Case Studies

HEALTH CARE

-HHS ENTERPRISE ARCHITECTURE-

Health Care Enterprise Architecture Service
Enterprise Architecture Office (EAO)
Department of Health Care Services (DHCS), California

The Problem:

DHCS wanted to establish the Enterprise Architecture (EA) practice to manage the enterprise changes via strategic transformation. The transformation plan provides the required expectations, prioritization, and trade-offs for the planned deliverables. The aim is to develop optimal business capabilities over time, which gives the enterprise its strategic edge. This requires investment in people, process, technologies, and information with an expectation of returns.

In addition to setting a long-term vision and goals, DHCS wanted to establish implementation Strategy that describes the department’s approach and roadmap to accomplish department’s goals and vision to advance Medicaid Information Technology Architecture (MITA) maturity levels for its Business, Information and Technology Architecture through business process automation, enterprise governance, information management, and establishing required technology capabilities.

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • Establish DHCS Enterprise Architecture Organization (EAO) from ground up
  • Assess various EA reference Models such as Federal Enterprise Architecture (FEA), ToGAF, Zachman, Pragmatic EA Framework and Service Oriented Architecture (SOA) etc. and establish DHCS Service Oriented Enterprise Architecture (SOEA) Reference Model, DHCS EA Lifecycle Model and high level EA Governance Model.
  • Responsible to analyze as-is technical architecture, develop Target Enterprise Technical Architecture, develop enterprise technical strategies - Infrastructure Strategy, Access and Delivery Strategy, SOA Strategy, Enterprise Integration (ESB) Strategy, Business Process Management (BPM) Strategy, Enterprise Business Rules Strategy, Legacy Modernization Strategy etc.; each of the technical strategy includes as-is architecture, Architecture Reference Models (ARM), Target Architecture (logical and physical), technology and product mapping, standards, best practices etc. that are aligned to MITA 3.0 Technical Architecture and the State of California Enterprise Architecture Reference Framework (CEAF 2.0)
  • Defined a Risk Based Security Framework for Health and Human Services based on HIPAA, California State HIPAA Standards, NIST, FIPS, FISMA, HITECH etc.
  • Work with the MITA State Self-Assessment (SS-A) team and defining the Capability Maturity Roadmap for Business, Technical and Information Architecture
  • Define and implement a communication & collaboration model for horizontal and vertical communication and collaboration for interviews, EA progress updates, training and education etc.
  • Defined EA Governance Model, Organization Structure, Roles and Responsibilities, Architecture Review Board (ARB) to integrate EAO with various projects within the department
  • Created a EA Repository to store and manage all the EA artifacts as enterprise assets such as Business Process Models (BPM), Logical and Physical Data Models, Metadata Definitions, Service Interface Definitions (WSDL, XML Schema) using Sparx Enterprise Architect, SQL Server Database, UML, BPMN, XML, MS SharePoint etc.
  • Implemented Architectural Assurance Program (AAP) for the ARB, to ensure strategic alignment of goals and objectives of individual projects, business technology alignment, and alignment to the EA Reference Architecture Models etc.

Tools, Standards and Best Practices Used: Enterprise Architecture (FEA), ToGAF, Zachman, Pragmatic EA Framework, MITA, CMS Seven Standards and Conditions, NIEM, BPMN, BPEL, UML, SOA, HL7, NIEM, HIPAA, FISMA, NIST, HITECH, Business Rules Management System (BRMS), Business Process Management System (BPMS), Enterprise Service Bus (ESB), XML, MS Project, UML, Enterprise Architect , Business Process Analysis and Design, Service Oriented Analysis and Design, Service Oriented Software Development Life Cycle and Service Portfolio Management, Service Oriented Governance Model.

OUTCOME

DHCS successfully established Health Enterprise Architecture practice; established target Architecture; defined Approach, Architecture Strategy and Principles and the Reference Architecture Models (RAM) for its future state Business, Information and Technology Architecture; Defines Health Care Innovation Strategy that defines the approach, principles and roadmap for the transformation of the Health Care Enterprise from its current state to the target state.

IN NEWS

Business Technology Architecture (BaTA) Program
Washington Healthcare Authority (WHA), Olympia, WA

The Problem:

The BaTA program fosters the integration of business, information, and technology architectures across the state’s Health and Human Services landscape that includes physical, behavioral health and human services programs. BaTA establishes an approach that allows the WA Health Care Authority (HCA) to extend beyond the Medicaid program to create a business reference model and roadmap for Washington State Health and Human Services enterprise.

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • As-Is analysis of Business Process, Information and Technical Architecture
  • Provide training on Medicaid Information Technology Architecture (MITA) and conduct stakeholders interview on vision and strategy
  • MITA State Self-Assessment (SS-A) for Technical and Information Architecture
  • Defining To-Be Technical and Information Architecture and MITA SS-A for the To-Be Architecture
  • Creation of a high-level roadmap for agency implementation of the BaTA and the State Self-Assessment.
  • Develop Enterprise Architecture Repository Model based on MITA Meta-model on ABACUS.
OUTCOME

WA HCA successfully established the BaTA program; established program goals and objectives, established in-house MITA knowledge and capabilities by training the existing staff members; established EA Repository using ABACUS; prioritized MITA SS-A by MITA Business Areas and conducted MITA SS-A.

