sets impose Alignment constraints on the types of Business Architecture elements hosted by the TRIADs. So each set of constraints represents a dimension of alignment between two TRIADs. The number of relationships contained in each set
  • 9. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 9 of 60 indicates the strength of alignment between the two TRIADs that share the set. This provides a solid reference for a qualitative and quantitative characterization of the alignment achieved by an organization through its existing and targeted Business Architectures [6]. The sets of relationships shared between the TRIADS are as follows:  Business Strategy and Business Operation shared relationships: o HOW to WHAT  Business Processes and Activities properly manage Assets  Business Processes and Activities produce and consume proper Data Objects  Assessment Metrics evaluate Business Capabilities  System Interaction Points are described in Use Cases or User Stories  Applications properly impact Business Capabilities  Applications are involved in providing useful Products or Services o WHAT to HOW  Business Capabilities are implemented through Business Processes/Activities  Data Objects are created or used in Applications  Business Requirements describe Application Features  Business Strategy and Business Motivation shared relationships: o WHY to HOW  Directives govern Business Processes and Activities  Success Metrics and Measures track success of Business Processes and Activities  Value propositions are inputs to Finance and Revenue Models o HOW to WHY
  • 10. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 10 of 60  Assessment Metrics prioritize Capability Roadmaps  Key Performance Indicators track Success Metrics and Measures  Business Strategy and Business Responsibilities shared relationships: o WHY to WHAT  Business Initiatives and Programs drive changes to Business Capabilities  Business Strategies and Objectives drive changes to Business Capabilities  Customer Demands and Relationships drive products and services  Value Propositions drive Required Competencies  Directives govern use of Assets  Capability Roadmaps describe changes to Business Capabilities  Business Responsibilities and Business Operation shared relationships: o WHO to WHAT  Business Units are responsible for Assets  Business Units are responsible for Business Capabilities  Business Units consume Products and Services  Business Units provide Products and Services  Business Responsibilities and Business Motivation shared relationships: o WHO to WHY  Governance Body enforces All Business Policies  Stakeholders are accountable for Business Strategies and Objectives  Stakeholders can be a type of Driver  Market Segments generate Customer Demands and Relationships  Influencing Organizations are sources of Influence  Business Motivation and Business Operation shared relationships:
  • 11. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 11 of 60 o WHO to HOW  Business Units perform Business Processes and Activities In the previous Relationships List, we have highlighted in blue Business model elements that appear in multiple Relationship sets. Highlighted in green are the Business model elements that appear more than once but only within one Relationship set. None-highlighted Business model elements only appear once across all Relationship sets. Figure: 2
  • 12. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 12 of 60 There are 4 possible Alignment approaches, each defined by the TRIAD that triggers the alignment effort. We have demonstrated that a Responsibilities-Driven Business Architecture Alignment can be significantly more efficient than its counterparts. The interested reader can refer to the following presentation for an overview of each approach and its efficiency: How to Use the EBMM-TRIADS to Conduct a Business Architecture Alignment Effort [7] 4-Responsibilities-Driven Business Architecture Alignment We advocate using a Responsibilities-Driven approach to aligning Business and IT Architectures. We have provided a quantitative rational in past presentations [7]. Let’s now explain our view from a qualitative standpoint by providing a series of steps that logically define relevant Business Architecture elements that can support a rational formulation of a Business Organizational structure. 4.1 Business Responsibilities and Motivation Alignment: WHO-WHY Relationships 4.1.1. Market Segments Generate Customer Demands and Relationships An Organization’s success is irrevocably tied to its customers’ satisfaction and loyalty. To ensure that an organization is properly aligned with its customers’ expectations, it must have a reliable and comprehensive enough understanding of its Market Segments. Clarifying the specific demands or expectations of each Market Segment allows the organization to justify its engagement towards each targeted customer group. Customers’ trust and hopefully their long term loyalty can then be effectively
  • 13. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 13 of 60 secured and nurtured by the organization through its profound understanding and undisputable fulfillment of customers’ expectations. 4.1.2. Influencing Organizations are Sources of Influence Influencing organizations could be Partners, Competitors, or Regulatory bodies. In some sense, Partners and Regulatory bodies are also Customers of the organization since they bring specific constraints or expectations often key to the organization’s success. Competitors’ influence is undeniable as they often cater to the same pool of customers as the ones targeted by an organization. Here again, knowing the strengths and weaknesses of Competitors as well as the organization’s own is key to the formulation of a Business Strategy that can ultimately secure the organization’s desired market position. 4.1.3. Stakeholders are accountable for Business Strategies and Objectives With a clear understanding of Customer Demands and Relationships and the proper consideration of influences generated by Partners, Regulatory bodies, and Competitors, Organization Stakeholders are empowered to formulate effective Business Strategies and Objectives that have a high probability of securing a desired Market Position. It is fundamental to hold Stakeholders accountable for those Strategies and Objectives as described next. 4.1.4. Stakeholders can be a type of Driver Stakeholders when held accountable for a given set of Business Strategies and Objectives become advocate for their effective implementation. Some stakeholders will carry this responsibility further than others by actually driving the Business Strategies and Objectives toward their fulfillment and by being actively involved in or accountable for all activities required for their realization.
  • 14. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 14 of 60 4.1.5. Governance Body enforces Business Policies Some Stakeholders play the role of Governance body by creating and enforcing Business Policies applicable to the entire Organization and/or specific Business Units. These Business policies are meant to support and articulate agreed upon Directives that contribute to the achievement of the established Business Strategies and Objectives. 4.2 Business Responsibilities and Strategy Alignment: WHY-WHAT Relationships 4.2.1. Business Capability Roadmaps describe Changes to Business Capabilities A Capability Roadmap is a well-articulated set of successive changes to the organization’s Business Capabilities aimed at progressively transforming the organization from its current state to its desired future states. Capability Roadmaps must be prioritized according to selected Assessment Metrics that highlight the most valuable opportunities for Capability improvements. Therefore, Capability Roadmaps are solid foundations upon which Business Initiatives and Programs can be chartered. 4.2.2. Business Strategies and Objectives drive changes to Business Capabilities The organization’s desired future Capabilities are the outcome of fulfilling its Business Strategies and achieving its Business Objectives. 4.2.3. Business Initiatives and Programs drive changes to Business Capabilities. Business Initiatives and Programs chartered from Capability Roadmaps drive changes to Business Capabilities in a coordinated and effective manner. 4.2.4. Customer Demands and Relationships drive Products and Services Properly assessed and understood Customer Demands and Relationships along with Influences
  • 15. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 15 of 60 created by Competitors, Partners, and Regulatory bodies all come into consideration for the formulation of desired product and service offerings that effectively package Business Capabilities specified by Capability Roadmaps. 4.2.5. Value Proposition drives Required Competencies The Value Proposition can be formulated by describing the rationale behind an organization’s featured products and services. Securing the targeted Market Position mandates Required Competencies through exceptional Capabilities included in or contributing to the organization’s product and service offerings. 4.2.6. Directives govern the use of Assets Once an organization has defined its Value Proposition and Required Competencies, it can elicit its Assets. Assets are resources employed, possessed, or controlled by the organization in order to deliver its products and services. The next step is for the Governance body to formulate Directives that govern the use of Assets in a way that contributes to the achievement of the established Business Strategies and Objectives. 4.3 Business Responsibilities and Operation Alignment: WHAT-WHO Relationships 4.3.1. Business Units are responsible for Business Capabilities The organization is now in a more reliable position to consolidate its structure by forming or allocating Business Units responsible for each Business Capability. Required Competencies can guide this allocation process.
