Service Oriented Architecture: Case Study - · PDF fileService Oriented Architecture: Case...

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

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© 2005 Blue Cross and Blue Shield Association

• BCBSA Background and Overview of HIT @ BCBSA

• Service Oriented Architecture at BCBSA

AgendaAgenda

2



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



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””

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© 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

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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.


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• BCBSA Background and Overview of HIT @ BCBSA

• Service Oriented Architecture at BCBSA

AgendaAgenda

7



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



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

9



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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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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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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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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Provider

ProviderStaff


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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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


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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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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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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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

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