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October 27, 2005October 27, 2005© 2005 Blue Cross and Blue Shield Association
Service Oriented Architecture: Case StudyService Oriented Architecture: Case Study
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
Lenel James Plamen PetrovProject Manager, Chef Enterprise ArchitectHealth Information Technology
Joint HL7 / OMG Workshop on Interoperability among Healthcare Servicesamong Healthcare ServicesAlexandria, VA
1
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
• BCBSA Background and Overview of HIT @ BCBSA
• Service Oriented Architecture at BCBSA
AgendaAgenda
2
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
EHR, PHR, eRX, CPOE
Attachments/CDA/XML
CHI & NHII
Quality &Performance &Medical Mgmt
August 2003 @ BCBSA Annual HIPAA Conference: August 2003 @ BCBSA Annual HIPAA Conference: ““Convergence Toward a New ParadigmConvergence Toward a New Paradigm””
3
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Multiple Initiatives,Multiple Initiatives,
Common DestinationCommon Destination
August 2003 @ BCBSA Annual HIPAA Conference: August 2003 @ BCBSA Annual HIPAA Conference: ““Convergence Toward a New ParadigmConvergence Toward a New Paradigm””
4
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield AssociationPrimary Care Physician
Specialty Physician
Server
Hospital / ED
Payers
Public Health Agencies
PBMPBMPharmacy Benefit Managers
Homeland Defense
LabsCare Management Care Coordination
Vision: Health Information Anywhere AnytimeVision: Health Information Anywhere Anytime
5
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
The Roadmap to Patient Safety, Quality & Efficiency*
“End Game” “Nirvana” “Happiness” “ Future State”Physician and Patient Satisfaction
EHR with Portable Documents, Full Functionality,EHR with Portable Documents, Full Functionality,Clinical Data Exchange, HL7Clinical Data Exchange, HL7-- CDA and Decision SupportCDA and Decision Support
Personal Health RecordPersonal Health Record““Disease ManagementDisease Management”” withwith
Specific PhysicianSpecific PhysicianPerformance MeasuresPerformance Measures
CCR Version 1.0CCR Version 1.0Current StateCurrent State
EE--PrescribingPrescribingCurrent StateCurrent State
Practice ManagementPractice ManagementCurrent StateCurrent State
Basic EHRBasic EHRCurrent StateCurrent State
Secure ESecure E--mailmailCurrent StateCurrent State..
*Assisted by Information Technology Tools*Assisted by Information Technology Tools--””Glue and GreaseGlue and Grease””, the Alliance, the Massachusetts Medical Society,, the Alliance, the Massachusetts Medical Society,The Mass Health Data Consortium, and Technology Partners. The Mass Health Data Consortium, and Technology Partners.
© 2005 Blue Cross and Blue Shield Association
6
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
• BCBSA Background and Overview of HIT @ BCBSA
• Service Oriented Architecture at BCBSA
AgendaAgenda
7
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Definition of ArchitectureDefinition of Architecture
•• ar·chi·tectar·chi·tect n.n.1.1. One who designs and supervises the construction of buildings or One who designs and supervises the construction of buildings or
other large structures. other large structures.
2.2. One that plans or devises One that plans or devises (From Greek)(From Greek): Architect : Architect –– chief, most important builderchief, most important builder[ [ arkhitektarkhitekt nn (Greek): (Greek): arkhiarkhi--, , archiarchi--, chief, chief
archiarchi-- or or archarch-- Chief; highest; most important Chief; highest; most important arkhiarkhi--, , arkharkh--, from , from arkheinarkhein, , to begin, ruleto begin, rule.].]
+ + tekttekt n, n, builderbuilder. . Latin Latin architectusarchitectus]]
•• ar·chi·tec·turear·chi·tec·ture n.n.
1.1. The art and science of designing and erecting buildingsThe art and science of designing and erecting buildings
2.2. Orderly arrangement of parts; structure Orderly arrangement of parts; structure
8
Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Definition of ArchitectureDefinition of Architecture
• A family of guidelines (concepts, principles, rules, patterns, interfaces and standards) to use when building a new IT capability.
