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CSC Copyright 7/23/2010 4:24 PM 9269-10 1
Shared Services/Cloud Computing Readyfor Key Linkages between Federal,
State and Local Communities
John C. Dodd, Fellow
for Health and Human Services and
Enterprise Architecture
•CSC
CSC Copyright 7/23/2010 4:24 PM 9269-10 2
Key Message: Alignment with Common Shared Service s can Create Key Design Platforms for Change and Innovati on
• Foster alignment between Federal-State-Local Communities is not needed
• Use UCore Concepts, Business Artifact Flows, and Semanti c matchingalong with Adapt with Harmonization with MDMI and Semantic Data Patterns to define Key universal data elements and shared services that can be common ground elements
• Defined as Shared Services in a Cloud Computing env ironment.
• Many Federal, State agencies, and local communities are definingcomprehensive sets of business capabilities and integration. Need Simple Core and Guidelines
• Some of those business areas e.g., in Medicaid are more outward facing areas like Provider Management, Client Management to be shared within the Cloud.
• The state of trusted shared services, standards and the readiness of cloud computing to address key aspects of an integrated environment .
• What are enablers and barriers to change?
• Is the technology ready? Are we ready? Roadmap to Align and Support Rapid Evolution
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Key Message: The Healthcare Business Complexity
Providerand
Supplier
Providerand
Supplier
HealthPlansHealthPlans
ElectronicHealth
Records
ElectronicHealth
Records
BillingBilling
QualityData
Reporting
QualityData
Reporting
Hospital/Facility
Affiliation
Hospital/Facility
Affiliation
ImagingImaging
LabLab
eRxeRx
CPOECPOE
ReferralsReferrals
BillingServiceBillingService
PatientContact
AndMgmt
PatientContact
AndMgmt
TrainingTraining
StaffingStaffing
COBCOB
Coordinate Care
Coordinate Care
ContractMgmt.
ContractMgmt.
SecuritySecurity
OtherPayersOther
Payers
EmployersEmployers
CMSCMS
InsurerInsurer
AssociationsAssociations EducationEducation
ProfessionalQualificationProfessionalQualification
CertificationCertificationResearchResearch
PatientSafetyPatientSafety
FinancialMgmt.
FinancialMgmt.
ReviewsAnd
Audits
ReviewsAnd
Audits
IncentivesIncentives
ProblemList
ProblemList
RegulationAnd
Compliance
RegulationAnd
Compliance
PrivacyPrivacy
LiabilityLiability
TreatPrescribeDiagnose
TreatPrescribeDiagnose
PreventiveCare
PreventiveCare
EducatingPatients
EducatingPatients
TechnologyMgmt.
TechnologyMgmt.
PracticeManagement
PracticeManagement
AttendingAttending
PayerMgmt.PayerMgmt.
WorkflowWorkflow
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Complete Alignment- Business and Services Framework: Support Alignment Cross Boundaries
To create a coordinated view of health and human services by linking information and creating meaningful information exchanges to better support the citizen.
• Common Local Services• Common LocalBusiness Processes
• Common State Services• Common State Business Processes• Common State Information Model
• Common Federal Services
• Common Federal Human Services Processes
• Common Provider Services• Common ProviderBusiness Processes COMMON VIEW
LOCAL-COMMUNITY
FEDERALSTATE
PRIVATE (Provider, Citizen)
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ONC: NIEM/NHIN Alignment
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Aligning Shared Services with NIEM/NHIN and HL7/OMG: Strategic Harmonization and
Transformation Planning
5. ServiceRegistry: HSSP
S-RAMP
2. Use CasePrioritized:
Business Process Artifact Flows &Semantic Data
Patterns
4. UCore by Domain :Meta Data
Management:Data Services: MDMI
3.AutomationSupport
Vocabularies &Ontologies:SemanticMapping Database
Tools:Modeling
1. Strategy-Standards Segment-Domain Guide: SAIF Plus
DesignStarterkits
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SAIF Value Proposition : Working Interoperability
Interoperability Paradigm (Messages, Documents, Services): specifications which enable two or more (HL7) trading partners to collaborate in the context of a specific business interaction– No assumptions of size, character, or identify of parties
• Nations, Enterprises, Departments, Individual, Systems, etc.
