Secure Healthcare Data Management


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Health care Technology and automation can lower costs, but introduces risks.

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  • Secure Healthcare Data Management

    1. 1. Secure Communication: Delivering Secure Connectivity for Healthcare Presented by: Jonathan Gatrell 11.20.2008
    2. 2. Automation Spending Out of Alignment 18X More spent on Internal automation than External B2B Automation $55B Internal Automation $3B External B2B Automation But… “Non-linear revenue growth for companies is not going to come from within but from their extended ecosystem…” Harvard Business Review
    3. 3. Unrealized Value in Healthcare Healthcare has huge inefficiencies vs. other industries McKinsey
    4. 4. Connections are EVERYWHERE! Who owns data and process governance?
    5. 5. How to monitor orphaned processes? Who has what data?
    6. 6. Opportunity is beyond the 4 walls.
    7. 7. Risk is also beyond the 4 walls.
    8. 8. Risk Doesn’t Go Away
    9. 9. Gartner Predicts in Healthcare By 2011, 50% of CEOs will demand a 10% reduction in the cost and time to collect payment, because reimbursement will be squeezed by federal deficit reduction imperatives. Through 2015, CDOs [Care Delivery Organizations] characterized as having a "low" probability of success are 80 percent more likely to seriously evaluate full IT operations outsourcing than are CDOs characterized as a "high" probability of CIO success. Outsourcing Real-time Automation
    10. 10. Access and Controls The right systems, the right platforms, the people and the right partners
    11. 11. Technology Dynamics Inflection Point <ul><li>Complexity </li></ul><ul><li>Varied Technology </li></ul><ul><li>Outsourcing </li></ul><ul><li>Multiple Standards </li></ul><ul><li>Increasing demand on data exchange </li></ul><ul><li>More “end points” </li></ul><ul><li>Need to manage diverse B2B and B2C communities </li></ul><ul><li>Multiple Models </li></ul><ul><li>Consumer Driven </li></ul><ul><li>“ Traditional” </li></ul>Mixed Technology Legacy SOA <ul><li>Changing Content </li></ul><ul><li>Payments </li></ul><ul><li>ePrescriptions </li></ul><ul><li>Rich eligibility/claims </li></ul><ul><li>Lab Results </li></ul>
    12. 12. Data is everywhere New processes and capabilities
    13. 13. Some of it just might be PHI Security inside and outside required
    14. 14. Technical Realities and Opportunities <ul><li>Production Technology </li></ul><ul><ul><li>Core transactional model and capabilities are EDI-centric </li></ul></ul><ul><ul><li>HIPAA compliance </li></ul></ul><ul><ul><li>Online portal access key </li></ul></ul><ul><ul><li>Limited Adoption </li></ul></ul><ul><li>Emerging Technology </li></ul><ul><ul><li>SOA Investments </li></ul></ul><ul><ul><li>Digital health records </li></ul></ul><ul><ul><li>New Transaction models </li></ul></ul><ul><ul><ul><li>RTA </li></ul></ul></ul><ul><li>New Opportunities </li></ul><ul><ul><li>XML </li></ul></ul><ul><ul><li>Web Services </li></ul></ul>
    15. 15. Increased Relevance of Security Source: “2007 Security Budgets Increase: The Transition To Information Risk Management Begins” “ What percentage of your company’s IT spending will go to Security?” 2007 2007 7.5% 6.9%