  • 16. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 16 of 60 4.3.2. Business Units are responsible for Assets From the previous elicitation of Business Assets and their respective Directives, the organization can further refine its structure by designating Business Units responsible for each Asset. 4.3.3. Business Units provide Products and Services Since Products and Services package Capabilities and since Business Units have been mapped to the Capabilities that they are responsible for, it is possible to determine which Business Units provide which products and Services based on the Capabilities packaged within products and services. 4.3.4. Business Units consume Products and Services A Business Unit consumes a Product or Service when it uses a Product or Service that is provided by another Business unit. The previous steps have contributed to aligning only 3 Business Architecture Dimensions out of 6 possible ones by examining 15 out of 30 total Relationship Rules. We have explained how to address the remaining 3 Dimensions of Alignment in our presentation titled: “EBMM-TRIADs Deep Dive: The Chemistry of Business and IT Alignment”[9]
  • 17. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 17 of 60 5-Responsibilities-Driven Business Architecture Alignment and the Microsoft CHF The remainder of this document uses the Microsoft Connected Health Framework (CHF) to illustrate a Responsibilities- Driven Business Architecture Alignment effort conducted by a fictional Healthcare organization that wants to adopt the CHF [8]. This is a link to the Microsoft CHF website: http://www.microsoft.com/health/ww/ict/Pages/Connected-Health-Framework.aspx We will identify key CHF Business Architecture actual elements and we will link them to their EBMM-TRIADS classifications. The fictional organization has specific Business Architecture elements not directly addressed by the CHF; we will highlight them and link them to CHF Business Architecture elements that influence or constrain them. When the Business Responsibilities TRIAD triggers the Business Architecture Alignment cycle, the following types of relationships are first examined: FOR BUSINESS MOTIVATION & RESPONSIBILITIES ALIGNMENT -WHO to WHY  Governance Body enforces All Business Policies  Stakeholders are accountable for Business Strategies and Objectives  Stakeholders can be a type of Driver  Market Segments generate Customer Demands and Relationships  Influencing Organizations are sources of Influence FOR BUSINESS STRATEGY & RESPONSIBILITIES ALIGNMENT -WHY to WHAT  Business Initiatives and Programs drive changes to Business Capabilities  Business Strategies and Objectives drive changes to Business Capabilities
  • 18. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 18 of 60  Customer Demands and Relationships drive products and services  Value Propositions drive Required Competencies  Directives govern use of Assets  Capability Roadmaps describe changes to Business Capabilities FOR BUSINESS OPERATION & RESPONSIBILITIES ALIGNMENT -WHO to WHAT  Business Units are responsible for Assets  Business Units are responsible for Business Capabilities  Business Units consume Products and Services  Business Units provide Products and Services The fictional organization’s specific Business Architecture elements that are not directly addressed by the CHF are highlighted in Yellow in the previous relationship list. Figure 3 is an example of a healthcare organization’s Business Architecture model based on Business Architecture element types found in the Business Responsibilities TRIAD. Figure 3 incorporates CHF Business Architecture elements that are relevant to most healthcare organizations. Business Architecture elements that are specific to our fictional healthcare organization are symbolized by yellow boxes and would need to be detailed by that organization.
  • 19. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 19 of 60 Figure 3: Responsibilities-Driven Business Architecture Model for Healthcare Organizations object Responsibilities-Driven Business Architecture Alignment WHO MARKET SEGMENTS PERSONS (C) :MARKET SEGMENT CARE PROFESSIONALS (D) :MARKET SEGMENT CARE PROVIDERS (P) :MARKET SEGMENT FUNDING ORGANIZATION (F) : MARKET SEGMENT INFLUENCING ORGANIZATIONS INFLUENCING ORGANIZATIONS RESEARCHERS and ANALYSTS (R) : MARKET SEGMENT WHY CUSTOMERS DEMANDS and RELATIONSHIPS CUSTOMERS DEMANDS and RELATIONSHIPS P2P :CUSTOMER DEMANDS and RELATIONSHIPS D2D :CUSTOMER DEMANDS and RELATIONSHIPS C2C :CUSTOMER DEMANDS and RELATIONSHIPS G2G :CUSTOMER DEMANDS and RELATIONSHIPS R2R :CUSTOMER DEMANDS and RELATIONSHIPS F2F :CUSTOMER DEMANDS and RELATIONSHIPS C2P :CUSTOMER DEMANDS and RELATIONSHIPS D2C :CUSTOMER DEMANDS and RELATIONSHIPS G2C :CUSTOMER DEMANDS and RELATIONSHIPS F2C :CUSTOMER DEMANDS and RELATIONSHIPS P2D :CUSTOMER DEMANDS and RELATIONSHIPS G2D :CUSTOMER DEMANDS and RELATIONSHIPS R2G :CUSTOMER DEMANDS and RELATIONSHIPS G2F :CUSTOMER DEMANDS and RELATIONSHIPS R2F :CUSTOMER DEMANDS and RELATIONSHIPS F2P :CUSTOMER DEMANDS and RELATIONSHIPS G2P :CUSTOMER DEMANDS and RELATIONSHIPS WHAT PRODUCTS and SERVICES PRODUCTS and SERVICES PERSON SERVICES :PRODUCTS and SERVICES CARE PROFESSIONAL SERVICES : PRODUCTS and SERVICES CARE PROVIDER SERVICES : PRODUCTS and SERVICES POLICY MAKER SERVICES : PRODUCTS and SERVICES POLICY MAKERS and LEGISLATORS (G) :MARKET SEGMENT FUNDING ORG SERVICES : PRODUCTS and SERVICES RESEARCHER and ANALYST SERVICES :PRODUCTS and SERVICES BUSINESS POLICIES CAPABILITY ROAD MAP Maturity Model for e-Health and e-Care :CAPABILITY ROADMAP Using Portals : BUSINESS POLICY ITU :INFLUENCING ORGANIZATION