ArchitectureArchitecture
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Forrester defines Service Oriented Architecture as:Forrester defines Service Oriented Architecture as:
• A style of design, deployment, and management of applications and software infrastructure in which:
– Applications are organized into business services that are (typically) network accessible
– Service interface definitions are first-class development artifacts
– Quality of service characteristics are explicitly specified in the design
– Services are categorized and discoverable by development tools and management tools
– Protocols are predominantly, but not exclusively based on Web Services
Definition: Service Oriented Architecture (Forrester)Definition: Service Oriented Architecture (Forrester)
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Multiple InterMultiple Inter--Plan Technology Roles of BCBSAPlan Technology Roles of BCBSA
•• BCBSA as a software development companyBCBSA as a software development company–– Develop software, deploy at PlansDevelop software, deploy at Plans
•• BCBSA as an Application Service ProviderBCBSA as an Application Service Provider–– Develop solutions, host systems centrally, provide services to PDevelop solutions, host systems centrally, provide services to Planslans
•• BCBSA as a system integratorBCBSA as a system integrator–– Integrate 3Integrate 3rdrd party software products and servicesparty software products and services
•• BCBSA as a standards organizationBCBSA as a standards organization–– Select, refine and define standards, formats, messagesSelect, refine and define standards, formats, messages
•• BCBSA as policy setting, performance tracking, and auditing bodyBCBSA as policy setting, performance tracking, and auditing body–– BCBSA establishes operational policies, rules, and procedures; tBCBSA establishes operational policies, rules, and procedures; tracks racks
performance and performs auditsperformance and performs audits
•• Internal Corporate Information TechnologyInternal Corporate Information Technology–– Financial, accounting, HR, time tracking systems, etc.Financial, accounting, HR, time tracking systems, etc.
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Provider
ProviderStaff
FinancialInstitution
Member
BCBS Licensee System
Affiliates /Surrogates
Brokers /Consultants
Accounts
Claims /
attachments
fax
telephone
Insurance
card scanner
Member
telephone
Employers
Debit cardscanner
Customers, Stakeholders,Partners
BCBSA
HomePlan
Host Plan
Host Plan
HostPlans
HomePlan
HomePlans
Hos
t Pla
nR
ole
Hom
e PlanRole
Current Blue System InterCurrent Blue System Inter--Plan ContextPlan Context
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Communicate and CollaborateCommunicate and CollaborateCommon Service Delivery PlatformCommon Service Delivery Platform
Inform and AnalyzeInform and AnalyzeCommon Information Management PlatformCommon Information Management Platform
Interact and AccessInteract and AccessCommon User Interaction PlatformCommon User Interaction Platform
Hos
t Pla
nH
ost P
lan
Hom
e PlanH
ome Plan
BCBS AssociationBCBS Association
Prov
ider
sPr
ovid
ers
Mem
bers
Mem
bers
Acc
ount
sA
ccou
nts
Empl
oyer
sEm
ploy
ers A
ffiliatesA
ffiliates
Financial InstitutionsFinancial InstitutionsB
rokers / Consultants
Brokers / C
onsultantsPartners / VendorsPartners / Vendors
Architectural Context and Common PlatformsArchitectural Context and Common Platforms
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Provider
ProviderStaff
FinancialInstitution
Member
BCBS Licensee System
Affiliates /Surrogates
Brokers /Consultants
Accounts
Claims /
attachments
fax
telephone
Insurance
card scanner
Member
telephone
Host Plan Home Plan
BCBSA
Employers
Debit cardscanner
Interact and Access(CUIP)
Inform and Analyze(CIMP)
Comminucate and Collaborate(CSDP)
Customers, Stakeholders, Partners
Technology Enabled Interoperable “Ecosystem”Technology Enabled Interoperable “Ecosystem”
