IBM Business Process Manager V7.5IBM BPM Healthcare Pack V7.5 IBM Business Process Manager V7.5 IBM BPM Healthcare Pack V7.5 This presentation provides details about the Business Process Manager (BPM) Healthcare Pack V7.5 Goals and Agenda Goals and Agenda Goals Introduction to BPM Healthcare pack V7.5 Introduction to different models within Healthcare pack Agenda Healthcare pack standards Healthcare pack assets Capability models Process models Service models Common components Business vocabulary Business objects models Healthcare pack V7.5 features Summary The goal of this presentation is to provide an introduction to the BPM Healthcare Pack V7.5 and to understand the various assets provided with the pack. Healthcare pack standards Healthcare pack standards Section This section provides a list of standards that are supported by the BPM Healthcare Pack V7.5 Summary of Key Standards Leveraged Summary of Key Standards Leveraged The Accredited Standards Committee (ASC) X12 chartered by the American National Standards Institute in 1979. It develops electronic data interchange (EDI) standards and related documents for national and global markets. With more than 315 X12 EDI standards and a growing collection of X12 XML schemas, ASC X12 enhances business processes, reduces costs and expands organizational reach Business Vocabularies, Business Object Models, Service Models Business Vocabularies, Business Object Models, Common Components Health Level Seven International (HL7) is the global authority on standards for interoperability of health information technology with members in over 55 countries. HL7's vision is to create the best and most widely used standards in healthcare HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of stakeholders, including healthcare providers, government agencies, vendor community, fellow SDOs and patients. In all of processes, we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or willingness to put the needs of stakeholders first www.x12.org/ www.hipaa.org/ www.hl7.org/ The key standards that are used by the BPM Healthcare Pack are the X12 electronic data exchange (EDI) standards and the Health Level Seven International (HL7) standards. The BPM Healthcare pack includes pre-built healthcare-specific assets based on this industry standards and IBM best practices. It is not a replacement of Healthcare standards – it provides derivative works based on ASC X12 EDI (HIPAA) and HL7 standards. Healthcare pack assets Healthcare pack assets Section This section provides details about different assets of BPM Healthcare Pack V7.5 IBM Business Process Manager Healthcare Pack V7.5 IBM Business Process Manager Healthcare Pack V7.5 Process Flows Coach Flows KPIs / Reports Integration Services Healthcare “Solution Scenario” for Benefits Eligibility Pre-built scenario that combines the Healthcare assets into an end-to-end BPM solution Business Object Models Conceptual Data Models to provide a foundation for information management Common Components Common Services & Utilities to enable interoperability with the application ecosystem Business Vocabulary Business Concepts, Terms & Relationships to ensure consistency Service Models Service Interfaces & Schemas to facilitate creation & assembly of process implementations Capability Models Capability Maps & Process Maps to align business strategy with process execution Healthcare Assets Process Models Process Flows to visualize human workflows & automate processes IBM BPM Process Designer IBM BPM Process Designer and Integration Designer IBM Rational Software Architect WebSphere Business Compass WebSphere Business Services Fabric IBM BPM Integration Designer The BPM Healthcare Pack provides the Benefits and Eligibility solution scenario to demonstrate the capabilities of assets in developing an end-to-end Business Process Management (BPM) solution based on a eligibility inquiry scenario that is considered common within the healthcare industry. The Healthcare provider can use Benefits Eligibility transactions to determine whether a payer or HMO has a subscriber or dependent on file and the status of the subscriber or dependent. It can also be used to check the current healthcare eligibility and the benefit information for the subscriber or dependent. The various artifacts that are used in the Benefits Eligibility Solution Scenario can be viewed by using the different tools that each of these artifacts use as mentioned in the boxes. Benefits Eligibility is used to view the data associated with the benefit and eligibility information of a patient and based on the patient name, date of birth, and so on, it determines the information that is supplied. A demonstration is provided on how to run the Benefits Eligibility Solution Scenario. The next few slides discuss healthcare assets that different users can use based on their business requirements. Use Healthcare Capability Model to identify target business areas Use Healthcare Capability Model to identify target business areas Business Leader Capability Maps & Process Maps align business strategy with process execution Capability maps are defined up to level 4 Based on HL7 EHR model and IBM Best Practices Tooling with WebSphere