Using Cloud Computing : BUSINESS POLICY Building Composite Applications : BUSINESS POLICY Using SOA : BUSINESS POLICY VALUE PROPOSITION Microsoft Value Proposition for Health and Social Care :VALUE PROPOSITION REQUIRED COMPETENCIES Connected – Interoperable by Design :REQUIRED COMPETENCY Productive – Familiar Tools to Automate the Way Users Work : REQUIRED COMPETENCY Dependable – Proven and Robust :REQUIRED COMPETENCY Extensive Partner Ecosystem : REQUIRED COMPETENCY WHO YOUR ORGANIZATION'S BUSINESS UNITS YOUR ORGANIZATION'S BUSINESS UNITS YOUR ORGANIZATION'S GOVERNANCE BODY YOUR ORGANIZATION'S GOVERNANCE BODY YOUR ORGANIZATION'S ASSETS YOUR ORGANIZATION'S ASSETS YOUR ORGANIZATION'S STAKEHOLDERS YOUR ORGANIZATION'S STAKEHOLDERS YOUR ORGANIZATION'S BUSINESS STRATEGIES & OBJECTIVES YOUR ORGANIZATION'S BUSINESS STRATEGIES & OBJECTIVES YOUR ORGANIZATION'S BUSINESS INITIATIVES & PROGRAMS YOUR ORGANIZATION'S BUSINESS INITIATIVES & PROGRAMS CHF BUSINESS CAPABILITIES PERSONS AND IDENTITIES : BUSINESS CAPABILITY PATIENT AND CLIENT GROUPS : BUSINESS CAPABILITY PERSONAL HEALTH AND CARE STATUS : BUSINESS CAPABILITY PERSONAL AFFILIATIONS AND ENTITLEMENTS : BUSINESS CAPABILITY PERSONAL CONSENTS : BUSINESS CAPABILITY PATIENT AND CLIENT JOURNEY : BUSINESS CAPABILITY PERSONAL CARE RECORDS : BUSINESS CAPABILITY PATIENT AND CLIENT MANAGEMENT : BUSINESS CAPABILITY ASSESSMENTS AND CARE PLANS : BUSINESS CAPABILITY HEALTH AND CARE CLASSIFICATIONS : BUSINESS CAPABILITY MEDICATIONS AND TREATMENTS : BUSINESS CAPABILITY INVESTIGATIONS, ORDERS, TESTS AND RESULTS : BUSINESS CAPABILITY CARE PATHWAYS : BUSINESS CAPABILITY PROCESSES AND PROTOCOLS : BUSINESS CAPABILITY ORGANIZATIONS, CARE PROVIDERS AND SERVICES : BUSINESS CAPABILITY CARE FACILITIES AND SCHEDULES : BUSINESS CAPABILITY WAITING LISTS : BUSINESS CAPABILITY CARE PROFESSIONALS : BUSINESS CAPABILITY PROFESSIONAL ROLES AND TEAMS : BUSINESS CAPABILITY CURRENT CLIENTS, PATIENTS AND CARE RELATIONSHIPS : BUSINESS CAPABILITY COSTS AND PRICES : BUSINESS CAPABILITY CLINICAL AND CARE DATA MANAGEMENT : BUSINESS CAPABILITY RULES ENGINE : BUSINESS CAPABILITY CLINICAL CODING AND DATASETS : BUSINESS CAPABILITY SOCIAL CARE CODING AND DATASETS : BUSINESS CAPABILITY Describes changes to Drive changes to Drive changes to Responsible for Are Accountable for Responsible for Govern use of Enforces Provide Consume Drive DRIVE Generate
  • 20. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 20 of 60 The various types or classifications of Business Architecture elements belonging to the Business Responsibilities TRIAD are presented next. 5.1-BUSINESS POLICIES Formally documented management expectations and intentions. Policies are used to direct decisions, and to ensure consistent and appropriate development and implementation of Processes, Standards, Roles, Activities, IT Infrastructure etc. Connections Connector Source Target Notes Dependency Enforces Source -> Destination YOUR ORGANIZATION' S GOVERNANCE BODY BUSINESS POLICIES Dependency Govern use of Source -> Destination BUSINESS POLICIES YOUR ORGANIZATION' S ASSETS 5.2-CAPABILITY ROAD MAP A Capability Roadmap is produced as the result of a maturity assessment. A maturity assessment is an element that describes a process that takes place at a specific point in time, and which does not question if the business is doing the right thing, but rather evaluates if the business is doing things
  • 21. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 21 of 60 right. (The former is the scope of a business model assessment). Once a capability roadmap is generated, it becomes a driver in its own right. In order to make a change to the business, based on any driver, the business would charter a business program. Connections Connector Source Target Notes Dependency Describes changes to Source -> Destination CAPABILITY ROAD MAP CHF BUSINESS CAPABILITIES 5.3-CHF BUSINESS CAPABILITIES A business capability is a conceptual "element" of a business. In many ways, a capability is the basic building block of a business in the same way that atoms and molecules are the building blocks of matter. A business capability is a stable component of the business architecture describing "what" a company does, whereupon a business process describes "how" it does it. It is important, when creating a business architectural model, to keep these interrogatives independent of one another. A business capability is implemented by process, people, technology and information. Business capabilities provide a stable anchor point as process re-engineering, sourcing and technology optimization occur. Linking business capabilities to strategies drives prioritization and focus enabling efficient and effective execution. Connections Connector Source Target Notes Dependency Describes changes to CAPABILITY CHF BUSINESS
  • 22. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 22 of 60 Connector Source Target Notes Source -> Destination ROAD MAP CAPABILITIES Dependency Drive changes to Source -> Destination YOUR ORGANIZATION' S BUSINESS STRATEGIES & OBJECTIVES CHF BUSINESS CAPABILITIES Dependency Drive changes to Source -> Destination YOUR ORGANIZATION' S BUSINESS INITIATIVES & PROGRAMS CHF BUSINESS CAPABILITIES Dependency Responsible for Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS CHF BUSINESS CAPABILITIES 5.4-CUSTOMERS’ DEMANDS and RELATIONSHIPS The customers’ demands and relationships element of the business model describes in precise terms, the motivations that lead customers to buy products and services from the business, and how the business nurtures those motivations through marketing and support activities.
