1. An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11
BCBSNC’s Healthcare Provider
and Network Management
Integration Architecture for a
Changing Market
AEC-5560
Arman Atashi
Senior Enterprise Solutions Architect
Blue Cross Blue Shield of North Carolina
2. Current State
Future State
Architecture Models
Architecture Vision
Integration Architecture
Message Model
Runtime Model
Deployment Model
Q&A
From Architecture Vision to Reality
Agenda
2
4. + Applications and interfaces are built independently
+ Standalone projects deliver data limited to specific function
Business Challenges
4
The Result
+ Complexity has been building over time
+ Systems need to interact and integrate for decision making
Complex IT Landscape with
Dispersed Data across
Disparate Systems
The Result
IT Silos in the Enterprise with
Bunch of Provider Data
Managed within Multiple
Systems
5. + Provider Data Integration
▪ Inflexible
▪ Reactive
▪ Manual
▪ Batch
Business Challenges
5
Limited Visibility in
Systems Interactions
Hinders Agility and
Productivity
6. + Consumers of Provider Information Entity within BCBSNC
Provider Information Usage
6
11. Architecture Models - Business Architecture
11
+ Establish a single Provider Information System of Record responsible for
creating and maintaining the Provider Information Entity
14. Architecture Models - Technology Specification
14
Web Applications & Portals
Workflows & Services
Enterprise Service Bus (ESB)
Message
Composition
Rules & Events
Routing &
Mediation
Adapters
Infrastructure
Message Server
Database
Server
Application
Server
Directory
Server & SSO
15. Architecture Vision - Implementation Principles
15
+ Provider Data Integration
▪ Flexible
▪ Proactive
▪ Event Based
▪ Right Time
Clear and Recognizable
Systems Interactions
Improves Productivity
and Value of the
Provider Information
+ Information as a Service
16. + SOA: Decouple systems and applications from each other (code,
data, and communication) while allowing them to communicate
with each other in a consistent way
Architecture Vision - Implementation Principles
16
System A
Private Code & Processes
System B
Private Code & Processes
Contract
Shared Code & Processes
Interoperable
Protocol
Interface
Interface
Interface
Interface
Interoperable
Protocol
17. + Canonical Message: Use message-specific common data in
canonical format expressed in XML to mediate data exchanges
between systems
Architecture Vision - Implementation Principles
17
Enterprise Service Bus
Adapter Adapter
System A
System CSystem B
Adapter
18. + Cloud Analytics: Enhance Provider Self-Service Strategy by
including Cloud Analytics to help Providers to have insights in
patient health and get answers in real-times
Architecture Vision - Implementation Principles
18
BCBSNC
Provider Portal
Cloud
Analytics
Healthcare
Provider
Episode
Bundling
Risks Adjustment
and Scoring
Implantable Device
Management
Others
19. + Safeguard Access to Applications/Services: Establish policies
for user access privileges and allow access to cross domain web
based applications using SAML for web browser Single Sign-On
Architecture Vision - Implementation Principles
19
BCBSNC
Portals
Workforce
User
Site 1
Non-Workforce
User
Site 2
Private
Cloud A
Site n
Public
Cloud
Site A Site Z
Private
Cloud Z
SAML SSO
20. Architecture Vision - Information Exchange
20
+ Three key technology layers participate in the exchange of
information:
+ Vendor Integration Layer: This layer includes the components that provide
information exchange via IBM Managed File Transfer as SDE (Secure Data
Exchange), SAML SSO using IBM WebSEAL and TFIM, and Web Services
for real-time integration
+ Enterprise Integration Layer: The components at this layer implement
BCBSNC Enterprise Service Integration Framework together with IBM
WebSphere Message Broker as the Enterprise Service Bus
+ Information Layer: The components managing data sources (provide data to
other systems and programs) such as Databases, Web Services, and Files
(XML, CVS, etc.) or deliver data to end users such as web browsers
24. + Canonical Message Model (CMM) represents the
standardized format used for exchanging BCBSNC Provider
business information on an Enterprise Service Bus (ESB)
+ XML schemas are used to represent the message definitions
and types
+ CMM XML XSDs are based on and derived from
McKesson’s Network Performance Management (NPM)
Standard Outbound XML (PSOX) XSDs
+ CMM is also the foundation for describing the functionality
provided by BCBSNC Provider Web Services used in
Services Definition Language (WSDL) schemas
Message Model
24
25. + CMM specification consists of the following:
▪ Structure and names of the data types and format
▪ Rules governing data composition/aggregation and the
allowable values, expressed in XSDs
▪ Business terms definitions of the types (Data Dictionary)
▪ A set of messages each including defined elements, types, and
attributes to provide a specific business context
– Provider Message, a coarse-grained message reflecting BCBSNC
provider business context
– Practitioner Message, a coarse-grained message reflecting
BCBNSC practitioner business context
– Additional fine-grained messages will be defined/constructed to
provide desired capabilities in the future
Message Model
25
26. + IBM RSA (Rational Software Architect) is extensively used in
the construction and maintenance of CMM
▪ PSOX to CMM mapping
▪ CMM XSD-to-UML round trip transformation
▪ PSOX to CMM Transformation using XSLT & STX transformation Style
Sheets
Message Model - Message Transformation
26
NPM
PSOX
XML
NPM
PIMS
NPM
PSOX
File
Single
CMM
XML
XSLT Processor WMB XSLT
Processor
MQ
Full
CMM
XML
RSA XSLT
Processor
Full
CMM
XML
STX Processor
31. Runtime Model
31
PIMS Adapter Overview
MFT from
Database
Server to
WMB server
Database Server
PSOX XSL
Transformation
RunSplit.sh
PSOX
Document
PSOX Feed
RunPSOX.sh
PSOX Provider
Documents
PIMS
Provider
Adapter
CMM Provider
Messages
PSOX Provider
Documents
Copy from
staging to
processing area
Message Broker Server
Copy
for MFT
32. Runtime Model
32
PIMS Adapter Overview
MFT from
Database
Server to
WMB server
Database Server
PSOX XSL
Transformation
RunSplit.sh
PSOX
Document
PSOX Feed
RunPSOX.sh
PSOX Practitioner
Documents
PIMS
Practitioner
Adapter
CMM Practitioner
Messages
PSOX Practitioner
Documents
Copy from
staging to
processing area
Message Broker Server
Copy
for MFT
36. From Architecture Vision
to Reality
“Establishing a Software
Architecture Vision is not
necessarily Implementing a
Software Architecture.”
37. Architecture Vision - Implementation Principles
37
Information as a Service
Service Oriented Architecture
Canonical Message
Cloud Analytics
Safeguard Access
40. Architecture Reality - [Cloud Analytics + Safeguard Access]
40
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41. Thank You
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