    16. 16. <ul><li>B2B content exchange and transaction management </li></ul><ul><ul><li>EDI </li></ul></ul><ul><ul><ul><li>Provider Claims </li></ul></ul></ul><ul><ul><ul><li>Employee Enrollments </li></ul></ul></ul><ul><ul><ul><li>Eligibility Requests </li></ul></ul></ul><ul><ul><ul><li>Batch Adjudication </li></ul></ul></ul><ul><ul><li>XML </li></ul></ul><ul><ul><ul><li>Real-Time Adjudication </li></ul></ul></ul><ul><ul><ul><li>Prescriptions </li></ul></ul></ul><ul><ul><ul><li>Point-of-Service Payment validation </li></ul></ul></ul><ul><ul><ul><li>Claims, enrollments and eligibility </li></ul></ul></ul><ul><li>Payments </li></ul><ul><ul><li>Providers </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Banks </li></ul></ul>Understanding Secure Healthcare Transactions
    17. 17. Limited Adoption & Automation Key Healthcare Value Chains Payers Consumers Employers Providers Banks <ul><li>Multi-Enterprise processes offer: </li></ul><ul><ul><li>Expertise </li></ul></ul><ul><ul><li>Efficiency </li></ul></ul><ul><ul><li>Scale and reach </li></ul></ul><ul><ul><li>Cost reduction </li></ul></ul><ul><li>… but create unique challenges: </li></ul><ul><ul><li>More complex data </li></ul></ul><ul><ul><li>Always changing </li></ul></ul><ul><ul><li>Real-time requirements </li></ul></ul><ul><ul><li>You don’t own the data </li></ul></ul>
    18. 18. Data Exchange Landscape Latency Data capture Batch Real-Time Bulk Transactional Documents Messages <ul><li>>80% of data movement today is by file exchange </li></ul><ul><li>80% of the data movement remains unmanaged </li></ul><ul><li>The primary method of multi-enterprise integration will continue to be file exchange </li></ul><ul><li>Only about one-seventh of all healthcare transactions are processed electronically today. </li></ul>Meta Group / Gartner
    19. 19. Complex Systems and Content MFT/ Batch B2B Messaging Records Mgt Payment Applications HRIS Pharmacy Consumer Applications Patient Care Apps LIS/ HIS
    20. 20. Fragmented Healthcare B2B Payments Benefits Banking RTA The Enterprise FTP Client HTTP Solution AS2 SW Translator Firewall Healthcare Revenue Healthcare Supply
    21. 21. Simplifying & Securing B2B Exchange in Healthcare VAN P2P – Direct Connect Managed File Transfer BizManager Suppliers Payers Banks Providers Clearing Houses
    22. 22. A B2B Gateway: Strategic Consolidation <ul><li>Digital certificates </li></ul><ul><li>SSH (secure shell) </li></ul><ul><li>PGP </li></ul><ul><li>SMTP </li></ul><ul><li>HTTP/s </li></ul><ul><li>FTP/s </li></ul><ul><li>NAESB </li></ul><ul><li>Event-driven </li></ul><ul><li>Scheduled </li></ul><ul><li>Leased line </li></ul><ul><li>VPN </li></ul><ul><li>Binary </li></ul><ul><li>User-defined </li></ul><ul><li>SSL, TLS/SLL </li></ul><ul><li>S/MIME </li></ul><ul><li>IPSEC </li></ul><ul><li>Proxy Servers (HTTP, FTP) </li></ul>Security Flexible Communication Capabilities <ul><li>AS1, AS2, AS3 </li></ul><ul><li>ebXML </li></ul><ul><li>JMS/MQ </li></ul><ul><li>Web Services </li></ul><ul><li>EBMX </li></ul>Transport <ul><li>Real-time </li></ul><ul><li>Store-and-forward mailbox </li></ul>Delivery <ul><li>Internet </li></ul><ul><li>Frame relay </li></ul>Connectivity <ul><li>EDI </li></ul><ul><li>XML </li></ul><ul><li>Text </li></ul>Data Formats
    23. 23. Benefits of a Consolidated B2B Gateway <ul><li>Legacy </li></ul><ul><li>Emerging </li></ul>Single Operational Environment <ul><li>Policy Definition </li></ul><ul><li>Run-time Enforcement </li></ul>Single Governance Environment <ul><li>Single Repository </li></ul><ul><li>Rules based notifications </li></ul>Better Audit Capability <ul><li>User access </li></ul><ul><li>Encryption </li></ul>Better Corporate Security
    24. 24. Secure Communication: Delivering Secure Connectivity for Healthcare Presented by: Jonathan Gatrell 11.20.2008