  • 23. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 23 of 60 The most important relationship any business can have is the one with their customers, and a failure to precisely describe the motivations that lead a customer to connect with the business can lead to errors in judgment that can ultimately cause the business to fail. Connections Connector Source Target Notes Dependency DRIVE Source -> Destination CUSTOMERS DEMANDS and RELATIONSHIPS PRODUCTS and SERVICES Dependency Generate Source -> Destination MARKET SEGMENTS CUSTOMERS DEMANDS and RELATIONSHIPS 5.5-MARKET SEGMENTS The customers’ demands and relationships element can be further broken down into market segments, with a detailed analysis of the buying habits or expectations of various types of customer within a particular segment. Connections Connector Source Target Notes Dependency Generate Source -> Destination MARKET SEGMENTS CUSTOMERS DEMANDS and RELATIONSHIPS
  • 24. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 24 of 60 Connector Source Target Notes 5.6-PRODUCTS and SERVICES This element of the business model describes the specific products and/or services offered by the business. It is important to recognize that the specific products or services developed must derive from customer demands in order to effectively provide revenue. This relationship, between customers’ demands and the products offered, is the central focus of marketing in many organizations. Connections Connector Source Target Notes Dependency Consume Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS PRODUCTS and SERVICES Dependency Drive Source -> Destination CUSTOMERS DEMANDS and RELATIONSHIPS PRODUCTS and SERVICES Dependency Provide Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS PRODUCTS and SERVICES
  • 25. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 25 of 60 5.7-REQUIRED COMPETENCIES An area or group of business capabilities where the business must excel in order for the business model to be successful. This is a general concept, not a specific grouping of business capabilities. This part of the business model drives the need for specific business unit capabilities to perform at higher-than-average levels of effectiveness and efficiency. Connections Connector Source Target Notes Dependency Drive Source -> Destination VALUE PROPOSITION REQUIRED COMPETENCIES 5.8-VALUE PROPOSITION The central notion of a business model, the value proposition describes how the business, through its activities, adds value to the consumer or marketplace. The Value proposition binds together the notions of customer demands, required competencies, revenue models and business partnerships. It is a statement from the viewpoint of the target customers that informs everyone "why" the business' products and services are valuable. Assessments of a business model often focus on this element. Many businesses make the mistake of “chasing money” by offering products and services that are ill-suited to develop, support, or make money from. By focusing on the value proposition, many businesses can clarify their objectives and focus their energies on those opportunities that are most likely to deliver value to their customers and
  • 26. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 26 of 60 themselves. Connections Connector Source Target Notes Dependency Drive Source -> Destination VALUE PROPOSITION REQUIRED COMPETENCIES 5.9-YOUR ORGANIZATION'S ASSETS In the context of this model, an asset is any property controlled by a business unit through a business process. The management of that asset is subject to the constraints created by business directives (policies). A resource can represent anything that the business must employ, possess, or control in order to deliver on a required competency. Examples of a resource may be: - a person or group of people able to fulfill a particular role or mission - a building, office, suite, or store in which some activities are performed - a physical asset used in the process of fulfilling a capability - materials or inputs to manufacturing - inventory of goods to be sold or distributed - inventory of services ready to be provisioned or provided - cash or equities - Intellectual Property
  • 27. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 27 of 60 Connections Connector Source Target Notes Dependency Govern use of Source -> Destination BUSINESS POLICIES YOUR ORGANIZATION' S ASSETS Dependency Responsible for Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS YOUR ORGANIZATION' S ASSETS 5.10-YOUR ORGANIZATION'S BUSINESS INITIATIVES & PROGRAMS Initiatives are chartered (or proposed) project designed to change the ongoing structure, capabilities, or performance of the overall business. Typically, initiatives are chartered to create a measurable improvement in a business capability, often through process improvement, technology improvement, structural change (reorganization, insourcing / outsourcing, etc.), or accountability changes (governance, reporting, scorecarding, incentives). Initiatives are intentional effort chartered to make a change to the manner, approach, products, structure, and/or contractual relationships that make up the various functions of the business. A business program is defined as:  A group of related business projects managed in a coordinated way to obtain benefits and control not available from managing them individually. Programs may include elements of related work outside the scope of the discrete projects in the program.  An ongoing set of capabilities within a business unit aligned to organizational commitments.
  • 28. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 28 of 60 Connections Connector Source Target Notes Dependency Drive changes to Source -> Destination YOUR ORGANIZATION' S BUSINESS INITIATIVES & PROGRAMS CHF BUSINESS CAPABILITIES 5.11-YOUR ORGANIZATION'S BUSINESS STRATEGIES & OBJECTIVES Strategy is a complex set of related statements used to motivate the creation of projects, the setting of goals, and the achievement of objectives by employees and partners of an enterprise in support of a business goal. It is not a course of action in itself, but instead it provides the general outlines of a course of action sufficient to drive specific changes in business operations. Strategies are defined in terms of objectives. Objectives are measurable milestones that support a strategy and measure the achievement of a business goal. Objectives must be measurable and must have a target date. In the EBMM, strategies and objectives are described by the same element because the statement of a strategy is often broken down into measurable objectives which then inspire lower level strategies for attaining them. As such, neither of the concepts is complete without the other to complement it. Connections Connector Source Target Notes Dependency Are
  • 29. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 29 of 60 Connector Source Target Notes Accountable for Source -> Destination YOUR ORGANIZATION' S STAKEHOLDERS YOUR ORGANIZATION' S BUSINESS STRATEGIES & OBJECTIVES Dependency Drive changes to Source -> Destination YOUR ORGANIZATION' S BUSINESS STRATEGIES & OBJECTIVES CHF BUSINESS CAPABILITIES 5.12-YOUR ORGANIZATION'S BUSINESS UNITS A group of people that employ tools, processes, and information to perform their responsibilities. Usually organized in a hierarchy (which means that one business unit can include a number of sub-units, and so on). Business units perform business processes. A business unit is composed of business units, all the way down to the department and team level. The role of a business unit is to provide resources (money, staff, infrastructure, governance) to enable business processes to occur. Any use of one business unit by another takes place through a business service. The business units that offer the service are said to “provide” it while the business units that rely upon that service are said to “consume” it. In smaller organizations, it is uncommon to see a single business service provided by more than one business unit.