– No assumptions of exchange details (What, Why, How, etc.)
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Common Ground elements Business Architecture: Service Framework, Common Capabilities, Adaptation, Extension Approaches
Current State:• Many functions• Many systems• Many point-to-point interfaces
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System M
anagement Services
Shared Services
Foundational Services
NHINShared
Services
Subject Discovery
Messaging Services
Event Log Services
Info. Exchange Services
State Service-Msmt Registry
Documents Services
Enrollment Services
Lab Services
Provider Directory Services
Demographics Services
Eligibility Check
Immunization Validation
Registry Services
NHIN Gateway Services
Analysis & Reporting
Clinical Data Services
Claim Services
Financial Services
EMPI Services
HER Interfaces Services
Record Locator Services
Potential Shared Services
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SAIF Value Proposition :Working Interoperability
• Interoperability: the deterministic exchange of data/information in a manner that preserves shared meaning
• Two “trading partners” interoperate based on a certified “level of shared compliance” to interoperability specifications/standards
• Certified “level of conformance” determine degree of automated interoperability that is possible and/or difficulty of the transformations that are required to enable interoperability
Agree on “Reference” view
Agree on “Conceptual” view
Agree on“Platform-Independent” view
Agree on“Platform -Specific” viewA
B
DC
F
Component Component
E
A -- F: trading
partners
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Many Aspects of Quality Measurement, Payment Reform , and Health IT Must Work Together to Improve Care
2010 2011 2012 2013 2014
Increasingly sophisticated,
patient-centered information about quality, costs, and care experience
Measurement and Data Collection
Meaningful Use of Health IT
Availability of Electronic Clinical Health IT SystemsPayment Reforms/Incentives
Health IT and Interoperability Standards
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Systemic Reform:Innovation Prescription
GeneralHospital
IsolatedBest Practices
SystemicReform
PhysicianPractices
BusinessModel Innovation
YourTransform Plan-
Aligned….
Affordable CareAct (2010)
To-Be “new”Health Business
Models
Intuitive Medicine :
Empirical Medicine :
Precision Medicine :
Outside and InsideInnovation:Focused Models
Personal H
ealth
Population H
ealth
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Working to improve health and human services to cit izens throughan information-driven enterprise
Working to improve health and human services to cit izens throughan information-driven enterprise
Local/State/Federal/Private Information Exchanges
Provide the Foundation to Support Business Priorities
Improving Services to Children
Enrollment and Coordination of Benefits
Population Health Reporting
Business and Services Framework
Federal Health Information Model
Performance Management
Business Process Improvement Areas
SNAP
Schools
SAC WISSocialWorkers
FamilyCourts
SubstanceAbuse
TreatmentCenters
HeadStart
Local ChildWelfare
JuvenileCourts
NewbornMetabolicScreening
NewbornHearing
Screening
IRS
SSA
ImmunizationRegistryLabs
ChildSupport
Enforcement
CHIP
StateDepartment
of VitalStatistics
TANF
WIC
SchoolBreakfastProgram
Medicaid
FosterCare
ChildCare
SchoolLunch
Program
HealthcareProviders
Alignment can link Health & Human Services
• Common Local Services• Common Local
Business Processes
• Common State Services• Common State Business Processes• Common State Information Model
• Common Federal Services
• Common Federal Human Services Processes
• Common Provider Services• Common Provider
Business Processes COMMON VIEW
LOCAL-COMMUNITY
FEDERALSTATE
PRIVATE (Provider, Citizen)
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Moving the Needle within 30 months: Agile Architect ure and Rapid Development
ImprovedQuality &Efficiency
ProviderFeedback &
Measurement
CareDeliverySystem
PaymentReform
HIT Foundation:Meaningful Use of EHR & HIE’s
Communities- Grants and Pilots….Looking forInnovations aligned to Goals
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Key aspects of an integrated environment: Capabilities with Coordinated Views of each Business Challenge w ith a