Business Compass; Packaged as Business Document Archive E.g. Claims Management, Plan Management, Member Management, Prospect and Sells, Patient Directory, Preventive Care and Wellness The Healthcare Capability Model consist of Capability Maps which represents the healthcare domain decomposition of business capabilities. Based on HL7’s EHR standards and IBM Best Practices, the capability models help in managing healthcare claims, plans, providers and members. In the previous release of the BPM Healthcare Pack, processes and sub processes were part of process maps, which were mapped to capability maps. In this release, these processes and sub processes have been moved such that they form the next level of sub capabilities in an existing capability map. These assets are packaged as a Business Document Archive (.bda) files and can be easily viewed using WebSphere Business Compass. Before you can begin using the capability maps you need to identify the business area that corresponds to your requirement. This identification helps in aligning the business strategy with process execution. Model detailed process flows, sub processes using Process Model (1 of 2) Model detailed process flows, sub processes using Process Model (1 of 2) Based on IBM Best Practices Tooling with IBM BPM Process Designer E.g. Check Eligibility and Duplicates, Track claims, view benefit details, Analyze health details, submit claims, correct claims Process Flows & Business Measures simulate human workflows & automate processes Based on capability maps (Level 4) Mapped to Service Interfaces and Variables Business Analyst The Healthcare Process Models are modeled as Business Process Definitions (BPDs) inside the IBM Process Designer. A BPD defines the process workflow for users, creating logic inside a process, and integrates with other applications and data sources. The process acts as a container for all the components of a process definition, which includes participant groups, lanes, services, activities, gateways, sequence lines, rules, and variables. Each of the BPDs related to a specific focus area are packaged as part of the Toolkits. The Healthcare Process Models include the Member and Sponsor Management and Claims Management toolkits. The BPDs that are available as part of the Healthcare Pack serve as templates that can be used to start, or in some cases, accelerate the development of a Process Application. This provides you an ability to use the provided assets as a starting point and customize them as per their requirements. In the earlier release, the Process Models were provided as WebSphere Business Modeler artifacts. Model detailed process flows, sub processes using Process Model (2 of 2) Model detailed process flows, sub processes using Process Model (2 of 2) Based on IBM Best Practices Tooling with IBM BPM Process Designer E.g. Check Eligibility and Duplicates, Track claims, view benefit details, Analyze health details, submit claims, correct claims Business Analyst Predefined Healthcare Business Measures Reports Tracking Groups The toolkits contain predefined Reports and Scoreboards for monitoring process related performance. Reports are used to analyze the process performance-related data as a graph or chart that easily depicts the data in an easy to understand format, as opposed to a tabular format of information. Scoreboards are an aggregation of reports that can be seen in the IBM Process Portal. Assemble Integration Solution by using Healthcare Service Models Assemble Integration Solution by using Healthcare Service Models Based on HL7 Reference Information Model, ASC X12 EDI for HIPAA and IBM Best Practices Tooling with WebSphere Integration Developer; Packaged as SCA libraries E.g. Bill Inquiry, Eligibility Transaction History, Eligibility Report, Filter Eligibility Data, Retrieve Eligibility Request, Apply Benefits, Eligibility callback, Notify Member, Retrieve Provider Fees Developer Service Interface & Schemas facilitate creation & assembly of process implementations Service definition includes input, output, operations, etc The Healthcare Service Models are pre-built service interfaces and schemas that facilitate interoperability across diverse platforms for a specific industry. You can use the service interfaces and the associated schemas to create and assemble process implementations that can later be used as endpoints for process flow executions. The service interfaces are created based on Industry Best Practices and are packaged as SCA libraries which can be viewed in the IBM Integration Designer. Achieve component reuse using Healthcare Common Components Achieve component reuse using Healthcare Common Components Based on HL7 Reference Information Model, ASC X12 EDI for HIPAA and IBM Best Practices Tooling with IBM Integration Designer; Packaged as SCA Modules E.g. Generate HIPAA 275, EDI Validation Result Transformation, EDI Unbundling, EDI Bundling, EDI Validation, EDI Error Extractor, Image Transformation, EDI Debulking Developer Common Services & Utilities enable interoperability with the application ecosystem Pre-built implementation logic to allow custom implementation using configurations The Healthcare Common Components