Example of a responsibilities driven business architecture alignment effort

Copyright © 2013-2014 Pragmatic Cohesion Consulting, LLC of 60

EBMM-TRIADS™ Responsibilities Driven Business Architecture Alignment

Case Study: The Microsoft CHF


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


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


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


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


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


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


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


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


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:


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


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

http://www.slideshare.net/adidierk/how-to-use-the-ebmm-triads-to-conduct-a-business-architecture-alignment-effort


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.


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


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.


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]

http://www.slideshare.net/adidierk/enterprise-business-motivation-model-ebmm-triads-the-chemestry-of-business-and-it-alignment



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



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.


Figure 3: Responsibilities-Driven Business Architecture Model for Healthcare Organizations

object Responsibilities-Driv en 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 :


POLICY MAKER SERVICES :


POLICY MAKERS

and LEGISLATORS

(G) :MARKET

SEGMENT

FUNDING ORG 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

Productiv e –

Familiar Tools to

Automate the Way

Users Work :

REQUIRED

COMPETENCY

Dependable – Prov en

and Robust :REQUIRED

COMPETENCY Extensiv e 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


STRATEGIES & OBJECTIVES


INITIATIVES & PROGRAMS


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

Driv e changes to

Driv e changes to

Responsible for

Are Accountable for

Responsible for

Gov ern use of

Enforces

Prov ide

Consume

Driv e

DRIVE

Generate


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


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


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


Dependency Describes changes to


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


Dependency Describes changes to

CAPABILITY

CHF BUSINESS




ROAD MAP

CAPABILITIES

Dependency Drive

changes to


YOUR

ORGANIZATION'

S BUSINESS

STRATEGIES &

OBJECTIVES

CHF BUSINESS

CAPABILITIES

Dependency Drive

changes to


YOUR

ORGANIZATION'

S BUSINESS

INITIATIVES &

PROGRAMS

CHF BUSINESS

CAPABILITIES

Dependency Responsible for


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.


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


Dependency DRIVE


CUSTOMERS

DEMANDS and

RELATIONSHIPS

PRODUCTS and

SERVICES

Dependency Generate


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


Dependency Generate


MARKET

SEGMENTS

CUSTOMERS

DEMANDS and

RELATIONSHIPS



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


Dependency Consume


YOUR

ORGANIZATION'

S BUSINESS

UNITS

PRODUCTS and

SERVICES

Dependency Drive


CUSTOMERS

DEMANDS and

RELATIONSHIPS

PRODUCTS and

SERVICES

Dependency Provide


YOUR

ORGANIZATION'

S BUSINESS

UNITS

PRODUCTS and

SERVICES


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


Dependency Drive


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


themselves.

Connections


Dependency Drive


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


Connections


Dependency Govern use of


BUSINESS

POLICIES

YOUR

ORGANIZATION'

S ASSETS

Dependency Responsible for


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.


Connections


Dependency Drive

changes to


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


Dependency Are



Accountable for


YOUR

ORGANIZATION'

S

STAKEHOLDERS

YOUR

ORGANIZATION'

S BUSINESS

STRATEGIES &

OBJECTIVES

Dependency Drive

changes to


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.


Connections


Dependency Consume


YOUR

ORGANIZATION'

S BUSINESS

UNITS

PRODUCTS and

SERVICES

Dependency Provide


YOUR

ORGANIZATION'

S BUSINESS

UNITS

PRODUCTS and

SERVICES

Dependency Are

responsible for


YOUR

ORGANIZATION'

S BUSINESS

UNITS

YOUR

ORGANIZATION'

S ASSETS

Dependency Are

responsible for


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


processes.

Connections


Dependency Enforces


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


Dependency Are

Accountable for


YOUR

ORGANIZATION'

S

STAKEHOLDERS

YOUR

ORGANIZATION'

S BUSINESS

STRATEGIES &

OBJECTIVES


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


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


“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


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


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


-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


-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


-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.


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.


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.


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


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


-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


-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:


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


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.


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


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.


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


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


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


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


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


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,


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


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


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.


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


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

http://motivationmodel.com/wp/




Example of a responsibilities driven business architecture alignment effort

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