360 Citizen-Client-Caseworker at the Center
Local-Community
View
StateView
FederalView
CitizenView
BusinessChallenges
ProviderView
Citizen-Client& Family
Common View
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“Strawman” Health and Human Services Business Capabi lity Categories: Human Services
Health and Human ServicesBusiness Service
Categories
Eligibility andEnrollment
Health ServicesPolicy, Reporting,
Oversight andResearch
Common Ground,and
Shared ServicesHuman Services
Aging and Disabilities Special Needs HousingPublic Health ServicesChildren, Youth, and
Family ServicesBehaviorial Health and
Crisis Management
Provider Management
Member-ClientManagement
Care andService Mgmt
Program-IntegrityAccountability Management
Common Ground Business Services
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Business Areas Alignment defining Cross Boundary Business Operations Models: Finding Common Ground Process
State &Local Communities:•State Architecture•NASCIO•MITA Self
Assessment &•HHS Business
Architecture
CommonGround:
Common State HHS Aligned with Fed
NIEMNHINMITAFHA
TransformCONNECT
Federal:•FEA
•HHS EA•NIEM•NHIN•MITA•FHA
•Transform•CONNECT
2. Business Process Artifacts-Entity-AccessPolicies and Process Alignment
1. Strategy and Concern Maps: Priorities
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Starter Kit: Support the Range of Organizations wit h a Family of Services
Shared Services Light
Big OrgChange
Linking Key Shared Services
HIENode inCloud
HealthEnterprise Transformation:
Tailored EA-SOACOTS partners
SmallOrg
Changes
Assurance:ServiceFactory
IdM-Security- Consent-Compliance Services
Enterprise Transformation for Health Care Reform: F rom Fragmented to Loosely Coupled
SharedServices
inCloud
ProviderMgmt
DataMgmt
MsmtMgmt
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“Strawman” Health and Human Services Business Capability Categories: Human Services
Health and Human ServicesBusiness Service
Categories
Eligibility andEnrollment
Health ServicesPolicy, Reporting,
Oversight andResearch
Common Groundand
Shared Services: Human Services
Aging and Disabilities Special Needs HousingPublic Health ServicesChildren, Youth, and
Family ServicesBehavioral Health and
Crisis ManagementTraining Programs
Fed BusinessCapabilities
State Business Capabilities
Local- CommunityBusiness Capabilities
ProviderBusiness Capabilities
Feds lead Alignment with Stakeholders
Series of Capability Templates Created
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Enablers and Barriers
Enablers
• It makes sense….
• The technology-standards are there- (privacy still being worked but much better than last year)
• NIEM/NHIN converging and many other related standards
• Many excellent examples of small to medium interoperability…
• Some models for Cancer Research, Public Health…..
• Lots of financial transactions….
Barriers
• But means you have to talk across boundaries…
fragmentation is strong
• Not well known and “Health” has often been isolated from the many other interoperability- “we are different”… .
• Distribution of knowledge- some real leaders but huge “gap”-“Crossing the Chasm” and becoming mainstream
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Is the technology ready? Are we ready?
• Good libraries of basic services and push for more open source for health issues…….adapters that can be shared
• Interoperability- HL7 and OMG others working together
• Office of National Coordinator – “don’t need to solve everything attitude”…and phased approach…..NIEM/NHIN and Health Interoperability Model
• Business Architecture and tie in Performance Architecture-Dashboards
• Business Artifacts/ BEDL……..IBM and others
• SOA- SOAML, Model Driven Message Interoperability (MDMI)
• Patterns and Architecture need to be shared and leveraged
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Trusted Cloud Services…
… will require orchestration, integration, monitorin g, SLA management, security, monitoring, master data manag ement, auditing, metering, billing, and so much more
Security Provisioning
Administration
Billing
Monitoring
DisasterRecovery
SLAManagementIntegration
Identity Authorization
Master DataManagement
Auditing
Service-OrientedArchitecture (SOA)
CSC Enterprise Cloud Services Management (Orchestra tion)
TransactionLogging
Federation Single Sign-On
FaultTolerance
Policy-Based Access Mgmt.