California Health Eligibility, Enrollment and Retention System (CalHEERS) Project
California Department of Health Care Services (DHCS), Office of Systems Integration (OSI)

The Problem:

California Health Eligibility, Enrollment and Retention System (CalHEERS) provides a state-based health insurance exchanges as envisioned by federal Affordable Care Act (ACA 2010). The CalHEERS provides a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and Services, and quality. DHCS and Office of Systems Integration (OSI) needed Business and Technical Architecture services to define Business, Information and Technology requirements for the CalHEERS system and development of RFP for the procurement of the SI Vendor for CalHEERS

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • Define CalHEERS Technology, Security, Infrastructure, Tools and Technology standards and requirements for the CalHEERS System Integration (SI) Vendor procurement RFP
  • Developed and documented technical artifacts for CalHEERS SI Vendor procurement library
  • Performed as-is eligibility business processes, system architecture analysis and, alternative analysis, defined CalHEERS implementation strategy and roadmap
  • Develop artifacts and assist in CMS Gate Reviews
  • Architected and documented CalHEERS Technology Reference Architecture (TRA) based on MITA, SOA, CMS Reference Architecture and other Open, Federal and State standards and guidance
  • Define architecture and strategy for business rules externalization, centralized business rules repository and decision services for California Eligibility and Enrollment Systems
  • Architect and document CalHEERS Integration Infrastructure Architecture using Enterprise Service Bus (ESB) and Service Oriented Architecture (SOA) for seamless integration of applications and resources within CalHEERS and outside CalHEERS with the partners (e.g. SAWS, Federal Data Hub, EDD, FTB, SSA, USCIS etc.) and suppliers (e.g. Providers)
  • Architect and document CalHEERS Risk Based Harmonized Security and Privacy Framework, a single, comprehensive, integrated risk based framework with process, tools, technology, standards and best practices to design, implement, manage, administer, govern the Security and Privacy of the CalHEERS System and Data using HIPAA, NIST, HITECH, FISMA, and CMS Guidelines etc.

Tools, Standards and Best Practices Used: SOA, FEA, MITA 3.0, CMS Reference Architecture, HL7, NIEM, HIPAA, FISMA, NIST, HITECH, Business Rules Management System (BRMS), Business Process Management System (BPMS), Business Process Modeling Notation (BPMN), Enterprise Service Bus (ESB), XML, MS Project, UML, Sparx Enterprise Architect, Business Process Analysis and Design, Service Oriented Analysis and Design, Service Oriented Software Development Life Cycle and Service Portfolio Management, Service Oriented Governance Model.

OUTCOME

Successfully performed Business Process Analysis, Alternative Architecture Analysis and adopted the target Business Process Model, Architecture and Concept of Operations for California’s Eligibility and Enrollment Business Process; Reference Architecture Model (RAM) for the Technical and the Security Architecture was established; Business, Technical, Data and non-functional requirements were defined RFP for CalHEERS SI vendor procurement.

-HEALTHCARE INTEROPERABILITY-

Healthy Exchange and Medi-Cal Interface (HEMI) Project
Department of Healthcare Services (DHCS), California

The Problem:

The Health Exchange & Medi-Cal Interface (HEMI) Project at DHCS is a sub-project of California’s Health Benefit Exchange, CalHEERS. Through this project, DHCS supports modernization of Medi-Cal Eligibility Data System’s (MEDS) legacy interfaces as interoperable, real-time web service interfaces and integration of those interfaces to various health eligibility and enrollment systems such as California Health Eligibility, Enrollment and Retention System (CalHEERS), Sate Automated Welfare Systems (SAWS) – C-IV, CalWIN, LEADRS, and various state agencies – EDD, FTB with a goal to enable real-time eligibility determination and enrollment for MAGI Medi-Cal, APTC/CSR health programs as envisioned by ACA 2010.

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • Business Process Analysis spanning across various state and federal integration partners, model, and develop as-is and to-be Business Process Model (BPM)
  • Identification of top-down business and technical requirements for the changes in the MEDS system and real-time business services from the to-be Eligibility and Enrollment (E&E) Business Process Model
  • Interface analysis with statewide integration partners such as, CalHEERS, DHCS, ITSD, CMIPS-II, CAMMIS, SAWS, EDD and FTB, identified gaps, interoperability, reusability, security and connectivity challenges.
  • Risk Based Security and Privacy (S&P) Analysis, classification of sensitivity of information being exchanged, defined Service Security requirements based on the information security classification (PII, PHI, FTI) using FIPS and NIST security control guidelines.
  • Define strategy, scope, requirements, service and integration architecture for web enablement of legacy MEDS interfaces to support the goal to enable real-time eligibility determination and enrollment for MAGI Medi-Cal, APTC/CSR health programs as envisioned by ACA 2010.
  • Design algorithm for transform of manual Member Identification process to Automated Identification process