  • 30. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 30 of 60 Connections Connector Source Target Notes Dependency Consume Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS PRODUCTS and SERVICES Dependency Provide Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS PRODUCTS and SERVICES Dependency Are responsible for Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS YOUR ORGANIZATION' S ASSETS Dependency Are responsible for Source -> Destination YOUR ORGANIZATION' S BUSINESS UNITS CHF BUSINESS CAPABILITIES 5.13-YOUR ORGANIZATION'S GOVERNANCE BODY A group of individuals with the right to create and enforce business policies applicable across business
  • 31. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 31 of 60 processes. Connections Connector Source Target Notes Dependency Enforces Source -> Destination YOUR ORGANIZATION' S GOVERNANCE BODY BUSINESS POLICIES 5.14-YOUR ORGANIZATION'S STAKEHOLDERS A "driving stakeholder" is a person within an organization that owns accountability for a business strategy or objective. This person is a stakeholder to a business strategy but may also be the source of that strategy and is clearly a driving force in insuring that it comes about. To be an effective driver, a stakeholder must not only be accountable for an objective, but must have some kind of formal relationship with the person or team that is responsible for delivering on that objective. Connections Connector Source Target Notes Dependency Are Accountable for Source -> Destination YOUR ORGANIZATION' S STAKEHOLDERS YOUR ORGANIZATION' S BUSINESS STRATEGIES & OBJECTIVES
  • 32. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 32 of 60 5.15-WHO-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES INFLUENCING ORGANIZATIONS ITU International Telecommunications Union, an agency of the UN, indicating that at least 50 percent of the global population now pays to use a mobile phone. Much of this growth is in Africa. Further, the ITU estimates that nearly a quarter of the world’s population now has access to the Internet. MARKET SEGMENTS CARE PROFESSIONALS (D) Care Professionals, in a medical context, include doctors, nurses, and allied care professionals. Doctors would include general practitioners, physicians and surgeons, and mental health specialists. Nurses would include hospital, community, and specialized nurses, such as cancer care nurses. Allied care professionals, who usually need formal training and accreditation before they are employed, would include medical assistants, dental hygienists, physio- and occupational therapists, laboratory technicians, medical equipment technicians, radiographers, medical secretaries, medical coders, care assistants, caterers, porters, and drivers. In a social care context, care professionals would include social workers, counselors, community care
  • 33. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 33 of 60 workers, and many accredited volunteers and private sector careers. In certain, clearly defined circumstances, they might include special needs teachers, home care assistants, personal financial and legal assessors and councilors, police and probation officers, and addiction treatment and prevention specialists. CARE PROVIDERS (P) Care Providers include hospitals, clinics, care and residential homes, medical practices, laboratories, and other organizations that accommodate and treat patients or clients. They provide physical premises and facilities and operate medical and other equipment. They operate administrative and clinical systems and employ care professionals. FUNDING ORGANIZATION (F) Funding Organizations are those bodies—public or private—that provide the funding for e-Health and e-Care. They include national and local government departments like Ministries of Health or Social Work departments, official agencies like National Health Services, insurance companies, and charities and philanthropic organizations. PERSONS (C) Persons are national citizens; resident aliens; short-term visitors; and tourists in need of or receiving medical attention, social care, or allied treatments. When health care is involved they are called
  • 34. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 34 of 60 “Patients,” if social care then “Clients,” and in commercial situations “Customers.” POLICY MAKERS and LEGISLATORS (G) Policy Makers and Legislators are government departments, quasi-government organizations, and professional bodies responsible for the organization and regulation of care services on a national or regional basis. This would include the enactment of legislation, the provision and control of funding, and the setting and governance of professional standards of care and process. RESEARCHERS and ANALYSTS (R) Researchers and Analysts are scientific, medical, statistical, and other professionals, institutes, and bodies interested in the analysis of trends, treatments, procedures, medications, facilities, screening programs, care initiatives, and many other aspects of Health and Social Care. Typically their interest lies in the experiences of groups of patients or clients rather than individuals, and patient information should be anonymized before use. 5.16-WHY-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES BUSINESS POLICIES Using Cloud Computing
  • 35. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 35 of 60 The concept incorporates Infrastructure as a Service (IaaS), Platform as a Service (PaaS), and Software as a Service (SaaS) as well as Web 2.0 and other recent technology trends that have the common theme of reliance on the Internet for satisfying the computing needs of the users. SaaS vendors provide common business applications online that are accessed from a Web browser, while the software and data are stored on servers “in the cloud”. Using Portals The portal is a vital piece of technology. It enables the assembly of relevant data from multiple sources, which can be presented to the user in a coordinated, task-oriented manner. It provides comprehensive content management and search capabilities, enables participation in shared business processes, and facilitates enterprise-wide information sharing across organizational boundaries. Portals must provide reliable means of establishing identity and ensuring privacy and confidentiality. Using SOA Service Oriented Architecture (SOA) provides the principles and guidance to transform an organization’s array of heterogeneous, distributed, complex, and inflexible systems into integrated, simplified, and highly flexible resources that can be changed and composed to more directly support business goals. SOA ultimately enables the delivery of a new generation of dynamic applications (sometimes called composite applications). These applications provide end users with more accurate and comprehensive information and insight into processes, as well as the flexibility to access it in the most suitable form and presentation factor, whether through the Web or through a rich client or mobile device. Service orientation uses standard protocols and conventional interfaces—usually Web
  • 36. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 36 of 60 services—to facilitate access to business logic and information among diverse services. CAPABILITY ROADMAPS Maturity Model for e-Health and e-Care Our (Microsoft) impression is that many current implementations are concerned with moving from the Baseline, Level 0, towards Integration, Level 1, rather than from an integrated platform through the Trigger Point to Transformation, Level 2, and eventual Revolution. In other words, Transaction might be happening, but Transformation and the Trigger Point most definitely are not. The main thrust of the CHF Architecture and Design guidance is to help bridge the gap between Level 0 (the Baseline) and Level 2 (Health 2.0) by ensuring that Level 1 (Integration) is effectively and efficiently implemented. In this part of the CHF ADB we present a Business Pattern that can be regarded as a template for Levels 1 and 2. CUSTOMER DEMANDS AND RELATIONSHIPS C2C PERSONS to PERSONS: -Community Care -Self-help Groups
  • 37. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 37 of 60 -Charities -Social Services -Insurers Typically concerned with self-help groups and community-based activities, including social services. In this group we would include charitable groups and activities such as hospices, elderly care, and other tertiary-care initiatives. We would include insurers in this set of interactions in so far as they trade with citizens and may represent patients in the arrangement of suitable care and treatment. C2P PERSONS to CARE PROVIDERS: -Appointments -Admissions -Discharges Typically concerned with administrative transactions such as the making of appointments, attendance at outpatient clinics, and hospital admissions and discharges. D2C CARE PROFESSIONALS to PERSONS: -Patient Doctor Relationships
  • 38. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 38 of 60 -Episodes of Care Typically concerned with episodes of patient care or treatment. These interactions are subject to stringent confidentiality requirements, including the observance of specific professional and ethical relationships. D2D CARE PROFESSIONALS to CARE PROFESSIONALS: -Care and Clinical Roles -Groups and Teams -Triage -Delegation of Care -Client/Patient Referrals Typically concerned with the referral of patients for further examination and treatment; case reviews and triage; peer knowledge and information sharing; and the delegation of care as well as the organization and management of clinical groups and specialist teams. F2C FUNDING ORGs to PERSONS: -Registrations
  • 39. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 39 of 60 -Contracts -Community Care -Screening Programs Typically include the transactions involved in the registration and enrollment of persons for various services; the calculation and collection of premiums, contributions, and payments for care services and programs; and the operation of health assurance activities such as screening and risk assessment sessions. F2F FUNDING ORG to FUNDING ORG: -Strategic and Business Planning -Marketing and Product Planning -Administration -Funds Management -Records Management -Programs and Plans -Targets and Budgets Typically include a full range of business management activities such as strategic and business planning activities, marketing and health and care product planning, financial planning and management, business improvement programs, and the setting and monitoring of financial and organizational targets.