includes a set of Healthcare-specific common service definitions and implementations. The common services help achieve component reuse and serve as accelerators for BPM solutions, where you can use the provided implementations or customize their configurations to suit your application needs. The Common Components are based on HL7 Reference Information Model, ASC X12 EDI standards for HIPAA, and IBM Best Practices. In this release of the BPM Healthcare Pack, it has added support for HIPAA5010 standard implementation in the Bulking, De-bulking and Error Extractor Common Components. Also the Electronic Data Interchange (EDI) parser has been made available as a utility to be used while working with HIPAA EDI files. It contains the object model for EDI transactions that can be used to read or write an EDI file. The parser can be used in an application to parse an EDI Document and generate an in-memory EDI Object Model instance of claims and other healthcare transactions. These assets are packaged as SCA Modules that can be imported within IBM Integration Designer and then deployed onto the IBM Process Server runtime. The entire list of Common Components packaged with the BPM Healthcare Pack is available in the Information Center for BPM Industry Packs. Use Business Vocabulary to define Business Services and Policies Use Business Vocabulary to define Business Services and Policies Based on HL7 Data Dictionary, ASC X12 EDI for HIPAA and IBM Best Practices Tooling with WebSphere Business Services Fabric; Packaged as Fabric Content Archive E.g. Calendar Cycle, Probability Distribution Type, Country, State, Claim Information, Premium, Claims Status, Account Employee, Transmission, Act Developer Taxonomy of Healthcare business vocabulary terms Define roles, channels, policies, business concepts Taxonomy of Healthcare business vocabulary terms Define roles, channels, policies, business concepts The Healthcare Business Vocabulary is a taxonomy of business terms derived from various industry models and standards for the Healthcare industry. The Business Vocabulary provides the ability to interoperate between diverse systems in an enterprise through business services metadata such as roles, channels, assertions, and policies. The Business Vocabulary terms are based on the HL7 Reference Information Model (RIM) version 3, HL7 Vocabulary, ASC X12 EDI standards for HIPAA and the IBM Best Practices. These assets are packaged as Fabric Content Archives that can be imported and deployed within WebSphere Business Services Fabric administrative console. Implement Logical Data Model using Business Object Models Implement Logical Data Model using Business Object Models Based on HL7 Reference Information Model Tooling with Rational Software Architect; Packaged as Project Interchange File E.g. Personal Health Record, Clinical management, Claims management, etc Developer Conceptual Data Models to provide a foundation for information management Starting point for logical data model and physical data model The Healthcare Business Object Models are conceptual data models that provide the foundation for information management. You can implement a logical data model (LDM) and physical data model (PDM) using the Business Object Models. These assets are based on the HL7 RIM (Reference Information Model) standards. The HL7 RIM specifies the grammar of HL7 messages, the basic building blocks of the language, and their permitted relationships. The Healthcare Business Object Model is made available as a UML model that can be imported in a UML modeling tool such as Rational Software Architect. Healthcare pack V7.5 features Healthcare pack V7.5 features Section This section provides details of new features in healthcare pack V7.5 Healthcare Pack Features V7.5 Healthcare Pack Features V7.5 Feature Healthcare Pack 7.0 Healthcare Pack 7.0 Healthcare Pack 7.5 Healthcare Pack 7.5 Capability Models Process Maps are mapped as sub capabilities level3 onwards. Process Models New models for Process Designer Service Models Business Object Models Common Components Enhanced support for HIPAA 5010 and ICD-10. Solution Scenarios Benefit and Eligibility Updated for Express, Standard, and Advanced editions, including: Process Flows Coach Flows Scorecards / KPIs Integration Services Dynamic Service Selection and Business Vocabulary Dynamic Assembler 2 New options: Integration Designer + Decision Service Process Designer + Decision Service Fabric vocabulary only needed for Fabric-based Dynamic Service Selection Key: Available Capability preserved but accomplished differently A comparison of the assets and the features provided in the previous release and the current V7.5 is shown in a tabular format. Capability Model - Updates Capability Model - Updates In the previous release of the BPM Healthcare pack, processes and sub processes were part of process maps, which were mapped to capability maps. In this release, these processes and sub processes have been moved such that they form the next level of sub capabilities in an existing capability map. As shown here the Claims Handling Processes is now a sub-capability under Claims Handling. Healthcare Pack Toolkits Healthcare Pack Toolkits