Health Care

We assist in the Technology Strategy and Architecture, Design, and Implementation of State and Private health information exchanges and modernize the legacy MMIS.


xFusion’s Healthcare practice brings years of experience serving various private and public Health and Human Services organizations that uniquely qualify us to establish an agile, interoperable and reusable Health Enterprise Architecture. We assist in the Technology Strategy and Architecture, Design, and Implementation of State and Private health information exchanges and modernize the legacy Medicaid Management Information Systems (MMIS).

xFusion provides Enterprise Architecture service to various organizations to establish an integrated and coor­dinated Physical Health, Behavioral Health and the Human Services Enterprise Architecture, conduct MITA State Self-Assessment (SS-A), and establish the roadmap for the Health Enterprise Transformation.

xFusion extensively worked with various state Medicaid and Human Services Agencies and Health Insurance Exchanges including California, Mississippi, and Washington in the planning and implementation phase as part of the Patient Protection and Affordable Care Act (PPACA) implementation and provided Business Process Analysis and Modeling, Technical Architecture, System Design, Legacy Modernization Strategy, and Solution Imple­mentation services.

  • Medicaid Information Technology Architecture (MITA)
  • Open Behavioral Health Information Technology Architecture (OBHITA)
  • National Human Services Interoperability Architecture (NHSIA)
  • Patient Protection and Affordable Care Act (PPACA)
  • Health Benefit Exchange (HBEx)
  • MITA State Self-Assessment (SS-A)
  • CMS Seven Standards and Conditions for Extended Funding
  • Medicaid Business Process, Medicaid Management Information Systems (MMIS) Modernization – Strategy, Architecture and Roadmap definition
  • Risk Based Security and Privacy Framework
  • Security and Privacy Standards: HIPAA, NIST, FISMA, HITECH
  • Service Oriented Architecture (SOA) – Adoption, Governance, Implementation

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

California Health Eligibility, Enrollment and Retention System (CalHEERS), California Department of Health Care Services (DHCS), Covered California

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


Healthcare Interoperability is the capability of different information systems in the Healthcare ecosystems such as Primary Care, Laboratory, Hospitals, Pharmacy, Specialists, Eligibility and Claims etc. to communicate, exchange and process data effectively and efficiently in a timely and secured manner in order to advance the effective delivery of healthcare for individuals and communities.

HIMSS defines three levels of health information technology interoperability: 1) Foundational Interoperability 2) Structural Interoperability 3) Semantic Interoperability.xf2-300x231

Health Information Exchange (HIE) allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically. The demand for electronic health information exchange from one health care professional to another is growing along with nationwide efforts to improve the quality, safety and efficiency of health care delivery. Meaningful use requirements, new payment approaches that stress care coordination, and federal financial incentives are all driving the interest and demand for health information exchange.

  • Health Data Integration, SOA, ESB, 5010 Architecture
  • Conceptual and Logical Data Models (CDM, LDM) for various MITA Business Areas
  • Health Information and Transaction Standards – NIEM, HL7, HIPAA ASC X12,
  • Vocabulary Data Standards – NCPDP, ICD 9/10, SNOMED, LONIC, CVX
  • Electronic Health Record (EHR) and Electronic Medical Record (EMR)
  • Master Patient Index (MPI)
  • Clinical Document Architecture (CDA)
  • Master Data Management (MDM)
  • Healthcare Analytics and Reporting
  • Health Information and Security Interoperability Architecture and Standards
  • Electronic Health Record (EHR) Meaningful Use (MU)

Knowledge In-Sourcing is extremely critical – analyze and document your existing business processes, Stakeholders, Use Cases, Technical Architecture & Components, Data, and Business Rules and identify and document the challenges and pain points associated to your current environment. The in-sourced knowledge serves as key inputs for the subsequent Modernization planning phases – To-Be Architecture definition, Modernization Strategy and Roadmap definition, Costing, To-be requirements definition and Funding activities.

Our integrated framework, xPlore is built with process, tools and best practices that will help end to end Legacy Systems Modernization planning effort from As-Is Architecture Analysis, To-Be Architecture and Strategy Definition and Funding and Procurement phases in extremely efficient and cost effective manner.

xPlore: Our Legacy Modernization
Strategy, Architecture, Roadmap, and
Business Rules Extraction (BRE) Solution
  • As-Is Architecture Analysis & Business Rules Extraction (BRE)
  • Business Process Analysis and Modeling
  • Target Architecture Definition
  • Modernization Strategy, Cost Analysis and Roadmap Definition
  • As-Is Analysis of Business, Technology and Information architecture, knowledge in-sourcing and identification of current pain points and challenges
  • Extraction of Business Rules and Policies from Legacy System
  • Assess Partner System Impacts and Partner System Integration Strategy
  • Alternative Analysis, To-Be Architecture Definition and Cost Analysis
  • Modernization Strategy and Roadmap Definition
  • Support Development of Advance Planning document (APD) for Funding
  • Support development of RFP for the procurement of SI vendor