  • 40. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 40 of 60 F2P FUNDING ORGs to CARE PROVIDERS: -Standards of Care -Direct Funding -Performance -Audit Typically concerned with funding and audit, measuring and improving performance, and monitoring of standards of care. G2C POLICY MAKER to PERSONS: -Registration -Awareness Programs -Screening Programs Typically concerned with registration for national and regional services and initiatives such as screening programs and community-based care activities. Citizens often will pay for their health service either as part of general taxation or through a specific, homologated charge.
  • 41. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 41 of 60 G2D POLICY MAKERS to CARE PROFESSIONALS: -Registrations -Standards of Care -Professional Bodies -On-going Education Under the term “Policy Makers and Legislators” we include not only national governments and state and regional authorities but also professional bodies concerned with registration of care professionals and the setting and observance of professional standards of care. G2F POLICY MAKERS to FUNDING ORGs: -Standards of Care -Indirect Funding -Performance -Audit Typically concerned with the setting and monitoring of budgets, levels of expenditure, and the audit and appraisal of performance.
  • 42. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 42 of 60 G2G POLICY MAKERS to POLICY MAKERS: -Strategic Planning -National Administration -National Programs -Targets and Budgets -Coding Standards -Service Frameworks Typically include the overall definition, planning, and execution of national policy; the administration of the national service including the setting and monitoring of national targets and budgets; the definition and management of national programs; and the definition and monitoring of disease-specific service frameworks and guidelines. G2P POLICY MAKERS to CARE PROVIDERS: -Standards of Care -Performance -Audit Typically concerned with the setting and monitoring of standards of care and audit and performance measurement activities. Depending on the national business model in use, these interactions may take
  • 43. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 43 of 60 place either directly or via the appropriate funding organization. P2D CARE PROVIDERS to CARE PROFESSIONALS: -Engagements -Assignments -Schedules -Test and Assessment Requests and Results -Administration Typically falling into two types: administrative activities around engagement and assignment to particular roles and responsibilities, and clinical activities associated with patient care and treatment, such as requests for tests and imaging and the use of specialized facilities and equipment. P2P CARE PROVIDERS TO CARE PROVIDERS: -Client/Patient Administration -Clinical and Social Care Systems -Monitoring Systems -Laboratory systems -Imaging Systems
  • 44. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 44 of 60 -Pharmacies -Care Management -Facilities Management These are many and varied, covering patient administration and clinical care; the management of facilities; and the provision of specialist services such as laboratories, imaging systems, and specialist diagnostic equipment. Independent services such as dentists, opticians, and pharmacies may also be included in this grouping. R2F RESEARCHERS to FUNDING ORGs: -Projects -Results Typically concerned with requests for, formulation of, and financing of research studies, statistical analyses, surveys, opinion polls, and so on, as well as the reporting of results. R2G RESEARCHERS to POLICY MAKERS: -Projects
  • 45. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 45 of 60 -Results Typically concerned with requests for, formulation of, and financing of research studies, statistical analyses, surveys, opinion polls, and so on, as well as the reporting of results. R2R RESEARCHERS to RESEARCHERS: -Collaborative Projects -Anonimized Data Access -Data sharing and Publication -Methods and Procedure Research -Treatment Analysis -Drug Trials Typically concerned with the organization and conduct of research and evaluation projects including collaborative projects, data collection and sharing, trials and evaluation of drugs and treatment procedures, and so on. VALUE PROPOSITIONS Microsoft Value Proposition for Health and Social Care The key features of the proposition, realized using the Connected Health Framework, are as follows:
  • 46. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 46 of 60 Connected – Interoperable by design  Open architectures built on industry standards that facilitate the flow of patient information and clinical knowledge seamlessly through the care continuum and across agencies  Leverage legacy application and infrastructure investment Productive – Familiar tools to automate the way you work  Let clinicians be clinicians: improve adoption  Enable delivery of public health services in a standardized, replicable manner Dependable – Proven and Robust  Applications that support 24/7/365 Health and Social Care operations  Financially stable Extensive partner ecosystem gives decision-makers a choice Best Economics – Driving down the cost of Health and Social Care technology  Create ROI faster than traditional investments  An integrated platform that lowers TCO overall  Local delivery model  Scalable from single providers to county-wide programs
  • 47. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 47 of 60 5.17-WHAT-LIKE BUSINESS ARCHITECTURE ELEMENT INSTANCES BUSINESS CAPABILITIES ASSESSMENTS AND CARE PLANS Assessments are structured analyses of a patient’s or client’s condition or situation. They are made using an agreed, applicable common protocol by one, or usually more, care professionals and perhaps, professionals from other disciplines. The result of an assessment is a plan for the patient’s or client’s care and hopefully recovery. The Assessments and Care Plans component provides capabilities and services to aid the conduct of the assessment, the production of the care plan and its subsequent execution. CARE FACILITIES AND SCHEDULES The Care Facilities and Schedules Component contains basic details of facilities operated or used by an organization unit (e.g. of hospitals, clinics, etc.) which includes accommodation to bed level, schedulable equipment such as scanners and major diagnostic devices and treatment facilities such as theatres. Facility and Team schedules are maintained. It also provides details of team schedules so that the joint availability of a physical facility and its operating and supporting personnel can be ensured. No capability for workload leveling or schedule optimization is provided at this stage.
