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InterConnect2015_BCBSNC_Healthcare Provider Network Management Integration Architecture

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InterConnect2015_BCBSNC_Healthcare Provider Network Management Integration Architecture

  1. 1. An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11 BCBSNC’s Healthcare Provider and Network Management Integration Architecture for a Changing Market AEC-5560 Arman Atashi Senior Enterprise Solutions Architect Blue Cross Blue Shield of North Carolina
  2. 2.  Current State  Future State  Architecture Models  Architecture Vision  Integration Architecture  Message Model  Runtime Model  Deployment Model  Q&A  From Architecture Vision to Reality Agenda 2
  3. 3. Current State “Establishing a Software Architecture Vision is not necessarily Implementing a Software Architecture.”
  4. 4. + Applications and interfaces are built independently + Standalone projects deliver data limited to specific function Business Challenges 4 The Result + Complexity has been building over time + Systems need to interact and integrate for decision making Complex IT Landscape with Dispersed Data across Disparate Systems The Result IT Silos in the Enterprise with Bunch of Provider Data Managed within Multiple Systems
  5. 5. + Provider Data Integration ▪ Inflexible ▪ Reactive ▪ Manual ▪ Batch Business Challenges 5 Limited Visibility in Systems Interactions Hinders Agility and Productivity
  6. 6. + Consumers of Provider Information Entity within BCBSNC Provider Information Usage 6
  7. 7. Future State
  8. 8. + Business Architecture ▪ Enterprise Capabilities ▪ Collaborations & Interactions ▪ Process and Information Flows Architecture Models 8 + Logical Architecture ▪ Business Services ▪ Components & Interfaces ▪ Messages & Data + Technology Specification ▪ Software & Hardware Platforms ▪ Portals & Web Services ▪ Database and XML Schemas BusinessConcerns Refinement
  9. 9. + Capabilities Architecture Models - Business Architecture 9
  10. 10. + Context Diagram Architecture Models - Business Architecture 10
  11. 11. Architecture Models - Business Architecture 11 + Establish a single Provider Information System of Record responsible for creating and maintaining the Provider Information Entity
  12. 12. + Service Architecture Architecture Models - Logical Architecture 12
  13. 13. + Service Architecture Architecture Models - Logical Architecture 13
  14. 14. Architecture Models - Technology Specification 14 Web Applications & Portals Workflows & Services Enterprise Service Bus (ESB) Message Composition Rules & Events Routing & Mediation Adapters Infrastructure Message Server Database Server Application Server Directory Server & SSO
  15. 15. Architecture Vision - Implementation Principles 15 + Provider Data Integration ▪ Flexible ▪ Proactive ▪ Event Based ▪ Right Time Clear and Recognizable Systems Interactions Improves Productivity and Value of the Provider Information + Information as a Service
  16. 16. + SOA: Decouple systems and applications from each other (code, data, and communication) while allowing them to communicate with each other in a consistent way Architecture Vision - Implementation Principles 16 System A Private Code & Processes System B Private Code & Processes Contract Shared Code & Processes Interoperable Protocol Interface Interface Interface Interface Interoperable Protocol
  17. 17. + Canonical Message: Use message-specific common data in canonical format expressed in XML to mediate data exchanges between systems Architecture Vision - Implementation Principles 17 Enterprise Service Bus Adapter Adapter System A System CSystem B Adapter
  18. 18. + Cloud Analytics: Enhance Provider Self-Service Strategy by including Cloud Analytics to help Providers to have insights in patient health and get answers in real-times Architecture Vision - Implementation Principles 18 BCBSNC Provider Portal Cloud Analytics Healthcare Provider Episode Bundling Risks Adjustment and Scoring Implantable Device Management Others
  19. 19. + Safeguard Access to Applications/Services: Establish policies for user access privileges and allow access to cross domain web based applications using SAML for web browser Single Sign-On Architecture Vision - Implementation Principles 19 BCBSNC Portals Workforce User Site 1 Non-Workforce User Site 2 Private Cloud A Site n Public Cloud Site A Site Z Private Cloud Z SAML SSO