ITIL Compliance
Directory Services
Policy Administration
Software as a Service
Platform as a Service
Infrastructure as a Service
Business Process as a Service
Cloud Computing Partnership
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Cloud Computing Partnership
Power of Choice: Software + Services
SERVICES
ManyChoices:
SomeStandards
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CSC TRUSTED CLOUD VISIONInformation Assurance is Cloud-Complicated, “Clouds are cloudy”
As visibility is lost …• Where is the data?
• Who can see the data?• Who has seen the data?
• Is data untampered?
• Where is processing performed?
• How is processing configured?• Does backup happen? How? Where?
Requirements
Services
… Security, compliance, and value are lost as well
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A “TRUSTED” CLOUD
Services rendered via a Trusted Cloud are “Trusted Cloud Services”
The generation of new enterprise value with Trusted Cloud Services isan application of Digital Trust
harmonizes the security for transactions and data with…
comprehensive transparency of control and result such that…
A Cloud That…
conveys evidence-based confidence that systems within its environment operate as advertised, and that no unadvertised functions are occurring…
Is A Trusted Cloud
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ORCHESTRATION CORETranslation of Business Needs to Trusted Cloud Service Delivery
. . .Trusted Cloud
1. Trusted Cloud Service decision support• Trusted cloud services business needs
analysis and recommendations (CloudAssist )
2. Orchestrator of Orchestrators• The automated arrangement, coordination,
connection, and accountability for individual cloud service contributions
CloudTrustProtocol
Business and technical needs integration knowledge
PrivateCloud
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Information Centric Security Solutions
Databases
Applications
DATABASE SECURITY
Encryption and Data Masking
Access Control and Authorization
Activity Monitoring
IDENTITY AND ACCESS MANAGEMENT
IdentityAdministration Directory Services
Access Management
INFORMATION
RIGHTS
MANAGEMENT
Centralized Document Access Control
Revocation (Digital Shredding)
Document Activity Monitoring and Audit
Content
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Defining a “Transparency-Msmt” Shared Services Cloud Technology Roadmap: Boundaries and Policies for Sha ring
HIE in Cloud
Registry-Data Collection-MsmtIn Cloud
ConsumerInformation-
InsuranceExchange in Cloud
ComparativeData-Effectiveness
in Cloud
OR & PerformanceImprovement
Tools in Cloud
“Partner-PolicyHybrid” Profiles
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Defining a “Common Ground” Shared Services Cloud Technology Roadmap: Boundaries and Policies for Sha ring
HIE with Service Registry
in Cloud
ProvideManagement
Registry- SupportIn Cloud
Consumer-ClientBenefit
RecommenderEnroller- Tracking
in Cloud
Care and ServiceManagement in
Cloud
Decision OptionsFor Consumer
in Cloud
“Partner-PolicyHybrid” Profiles
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Standards and Open Services: Strategic Roadmaps to Citizen-Population Group Coordinated Services and Integrate d Across
Views: Addressing Aligned Concerns
• Leveraging
• Focused Concerns
Foster IntegratedPilots and
DemoExperience
Review Manypilots : Look for
Integrated Results
LegislativeReform Vision
GatherConcerns:
Continuing toEngage
Community- FillingGaps
Payment C
hanges: Mega O
utcomes
Gather-Select
Early Results
TargetVision:Open
InnovationRoadmap
Adopting EHR’s and “M
eaningful Use
” Changes
Informatio
n Commonality and Q
uality Im
provement
Population Focuse
d and Practice Changes
HSSP Align with“Current” Fed Health
Strategy & FHA
EngageState-Local-
ProviderCommunities