  • 48. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 48 of 60 CARE PATHWAYS The Care Pathways Component provides services in support of standard programs of treatment and care for defined diseases and medical and social conditions. Such programs are often applicable at a national level and include target timings for the provision of treatment. A Care Pathway is lengthy and may last for some months or even years. Although standard programs are specific, an individual care pathway for a particular patient or client can be constructed to suit individual circumstances and may be modified, in flight, to respond to changes in the patient’s or client’s condition. Thus the Care Pathway is built from “phases” which lie between major decision points on the pathway. Segments contain “activities” which specify actions to be taken in the course of treatment. In terms of granularity, these planned events correspond to Patient Events. CARE PROFESSIONALS The Care Professionals’ Component records details of individuals employed contracted or assigned to professional work within the Health and Social Care domain, their specific roles and effective dates. CLINICAL AND CARE DATA MANAGEMENT A Patient Encounter might involve taking measurements, readings, and so on. For a particular medical condition of procedure there is a defined set of items that should be recorded. The Clinical Data Management Component provides facilities to define the items required for each
  • 49. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 49 of 60 encounter type. Optionally, data may be structured using archetypes as used in the OpenEHR methodology CLINICAL CODING AND DATASETS This component manages the data capture and maintenance of Clinical datasets, the items of information that should be recorded for a medical condition or procedure. Mechanisms are provided to anonymize such that the specific patient is not identifiable COSTS AND PRICES The Costs and Prices Component provides means of recording the prices and costs of Health and Social care activities and billing the appropriate “payer”. Means are available to record standard unit costs for the elements of care activity e.g. Facility usage, Professional Time, Prescription Item, Test and Images, etc. and the billing tariff for defined care activities. Actual usage of the billable elements is recorded and thus margins and Price variances can be calculated. CURRENT CLIENTS, PATIENTS AND CARE RELATIONSHIPS Patients and Clients are formally assigned to Care Professionals. Each Professional has established “care relationships” in which they are charged with specific aspects of individual patient’s care. The Current Clients, Patients and Care Relationships Component maintains these care relationships.
  • 50. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 50 of 60 Care Professionals have a formal range of permissions to access “their” patient or client data derived from their roles, specialties and team memberships or by specific wish of the patient or client. This component maintains and communicates a record of accesses made to patient related data by each Care Professional. This includes information on the use of clinical overrides. HEALTH AND CARE CLASSIFICATIONS The Health and Care Classifications Component maintains and applies a categorization scheme for summarizing the disease, medical or social condition or procedures involved in patient or social care client care. A Health Subject may comprise smaller, more detailed Health Subjects and in turn may be a sub-division of a more general Health Subject. A Health Classification may align with a medical “Specialty” – such as “geriatrics” or “cardiology” or “gastroenterology”, etc. or the Social care equivalents such as “care of the elderly” or “visual impairment”, etc. A Health Subject qualifies Patient Events, Consents, Permissions and Roles of Care Professionals. Health Subjects provide a common denominator between schemes and the component provides a translation service between a code value in a particular scheme and the corresponding code in another. INVESTIGATIONS, ORDERS, TESTS AND RESULTS Orders are created in order to perform tests or to carry out various imaging or diagnostic examinations. Orders are raised as a result of a Patient Encounter and are sent to the appropriate laboratory or facility. Coordinated sets of orders can be specified to carry out a detailed investigation. Tests involving
  • 51. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 51 of 60 samples are usually carried out anonymously as far as the patient is concerned; the test being identified by a sample number with is related back to the patient by the requestor. Tests and examinations carried out on the person are clearly not anonymous. Some orders are not patient-related and others are for non-clinical purposes (e.g. catering). Orders may be grouped in sets for one patient or be for a group of patients. Tests and examinations are carried out using standard processes and may involve automated or manual activity. The Investigations, Orders, Tests and Results component provides capabilities to manage and conduct order processing and results production. MEDICATIONS AND TREATMENTS The Medication Component offers basic information on medication items, their recommended usages and dosages and information about their use in conjunction with other medications. It provides only a quick reference and is not intended as a full prescribing system or pharmacopeia. ORGANIZATIONS, CARE PROVIDERS AND SERVICES This component is concerned with the provision of Organizational information about official bodies, private companies and any enterprise active in the broad health and social care domains in response to a request from any approved consuming process. Organizational Information includes data about organizational units, their structure (both hierarchical and matrix), and their inter-relationships. An important sub-set is that of Care and Service Providers who provide diverse Health and Social Care
  • 52. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 52 of 60 related services of various types and functions. They include hospitals, general practices, groupings of providers (e.g. Health and Social Care trusts), ancillary disciplines such as dentists and opticians, tertiary facilities such as care homes, hospices, etc. PATIENT AND CLIENT GROUPS The Patient and Client Groups component provides facilities for the definition, formation, operation, analysis and reporting of patient/client groups and the population of such groups with relevant patients or clients. Screening Groups are formed to perform preventative medicine and clinical surveillance of defined groups of patients. Care Groups are formed to provide help and assistance to persons with similar care needs and might include self help and voluntary care sector activities as well as “official” provisions. PATIENT AND CLIENT JOURNEY Patient and Client Journey Component summaries of care received or to be received in future by a patient or client for a specific medical or social condition at a particular time or over a defined timeframe. Planned care is described by the Patient Journey. This may be based on a generic care pathway for a particular disease or condition. However, the care pathway is usually customized for the patient particular situation and needs. The Patient Journey is also records “future” events which are used as triggers for appointment making. Care Records are usually held in local systems but may be accessed remotely via Patient Data Links
  • 53. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 53 of 60 held in the Patient Identity and Health Status Component. PATIENT AND CLIENT MANAGEMENT The Patient and Client Management Component handles all administrative actions with regard to a patient or Client relative to arranging, conducting, recording and reporting patient or client contacts and interactions in both primary and secondary care health settings and social care situations. Activities include receiving and responding to referrals, making appointments, handling admissions, monitoring attendance and “patient processing”, handling discharges and clinic and session attendance. Also included are the maintenance of indices of patients registered with a Care Provider and attending, or who have attended, a particular facility operated by a Care Provider. PERSONAL AFFILIATIONS AND ENTITLEMENTS The Personal Affiliations and Entitlements Component indicate from whom a person receives health and social care and the nature and extent of the care services provided The affiliation will be with a national health service or an insurance scheme or care plan organization. The entitlement will describe the extent of cover and the applicable terms and conditions