Benefits Eligibility Healthcare Common Toolkit Process Apps Dependency This toolkit contain Business Process Definitions (BPDs) Approach: There are separate toolkits per function/subject area. A common toolkit is available for all variable types, roles and so on Member and Sponsor Management Claims Management User Specific Solution This toolkit contains Variable Types, Participant groups, Integration Services, Common utilities (such as jar files, CSS, …) instantiates The Healthcare Process Models are modeled as Business Process Definitions (BPDs) inside the IBM Process Designer. Each of the BPDs related to a specific focus area are packaged as part of the Toolkits. The Healthcare Process Models include the Member and Sponsor Management and Claims Management Toolkits. The Healthcare Common toolkit contains reusable assets like Variable Types, Participant Groups, Integration Services and common utilities like jar files, css and so on. Customer can use these toolkits as dependent project or can create new process applications using assets defined in toolkits. Electronic Data Interchange (EDI) Parser Electronic Data Interchange (EDI) Parser EDI Interchange 4010 EDI Object Model Version? 5010 EDI Object Model 4050 EDI Object Model HIPAA EDI Parser type? 270 Document Object 271 Document Object 837i Document Object 837p Document Object type? 270 Document Object 271 Document Object 837i Document Object 837p Document Object type? 275 Document Object In this release the Electronic Data Interchange (EDI) parser has been made available as a utility which can be used for working with HIPAA EDI files. It contains the object model for EDI transactions that can be used to read or write an EDI file. The parser can be used in an application to parse an EDI Document and generate an in-memory EDI Object Model instance of claims and other healthcare transactions. The table shown here provides information about the supported HIPAA versions for each HIPAA documents/transactions. HIPAA5010 Implementation Support for Existing EDI based Common Components HIPAA5010 Implementation Support for Existing EDI based Common Components EDI Bulking This service provides the necessary interface and implementation for bulking the multiple HIPAA EDI transaction sets into one EDI file. EDI Debulking This service provides the necessary interface and implementation for debulking the HIPAA EDI transaction sets to multiple EDI files. EDI Error Extractor This service provides the necessary interface and implementation for removal of the erroneous requests from the original request. In this release of the BPM Healthcare Pack, it has added support for HIPAA5010 standard implementation in the existing EDI based common components like Bulking, De-bulking and Error Extractor. ICD 9/10 Conversion Common Components ICD 9/10 Conversion Common Components ICD stands for International Classification of Diseases What is this feature? ICD Report Generator Common Service added for extracting ICD and EDI Transaction related information from the incoming EDI Message ICD Code Updation Common Service added for the updation of ICD 9 or ICD 10 Codes within the EDI transaction based on the Analysis Result Why have this enhancement? These services will participate as part of integration or crosswalk solution. The EDI document is intercepted and updated with appropriate version of ICD code supported by backend systems. Customer Scenario ICD Common Services can be used as part of a solution that is targeted to solve the ICD code version compliance problem which is common in US healthcare market currently before all healthcare proxies and transactions are mandated to use ICD version 10. International Statistical Classification of Diseases and Related Health Problems (ICD) is an international coding system that is used to record medical diagnoses and hospital inpatient procedures. To help industry users with this transition from ICD-9 to ICD-10, several vendors are providing custom solutions. These two ICD common services can participate in development of such solutions keeping the effort of working with EDI file separate from the actual augmentation of the code. Summary and References Summary and References Section This section provides summary about different assets and new features of BPM Healthcare Pack V7.5 Goals and Agenda Goals and Agenda Summary Learned about different industry standards that are supported by BPM Healthcare pack Provided details of healthcare-specific assets Capability models Process models Service models Common components Business vocabulary Business objects models Learned about new features and enhancements in V7.5 References Industry Packs information center V7.5 http://publib.boulder.ibm.com/infocenter/dmndhelp/v7r5mx/index.jsp?topic=/com.ibm.ws.wicp.icmaster.doc/ic-homepage.html In summary, you have learned about different standards and assets that are supported by BPM Healthcare Pack V7.5. You have also learned about new features in Healthcare pack V7.5 Feedback Feedback Your feedback is valuable You can help improve the quality of IBM Education Assistant content to better meet your needs by providing feedback. 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