  20. 20. Architecture Vision - Information Exchange 20 + Three key technology layers participate in the exchange of information: + Vendor Integration Layer: This layer includes the components that provide information exchange via IBM Managed File Transfer as SDE (Secure Data Exchange), SAML SSO using IBM WebSEAL and TFIM, and Web Services for real-time integration + Enterprise Integration Layer: The components at this layer implement BCBSNC Enterprise Service Integration Framework together with IBM WebSphere Message Broker as the Enterprise Service Bus + Information Layer: The components managing data sources (provide data to other systems and programs) such as Databases, Web Services, and Files (XML, CVS, etc.) or deliver data to end users such as web browsers
  21. 21. Architecture Vision - Reference Architecture 21
  22. 22. Architecture Vision - Logical Architecture 22
  23. 23. Integration Architecture
  24. 24. + Canonical Message Model (CMM) represents the standardized format used for exchanging BCBSNC Provider business information on an Enterprise Service Bus (ESB) + XML schemas are used to represent the message definitions and types + CMM XML XSDs are based on and derived from McKesson’s Network Performance Management (NPM) Standard Outbound XML (PSOX) XSDs + CMM is also the foundation for describing the functionality provided by BCBSNC Provider Web Services used in Services Definition Language (WSDL) schemas Message Model 24
  25. 25. + CMM specification consists of the following: ▪ Structure and names of the data types and format ▪ Rules governing data composition/aggregation and the allowable values, expressed in XSDs ▪ Business terms definitions of the types (Data Dictionary) ▪ A set of messages each including defined elements, types, and attributes to provide a specific business context – Provider Message, a coarse-grained message reflecting BCBSNC provider business context – Practitioner Message, a coarse-grained message reflecting BCBNSC practitioner business context – Additional fine-grained messages will be defined/constructed to provide desired capabilities in the future Message Model 25
  26. 26. + IBM RSA (Rational Software Architect) is extensively used in the construction and maintenance of CMM ▪ PSOX to CMM mapping ▪ CMM XSD-to-UML round trip transformation ▪ PSOX to CMM Transformation using XSLT & STX transformation Style Sheets Message Model - Message Transformation 26 NPM PSOX XML NPM PIMS NPM PSOX File Single CMM XML XSLT Processor WMB XSLT Processor MQ Full CMM XML RSA XSLT Processor Full CMM XML STX Processor
  27. 27. Message Model - Provider Message 27
  28. 28. Message Model - Practitioner Message 28
  29. 29. Message Model - Provider/Practitioner Identifier 29
  30. 30. Runtime Model 30
  31. 31. Runtime Model 31 PIMS Adapter Overview MFT from Database Server to WMB server Database Server PSOX XSL Transformation RunSplit.sh PSOX Document PSOX Feed RunPSOX.sh PSOX Provider Documents PIMS Provider Adapter CMM Provider Messages PSOX Provider Documents Copy from staging to processing area Message Broker Server Copy for MFT
  32. 32. Runtime Model 32 PIMS Adapter Overview MFT from Database Server to WMB server Database Server PSOX XSL Transformation RunSplit.sh PSOX Document PSOX Feed RunPSOX.sh PSOX Practitioner Documents PIMS Practitioner Adapter CMM Practitioner Messages PSOX Practitioner Documents Copy from staging to processing area Message Broker Server Copy for MFT
  33. 33. Runtime Model 33
  34. 34. Deployment Model- Reference Model 34
  35. 35. Q&A
  36. 36. From Architecture Vision to Reality “Establishing a Software Architecture Vision is not necessarily Implementing a Software Architecture.”
  37. 37. Architecture Vision - Implementation Principles 37 Information as a Service Service Oriented Architecture Canonical Message Cloud Analytics Safeguard Access
  38. 38. Architecture Vision - Reference Architecture 38
  39. 39. Architecture Reality – [Information As a Service + SOA + CMM] 39
  40. 40. Architecture Reality - [Cloud Analytics + Safeguard Access] 40 Pulse8 is the cutting-edge healthcare analytics and technology company that delivers an unprecedented view into risk adjustment enabling health plans to achieve the highest financial impact in the Commercial Health Exchanges, Medicare Advantage and Medicaid markets. www.Pulse8.com Aver is an end to end solution for bundled payment design, analytics, and payment reform processes for gain sharing and pay for performance. The software includes analytics around chronic, inpatient-procedural, inpatient- medical and outpatient episodes. www.averinformatics.com IPG PathFinder 360™ analytic toolkit and consultative solution by IPG, the provider of Device Benefit Management™ solutions, delivers never before seen transparency in creating informed consumers and improving quality and cost of healthcare for surgical procedures. www.IPG.com
  41. 41. Thank You Your Feedback is Important! Access the InterConnect 2015 Conference CONNECT Attendee Portal to complete your session surveys from your smartphone, laptop or conference kiosk.

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