Policy Paper

Ensuring that technology serves the mission of your enterprise

Developing an Enterprise Information Strategy:

A Pillar of Success in Building the Future of Health Care

3e Services LLC 6667A Old Dominion Drive McLean, VA 22101 703-340-8818 [email protected]

Version 1.0 January 21, 2015

2 6667A Old Dominion Drive, McLean, VA 22101 Main: 703.340.8818 http://www.3eservicesllc.com

Background

Information-centric decision-making is a foundational concept in today’s world of rapid change, high competition, and big data. Technology solutions exist in excess, claiming to create efficiencies, improve outcomes and reduce costs by analyzing data. All too frequently though, technology solutions are developed for single purposes; serving the needs of one department or group of users without consideration of the broad needs in the organization. This results in technology silos that are costly to develop, inflexible, and difficult to apply in other departments or divisions, and often restrict rather than extend collection and analysis of data.

Technology solutions succeed when they are enterprise-focused, collaboratively developed, and implemented with the intent to scale throughout an organization to meet the broad needs of multiple stakeholders. Solutions must seek to not only aggregate data and information into static databases, but must be sophisticated enough to put data and information into an actionable format, using relevant context to then enable business and clinical decision-making.

Enterprise Information Strategy

In order to improve business performance by using data analytics an organization needs a rich understanding of current data sources, their strengths and shortcomings, as well as a clear understanding of how data and information can benefit your business intelligence and decision making. This is most effectively addressed when you have a comprehensive Enterprise Information Strategy (EIS).

A comprehensive Enterprise Information Strategy is informed by:

 Knowing What You Have: A clear understanding of your current data and systems assets can be applied to solving enterprise problems and adding value.

 Appropriate Problem Definition: Understand user needs and how data and information can help them achieve their business goals. Define problems, opportunities, objectives and goals clearly and build to a defined outcome.

 Understanding Data and Information in Context: Data and information are enterprise business assets and need to be leveraged to improve business intelligence. Data becomes information when placed in context – understanding data in context makes it a productive asset.

Technology projects rarely fail because of the technology.

Technology projects fail because we have not adequately defined what we are trying to achieve with them.

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 Defining success criteria: Identify and define the boundaries of acceptable technical solutions, define and measures improvement, and define clear success metrics to assess program performance.

 Improved Process: Recognize the shortcomings in current information management processes and create a strategy for improvement.

 Thoughtful Standards: Identify enterprise standards that drive toward convergence while minimizing the burden on users and solutions providers.

 Implementation Roadmap: Maintain a roadmap and action plan to implement – An Enterprise Information Strategy is just paper without a detailed implementation plan.

An Enterprise Information Strategy doesn’t live in a vacuum. A truly effective EIS is conducted in partnership with optimizing your infrastructure and organizational performance, specifically:

 Enterprise Technology Alignment: Getting the right information to the right person at the right time requires technology to be aligned with user needs to enable agile use of information for decision making. Optimizing information technology solutions that make your data actionable give you greater utility of the information that is centric to your business. Information exchange through systems interoperability enhances your ability to access data from the many technology platforms that exist in an enterprise.

 Enhanced Enterprise Operations: Resources appropriately aligned and utilized within the organization’s infrastructure optimize the use of information to drive business intelligence. This means creating an information-centric culture that is prepared to take advantage of enterprise information, and includes process engineering, socialization of new solutions, an enterprise organizational security approach, and new service models.

When an Enterprise Information Strategy is supported by an optimized technology infrastructure in an information-centric organization, these 3 principles enable an enterprise that is agile and able to not only respond to a global, fast-changing world, but succeed and thrive because of it.

Why Enterprise?

Approaching technology from an enterprise perspective allows you to see across your enterprise to take advantage of excellence where you find it and raise your performance standards across the board. A successful EIS aims to:

 Transcend your organizational structure: Many information management and technology initiatives are undertaken in silos: an individual or department needs a new way of looking at and analyzing their data so they employ the services of the IT department to devise a single solution for this problem. The individual solution may indeed be successful for the needs of one group of stakeholders, but little is done to assess the broader scope of need for a similar solution or to identify if perhaps the technology solution is transferrable to another stakeholder group within the organization. EIS aims to break down silos and allow for users to assemble solutions from best-in-class data, systems, and information assets within your organization – regardless of where they may be.

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 Transform your business: Standardizing and describing solutions throughout the enterprise, has the potential to transform how your employees interact with technology. By following the principles of reduce, reuse, and recycle, EIS drives an organization to the flexible reuse of standardized, scalable solutions. This enables the delivery of faster, more scalable, more flexible solutions that reduce both development and operations cost. Core principles of EIS also serve as the foundation for the creation of a standardized technology infrastructure that allows the enterprise to focus on mission instead of maintenance.

 Drive information-centric decision-making: Business decision-making happens enterprise-wide; your infrastructure should reflect that. Drive business outcomes by having a global view of your information to allow for continuous improvement of business outcomes. By focusing decisions using enterprise-wide information, we reduce duplication of effort, learn from the successes of others, avoid repeating mistakes, and have the ability to rapidly identify synergies and opportunities across the enterprise.