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
BCBS Licensee Plan
ClaimsAdjudication
Systems
AggregatedData (PDR)
HIPAA Services(BlueExchange)
PlanOpera-tions
Plan Data
BenefitsSystems
ProviderSystems
Membership /Billing
Systems
Managed CareSystems
AffiliateSystems
PlanPortals
Member Provider
PlanOpera-tions
Sales /EnrollmentSystems
CSRs /CRM
System
Stakeholders, Partners,Customers
Provider
FinancialInstitution
Member
Affiliate /Surrogate
Broker /Consultant
Account
Member
telephone
Employer
fax
Insurance
card scanner
Debit cardscanner
BCBSA
ITS - IPPClaim Edit /
Submit(Legacy)
Claim Exception/ Web Interaction
(Modern Platform)
Inter-PlanData
Inter-Plan
Eligibility / Status(BlueExchange)
Provider DataServices
(PDR)Audit
Services(LDLA)Performance
Services(PTS)
WarehouseBHI
Pricing
Common Service Delivery PlatformCommon Information Management Platform
Common User Interaction Platform
Extended Technology Enabled Interoperable “Ecosystem”Extended Technology Enabled Interoperable “Ecosystem”
Plans can leverage Plans can leverage the common the common
platforms for their platforms for their external interactionsexternal interactions
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
BCBSA copyright © 2004
BCBS Plans BCBS Association Partners
ClaimsData
ProviderData
Member-ship Data
Information Repositories
Common UserInteraction PlatformCommon Service Delivery PlatformCommon Information
Management Platform
Common Inter-Plan Business Services
ClaimStatus
ClaimSubmission
ClaimEdit
ClaimException
ClaimAdjustment
Pre-AuthReferrals
ClaimAttachment
Claims Applic ation
ClaimAudit
BusinessMetrics
EligibilityStatus
ProviderData
MembershipExchange
Common Platforms and Business ServicesCommon Platforms and Business Services
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
Client TierClient TierRich client apps, applets, thin clients, etc.Rich client apps, applets, thin clients, etc.
Standards MultiStandards Multi--Tier Application ModelTier Application Model
Presentation TierPresentation TierASP, JSP, Servlets, Portlets, other UI, etc.ASP, JSP, Servlets, Portlets, other UI, etc.
Business TierBusiness TierBusiness Objects, Rules, Logic, Workflow, etc.Business Objects, Rules, Logic, Workflow, etc.
Integration TierIntegration TierData/Legacy connectors, messaging, EAI, etc.Data/Legacy connectors, messaging, EAI, etc.
Resource TierResource TierDatabases, external systems, legacy resourcesDatabases, external systems, legacy resourcesA
dmin
istr
atio
n, S
ecur
ity, I
dent
ity, P
olic
y, O
pera
tions
Adm
inis
trat
ion,
Sec
urity
, Ide
ntity
, Pol
icy,
Ope
ratio
ns
Common Information Management PlatformCommon Information Management Platform
Common Service Delivery PlatformCommon Service Delivery Platform
Common User Interaction PlatformCommon User Interaction Platform
Common Infrastructure PlatformsCommon Infrastructure Platforms
Business Services, Products, ApplicationsBusiness Services, Products, Applications
InterInter--Plan Reference Architecture ModelPlan Reference Architecture Model
BusinessBusiness
ServiceService
BusinessBusiness
ServiceService
BusinessBusiness
ServiceService
BusinessBusiness
ServiceService
BusinessBusiness
ServiceServiceBusinessBusiness
ServiceService
Architectural Layers and Common PlatformsArchitectural Layers and Common Platforms
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Achieving InterAchieving Inter--Plan Interoperability through SOAPlan Interoperability through SOA
© 2005 Blue Cross and Blue Shield Association
BCBS Association
Plan B (No Deployed Inter-Plan Services)
Plan Data
CSDP
Plan A (Deploys Inter-Plan Services)
Plan Data
Inter-PlanServices
Plan System
CSDP
Plan C(Deploys Inter-Plan Services)
Plan Data
Inter-PlanServices
Plan System
CSDPBluesNet
Plan System
Inter-PlanServices
Common Inter-Plan PlatformsService Delivery, User Interaction, Information Management Platforms
Inter-PlanServices
Operational ViewOperational View