Tools, Standards and Best Practices Used: Medicaid Information Technology Architecture (MITA 3.0), CMS Seven Standards and Conditions, NIEM, BPMN, BPEL, UML, SOA, Web Sphere Application Server, Web Services, CICS Transaction Server, SAP Business Objects, DB2, Informatica, ETL, HL7, NIEM, HIPAA, FISMA, NIST, HITECH, Business Rules Management System (BRMS), XML, MS Project, UML, Enterprise Architect, Business Process Analysis and Design, Service Oriented Analysis and Design, Service Oriented Software Development Life Cycle.

OUTCOME

California Department of Health Care Service (DHCS) could successfully implement the business and technical changes driven the policy and compliance requirements of Affordable Care Act, 2010 in the Medi-Cal Eligibility Data System (MEDS), implemented real-time business services through web enablement of legacy MEDS components to support the Eligibility and Enrollment business process needs. The changes in the MEDS system and it’s support for the real-time business services were very critical for the successful implementation of California’s Health Benefit Exchange, CalHEERS.

DHCS Enterprise Data Warehouse, Analytics and Reporting (EDWAR) Platform – Strategy, Architecture and Roadmap
California Department of Health Care Services (DHCS)

The Problem:

DHCS established a vision to achieve an integrated, 360 degrees view of the Physical Health, Behavioral Health and Social Services program information to support current and future decision support needs for all the stakeholders across the DHCS Enterprise to achieve efficient program integration, management and outcome. In order to implement the vision, DHCS required assistance to establish enterprise wide Data Warehousing and Business Analytics Strategy, Architecture and Roadmap.

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • As-is analysis of Data, Architecture, Technology used for Data Warehousing and Business Analytics across the DHCS Enterprise
  • Identification of business and technology challenges associated to the as-is Data Warehousing and Business Analytics across the DHCS Enterprise
  • Analysis of current Operational and Reference Data Sources and Data Integration Architecture and associated challenges
  • Identification key Users and Analytics Use Cases
  • EDWAR Functional Scope, Data Scope, and key Operational and Reference Data Source Definition
  • EDWAR Strategic Goals, Objectives and Approach Definition
  • EDWAR Reference Architecture Model, Logical and Physical Architecture Definition
  • Enterprise Information Integration Strategy and Architecture Definition
  • As-is to to-be transformation Strategy and Roadmap Definition
OUTCOME

DHCS successfully documented the as-is analytics and reporting environments and associated challenges and pain points; defined vision and goals for the future state of the data warehouse, analytics and reporting architecture; successfully established logical architecture, strategy and a high level roadmap for the future state of the Enterprise Data Warehouse, Analytics and Reporting (EDWAR) Platform.

Hospital Presumptive Eligibility (PE) – Data Interface Analysis, Datamart Design and Reporting, Department of Health Care Services (DHCS), CA

The Problem:

As part of implementation of the Affordable Care Act (ACA) 2010, California wanted to implement a solution for Hospital Presumptive Eligibility (HPE) business function and related reporting capability. The HPE application provides business capability to provide immediate access to Medi-Cal services for sixty days to the eligible applicants.

SERVICES PROVIDED

xFusion was engaged to perform the following key activities:

  • Alternative analysis, solution design for the Hospital PE system.
  • Business Process and Interface Analysis, define integration architecture
  • Analysis and Solution design for Hospital PE Reporting System
  • Analyze and design of interoperable web service interface for the legacy components
  • Logical and Physical Data Modeling for Hospital PE Database, Interface and Datamarts
  • Implementation and testing Hospital PE reporting solution components – ETL, Reports etc.
  • Implementation and testing of Hospital PE and the reporting solution

Tools, Standards and Best Practices Used: Java, XML, JAXB, Eclipse, WebSphere application server 8.0, Apache Ant, Apache Tomcat 6, SOAP, WSDL, Soap UI, Load UI,JIRA,MS Visio, Mainframe z/OS, COBOL, CICS, VSAM, Mainframe TSO/ISPF, ESP Automated Job Scheduler, Filezilla, DB2 for OS/390 database Systems, FTP, SFTP, Agile Scrum Methodology, SharePoint, QMF and Enterprise Architect tool.

OUTCOME

DHCS successfully implemented the Hospital PE solution as required by the ACA 2010 that integrates the Providers, DHCS Fiscal Intermediary (FI) and Medi-Cal Eligibility Data System (MEDS). Legacy business components on the mainframe system was transformed into interoperable web services for integration and workflow implementation. A datamart was implemented to extract and load necessary data to support reporting requirements for the Hospital PE program; Reporting solution was successfully implemented on top of the Hospital PE datamart.