At its core, EIS is about simplicity. It is about identifying best practices, broadening your view, and taking full advantage of your investment in data and systems. The key is to acknowledge the complexity of the enterprise and then identify and optimize the essential and reusable parts to make them available, standardized, consistent and scalable. Complexity is easy – reducing complexity to simple components is genius. The result is a continuously transforming enterprise.

Today Becomes Tomorrow Data and information are managed without standard, enterprise-wide methods.

For Business Users

User needs supported using enterprise standardized components and uniform governance and process.

Business requirements and systems inventory are silos, manually identifying requirements, data, and building solutions piecemeal.

For Information Technology

Staff

Integrated enterprise references, standards, templates, and system and data catalogs. Solutions are reusable and compliant by design, IT focuses on identified gaps.

Data manually collected from disparate systems, analysis performed offline without standard tools. Producing answers is time consuming and often produces divergent results. Multiple logins to retrieve outdated information.

For User Experience

Information presented contextually to the user based upon mission and need, assembled and analyzed using common services. Users focus on the quality of analysis and decision making rather than data aggregation and cleaning.

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The 3e Services Advantage: Methodology

EIS promotes a holistic approach to leveraging enterprise-wide resources towards streamlined information management resulting in optimal use of data and information to inform business intelligence. 3e brings experience and a rigorous methodology to enable your EIS.

Enterprise Information Strategy Primer What EIS is not . . . What EIS is . . .

A software program or a technology system.

An enterprise discipline that utilizes technology to enable better business decision making regardless of the tools or technology systems you have in place.

A mandate to throw out your current IT investment.

An enterprise approach that promote convergence of existing IT solutions to leverage your existing investments.

Defining your business mission.

An enterprise methodology that enables you to achieve desired business outcomes more efficiently and cost effectively.

A single siloed approach to solving a single IT problem

An enterprise center that drives business intelligence by standardizing data and information from many diverse sources.

3e Services uses a long-horizon approach to advise you on achieving a future state of your organization through effective information management. Our approach to EIS is a step-wise one: founded on an inventory of your existing data and systems assets, using the expertise of subject matter experts in your organization, and using industry standards wherever possible to maximize the return on your existing investments and lower the burden of maintaining them.

With extensive experience in enterprise technology design, development, and implementation, our team works collaboratively with your organization to develop a vision for the transformation of your enterprise through a comprehensive EIS.

Our focus is to identify the business value derived from an enterprise strategy. We identify current and end-state tools, methods, templates and best practices; aligned to clearly defined goals and objectives in an implementation roadmap. A comprehensive EIS has many interlocking components, but each is a standalone method that allows many entry points into EIS that can grow across the enterprise:

 Data and Inventory and Catalog: Because of the history of siloed systems development, many organizations have a poor view of data as an asset across the enterprise. Using repeatable methods, we can quickly develop an enterprise inventory of data assets.

 Systems Inventory and Catalog: Organizations frequently reinvent or recreate existing capabilities instead of tailoring and extending existing ones because of a poor view of existing in-house capabilities. By quickly building a function, as opposed to acquisition, oriented system inventory, 3e can identify areas where operating costs can be reduced through shared services.

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 Standards Inventory and Alignment: Organizations use a patchwork of standards to support data and systems, often with a high degree of overlap. Standards review and development of a standards matrix, including an external and regulatory review, will often identify areas for standards convergence, facilitating interoperability and lowering maintenance costs.

 User Needs Inventory and Standardization: User needs assessment is often conducted in a silo, resulting in duplication of effort and limiting the broader utility of technology. Like data and systems, user needs can be described and inventoried with standard components. With extensive experience in workflow design, process improvement, and systems development 3e can bring a new rigor to the user experience design of enterprise systems.

 Metadata and Information Architecture Development: In order to achieve reusability, scalability, and standardization, it is critical that we operate on a common language. 3e has extensive experience in developing semantic approaches that will allow data, systems, and user needs to be compared on an apples-to-apples basis.

 Interaction Matrix: By completing inventories, catalogs, and a common information architecture, data, systems, and user needs can be incorporated into a single overlay of enterprise capability. 3e can help you quickly identify high value assets for reuse, gaps in capability, pain points, systems consolidation opportunities and new organizational capabilities.

 Business Mission Technology Alignment: With a view of your enterprise, data integration and use, as well as technology acquisition and development, can be clearly aligned to your strategic goals, saving time, reducing waste, and increasing productivity. 3e brings extensive experience in development and implementation management to support this alignment.

 Security Posture and Requirements: Security is often viewed as a technical issue, but most security issues (even technical ones) stem from flawed organizational models. With extensive experience in security management in some of the most demanding environments, 3e has the ability to help you design an integrated, effective security model.

 Governance Posture and Planning: Finally, an effective EIS is only as good as your ability to implement and manage it. 3e applies experience in organizational governance to help you tailor and streamline your governance processes to optimize between compliance and performance.