  • 54. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 54 of 60 PERSONAL CARE RECORDS This component manages Patient and Client Care Records – the summaries of care received by a patient or social care client for a specific medical or social condition at a particular time or over a defined timeframe. The component provides functionality and data to support the actual provision of patient care. Planned care is described by the Patient Journey. The actual care received is recorded in a structured manner in the form of Patient Events (or spells of care), Patient Episodes (such as a hospital admission) and Patient Encounters (an interaction with a care professional) such as a consultation, examination or administration of a treatment or perhaps a merely a telephone conversation). Looked at another way, a Patient Encounter entails a single interaction between patient and professional, a Patient Episode is a related series of encounters, with a clear beginning and end such as a stay in hospital, addressing a particular patient condition or complaint. A Patient Event (sometimes called a “Spell of Care”) encompasses a number of episodes over a period of time, perhaps lifelong, addressing a particular condition or complaint. Care Records are usually held in local systems but may be accessed remotely via Patient Data Links held in the Patient Identity and Health Status Component. PERSONAL CONSENTS The Personal Consents component manages the default values for granting access to patient or Social care client data pairing Health/Care Subjects with professional roles. It also supports the recording of specific consents which note the wishes of a patient or client in granting or denying access to his or her record. It also handles the reversal of default consents by patients and clients and the granting of
  • 55. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 55 of 60 specific access rights to nominated Care Professionals in respect of individual patients, clients and health/care subjects. The component can also compose “Sealed Envelopes” – a virtual, protected set of patient information and data links (for example, pertaining to a particular health subject) which may be opened by authorized care professionals in defined situations like emergencies. PERSONAL HEALTH AND CARE STATUS The Personal Health and Care Status Component offers data regarding a person’s current wellbeing such as would be useful in providing a summary to a new health or social career. This includes current medication and medical problems and allergies that would be of assistance in emergencies and for treatment when away from home. In effect the component constitutes a summary health record. PERSONS AND IDENTITIES The Persons and Identities Component stores, maintains and enables access to data regarding a Person, their Health enrollment (as Patient) and their Social Care enrollment (as Social Care Client). Capabilities are provided to input, validate, maintain, store and output personal demographic data such as name and address, personal details, family relationships and care arrangements and limited medical and social care-related data. A linkage is provided via the personal identifier to the different identifiers used in the health and care domains, of which there could be many. Details of patient and client care and treatments are often stored in local doctors, care professionals,
  • 56. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 56 of 60 hospital and social work department systems in local ePRs (electronic patient records) or eCRs (electronic care records). Linkages are provided to these systems in the form of pointers, or URLs to the appropriate ePR or eCR records. PROCESSES AND PROTOCOLS A Clinical or Care Process describes the activities undertaken by a specific Health and Social Care Team. Clinical or Care Process Actions are the individual actions taken. These are described at a level of granularity such that when commenced an action must be completed or restarted. Examples might be x-rays or blood tests. The component manages the definition of the clinical or care process and its actions. PROFESSIONAL ROLES AND TEAMS Care Professionals perform defines roles and are organized in groups and teams dedicated to specific activities in clear areas of treatment and care. The Professional Groups and Teams component maintains the definitions of roles and the structure and membership of each group and team. These structures are used to determine the access permissions of individuals to patient records either on the basis of role or team membership. RULES ENGINE Two Business components that are often required are for Clinical Decision Support and Health and
  • 57. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 57 of 60 Social Care Knowledge Management. However, since business components are fully encapsulated, the functionality and data (or “rules”) associated with decision support and knowledge management are usually included within the specific component. Sometimes however, the logic involved is part of the overall business process and is dependent upon interactions between components, for example, in following a particular patient journey based on patient condition and treatment availability. This is sometimes called a “rules engine”. In this case the logic is contained within the business process as distinct to the actual business component. A Rules Engine Component would contain a Rules Database which for example might contain Prescribing rules, Clinical Process rules, Datasets rules (value ranges etc), Form Set rules, scheduling and capacity management rules and the rules used to raise clinical and administrative alerts. The Rules Database might also contain lists of valid codes e.g. departmental codes. SOCIAL CARE CODING AND DATASETS This component manages the data capture and maintenance of Social Care datasets, the items of information that should be recorded for a social condition or procedure. Mechanisms are provided to anonymize such that the specific client is not identifiable WAITING LISTS The Waiting Lists component provides capabilities to manage demand for patient/client: professional interaction and facility usage. The approach is simple – capacity of teams and team members and also for facilities is expressed in
  • 58. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 58 of 60 units or “slots” of defined duration – a consultation or a hospital bed for a day is regarded as a “slot”. Requirements (i.e. appointments or orders) are allocated to slots, the nature of the requirement determining how many slots will be required of any particular team discipline or facility. The “queue” of requirements is maintained in a number of lists sequenced by arrival and modified by urgency. Lists are serviced by multiple teams and facilities by allocating a requirement to a slot. PRODUCTS AND SERVICES CARE PROFESSIONAL SERVICES Typically concerned with the viewing and maintenance of permissions to access patient data and the creation, updating, and audit of the patient Care Record. CARE PROVIDER SERVICES Typically concerned with the recording of activities such as patient attendance; maintenance of waiting lists; the scheduling of teams and facilities; and the recording of examination and test results FUNDING ORG SERVICES Typically concerned with administrative processes, funds management, billing and cash flow management, records management, management and statutory accounting, and so on.
  • 59. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 59 of 60 PERSON SERVICES Typically concerned with the setting and maintenance of patient-supplied data such as some demographic details, family information, and, importantly, the viewing and variation of consent data for patient data access. POLICY MAKER SERVICES Typically concerned with the setup and maintenance of national administrative facilities; standard procedures and coding systems; and the setting of targets and budgets RESEARCHER and ANALYST SERVICES Typically includes project planning and control, the management of test and trial data (usually anonymized), and trial results processing and publication. REQUIRED COMPETENCIES Connected – Interoperable by Design Dependable – Proven and Robust Extensive Partner Ecosystem Productive – Familiar Tools to Automate the Way Users Work
  • 60. Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC Page 60 of 60 REFERENCES [1] Malik N. The Enterprise Business Motivation Model (EBMM) : http://motivationmodel.com/wp/ [2] Sowa J. F. and Zachman J. A.(1992), Extending and Formalizing the Framework for Information Systems Architecture, IBM Systems Journal, 31/3, pp 590-616. [3] Anaya V. and Ortiz A. (2005), How enterprise architectures can support integration. Proceedings of the first international workshop on Interoperability of heterogeneous information systems. pg. 25‐30. [4] Chen L. (2010), Business–IT alignment maturity of companies in China. Inform. Manage. 47, 1, 9–16 [5] Henderson, J. C. and Venkatraman, N. (1992), Strategic Alignment - A model for Organizational Transformation Through Information Technology. Oxford University Press, 97–117 [6] Ullah A. and Lai R. (2013), A Systematic Review of Business and Information Technology Alignment. ACM Transactions on Management Information Systems (TMIS). Volume 4, Issue 1 [7] Pragmatic Cohesion Consulting, LLC, How to Use the EBMM-TRIADS to Conduct a Business Architecture Alignment Effort: http://www.slideshare.net/adidierk/how-to-use-the-ebmm-triads-to-conduct-a-business-architecture-a lignment-effort [8] Microsoft Connected Health Framework (CHF): http://www.microsoft.com/health/ww/ict/Pages/Connected-Health-Framework.aspx [9] Pragmatic Cohesion Consulting, LLC, Enterprise Business Motivation Model (EBMM) TRIADS - The Chemistry of Business and IT Alignment: http://www.slideshare.net/adidierk/enterprise-business-motivation-model-ebmm-triads-the-chemestr y-of-business-and-it-alignment