About 3e Services

3e Services was founded in 2014 by a group of industry experts who had a common philosophy; information technology consultants should have deep knowledge and expertise that enables them to work as peers with their clients towards enterprise level solutions. 3e Services is technology agnostic, vendor neutral, and results focused.

Our philosophy centers on using a strategic approach to information technology that enables business intelligence to meet the mission of your enterprise. Our partners have deep expertise and collaborate to strategize and problem solve your unique needs. We analyze the known state of your business and we strive to enable you to create the future through high value IT solutions.

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EIS Use Case: Healthcare Clinical Information Exchange

The vast amount of data and the wide array of information systems used in health care provide an ideal opportunity for performance improvement through Enterprise Information Strategy. Healthcare is complex in the way data is generated, stored, secured, and regulated. Holders of healthcare data are subject to stringent rules regarding privacy and security of data that often dictate the way data are captured and reported. 3e looks at healthcare data through an Enterprise Information Strategy lens:

 Healthcare is replete with standards (HL7, HL7 CDA, SNOMED, LOINC, ICD, CPT) yet we struggle to make data interchangeable and interoperable because we don’t make effective use of these standards.

 Instead of separating clinical data from business and practice management data, these data should use a common semantics through interoperable systems to provide an enterprise view of the system.

 Data replication and redundant data sources lead to inaccuracies and poor data quality. The development of peer-based, interoperable systems can assure that clinical and business decisions are informed by accurate, timely information.

 Compliance by design should be a mantra. Regulatory and compliance reporting, while valuable, is time consuming and repetitive. These are ideal tasks for computers – and a flexible compliance framework should be designed into system up front, instead of being reviewed and certified at the back end, as is often the case.

 Open, yet secure. Openness and security are not mutually exclusive. Security is enabled through appropriate design and organizational controls, and closed systems often provide a single point of failure for security breaches, while open, distributed systems are resilient and control the impact and risk of breach. We have the ability to satisfy security concerns and reduce risk while also enabling greater data sharing and analysis.

Much of healthcare data is static data that when analyzed only tells us about what happened in the past. Technology solutions that are strategically aligned with healthcare operations and open infrastructure can transform data into actionable information, giving real-time perspective on clinical and business decision-making.

The current state of information exchange in health care

Right now the information collected through EHRs, practice management system, computerized order entry systems, lab management systems, scheduling and billing software, accounting spreadsheets, HR portals, and pharmacy benefit systems are all forms of data. This data is based on the individual patient encounters and is often formatted to meet the needs of billing, rather than clinical and business decision making. These systems traditionally reside in silos, and currently still do across enterprises, and often even within the enterprise.

These data silos constrict data sharing and impede effective clinical and business decision making. Further, federal regulations are mandating greater interoperability and Meaningful Use of information technology in healthcare. These efforts are struggling because of the

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volumes of disparate, disjointed data and an existing healthcare technology infrastructure that was never designed for broad data sharing.

Currently, data sharing is achieved through three models: i) manually, ii) point-to-point, or iii) through Health Information Exchanges (HIEs). Manual is the traditional, and most prevalent, method of clinical data sharing, whether it consists of a paper form, handing a CD to a patient, or a manual import and export of a clinical record. This is not an effective, or scalable, solution so IT professionals developed point-to-point integration between systems. Point-to-point allows for effective data sharing however the time and cost of implementing these solutions restricts their growth and makes them very brittle. The HIEs are a valid approach to reducing the infrastructure cost by creating secure exchange networks, similar to the EDI VANs of the 1980s and 1990s. However, provisioning access is still fairly complex and beyond the capabilities of many providers. Is there a better way?

Identifying a solution by learning from other models

The pace of technology development is accelerating, and with better communications networks, open source solutions, service based architectures, and better understanding of security, it is possible to look at applying other technology models to healthcare information exchange.

There are several clear examples of open, scalable, secure technical solutions for broad data sharing that leverage next generation technologies. PKI and PGP certificates use a “delegated” authority model that supports the broad use of encryption and authentication while minimizing cost and technical overhead. Protocols underlying email (SMTP) and internet addressing and routing (IP, PGP, DNS, and DHCP) are examples of systems that rely on distributed, hierarchical directories – allowing for services to be deployed locally and at extremely low cost. Under the IC ITE (Intelligence Community Information Technology Enterprise) initiative, the Intelligence Community has standardized metadata and security protocols (without having to standardize data or security models) to enable self-service information sharing. Other open, peer-based messaging models such as RSS and SMS/MMS also show the potential to create an open, low-cost, flexible peer-based information sharing architecture.

With the advent of HL7 CDA and FHIR, in addition to other healthcare standards, the opportunity is ripe to take advantage of these technologies and these models to rapidly and inexpensively expand health data sharing ad transform healthcare. We can use open source technologies (such as Apache Storm, PGP, AJAX), use design patterns from other successful examples of open, secure, peer based information sharing (such as those referenced above), and use existing healthcare standards such as HL7 CDA, HL7 FHIR, SNOMED, and LOINC to develop open, scalable, low-cost solutions for health data interchange. However, to realize the full potential we need to ensure that there is a strategy to use this data appropriately and effectively: we need and Enterprise Information Strategy for healthcare.