CMS has published a final rule (http://federalregister.gov/a/2015-14005) focused on changes to the Medicare Shared Savings Program (MSSP) which impacts Accountable Care Organizations (ACO) significantly. There are a variety of interesting changes being made to the program. For this discussion I’m looking at CMS’ continual drive toward data use and integration as a basis for improving quality of care, gaining efficiency and cutting costs in health care. One way this drive is manifested in the new rule regards an ACO’s plans as related to “enabling technologies,” which is an umbrella term for leveraging electronic data.

As background, Subpart B (425.100 to 425.114) of the MSSP describes ACO eligibility requirements. Two of the changes in this section clearly underscore the importance of electronic data and data integration to the fundamental operation of an ACO. Specifically, looking at page 127, the following updates are being made to section 425.112(b)(4) (emphasis mine):

Therefore, we proposed to add a new requirement to the eligibility requirements under § 425.112(b)(4)(ii)(C) which would require an ACO to describe in its application how it will encourage and promote the use of enabling technologies for improving care coordination for beneficiaries. Such enabling technologies and services may include electronic health records and other health IT tools (such as population health management and data aggregation and analytic tools), telehealth services (including remote patient monitoring), health information exchange services, or other electronic tools to engage patients in their care.

It goes on to add:

Finally, we proposed to add a provision under § 425.112(b)(4)(ii)(E) to require that an ACO define and submit major milestones or performance targets it will use in each performance year to assess the progress of its ACO participants in implementing the elements required under § 425.112(b)(4). For instance, providers would be required to submit milestones and targets such as: projected dates for implementation of an electronic quality reporting infrastructure for participants;

It is clear from the first change that an ACO must have a documented plan in place for continually expanding its use of electronic data and providing data visibility and integration between itself and its beneficiaries and providers. This is a tall order. The number of different systems and data formats along with myriad reporting and analytic platforms makes a traditional integration approach tedious at best and a significant business risk at worst.

The second change, keeping CMS apprised of the progress of data-centric projects, is clearly intended to keep the attention on these data publishing and integration projects. It won’t be enough to have a well-articulated plan, the ACO must be able to demonstrate progress on a regular basis.

(more…)

This week I had the opportunity to attend the Medicaid Managed Care Congress (MMCC) in Baltimore, MD and the privilege of speaking with a variety of leaders from provider, payer, and services organizations. With me from Blue Slate Solutions were Scott Van Buren and Chris Garber. A common theme we heard as we spoke with the attendees was the challenge of bringing data together from multiple sources and making sense of that information.

Medicaid is potentially the most complex government program that exists in the United States. There are federal and state aspects as well as portions that are handled at a local level. Some funding and services are defined as required while others are optional. The financial models’ formulas involve many variables. In short, there are numerous challenges in Medicaid, including the dual eligible changes that seek to address the services disconnects that often exist when a person is eligible for both Medicare and Medicaid.

Combining data from providers, payers, patients, government entities and the community are all necessary in order to optimize the quality of care that is provided to each patient. The definition of provider continues to expand, covering not just the medical needs of a person but incorporating the various social services, so important to the holistic care of an individual, under the umbrella of “provider.”

As we listened to people and talked about their data challenges we were also able to walk them through the Data Unleashed™ approach. The iterative learn-as-you-go process resonated across the board, whether people represented patient advocacy groups, provider organizations or healthcare plans. The capability to start small, obtain value quickly and adapt rapidly to changing environments fits the Medicaid complexities well.

If you would like to learn more about our agile and lightweight approach to accessing data from across your enterprise in order to quickly begin creating meaningful reporting and analytics, please check out dataunleashed.com for descriptions, videos and case studies. We’d also appreciate the opportunity to host a webinar with your team where we can explore Data Unleashed™ in more depth and discuss your specific data challenges.

That is a very dangerous question for a leader to ask when evaluating options. Yet it is one I hear far too often in the healthcare realm. It encapsulates a rejection of innovation, evolution and learning all in one terse, often rhetorical, question.

A common context for this question, often prefixed by, “If this is so great…,” is when discussing semantics and semantic technology. Although these concepts are not new to some industries, such as media, they are foreign in many healthcare organizations. Yet we know that healthcare payers and providers alike struggle with massive data integration and data analytics challenges just like media conglomerates.

The needs to: combine siloed information; drive an analytics mindset throughout an organization; and support the flexibility of a constantly changing IT environment are common in large healthcare organizations. Repeated attempts by organizations to meet these needs betray a lack of consensus around how to best achieve a valuable result.

Further, the implication that how most organizations solve a problem is optimal ignores the fact that best practices must change over time. The best way to solve a problem last year may not be the same this year. The healthcare industry is changing, the physical world of servers, networks, disk drives, memory is changing, and the expectations of members are changing. What was infeasible years ago becomes commonplace. Relational databases were all but unworkable in the 1970s due to a lack of experienced DBAs, slow disk drives, slow processors and limited memory.

In the same way, semantic formalization and graph databases were too new and limited to deal with large data sets until people gained expertise with ontologies while system hardware benefitted from another generation of Moore’s law. In the face of ongoing innovation, the question leaders should ask when approaching a challenge is, “What advancements have been made since the last time we looked at this problem?”

Leadership requires leading, not following. Leaders mentor their organizations through change in order to reach new levels of success. Leadership is based on learning, open-mindedness, creativity and risk-taking. The question, “Why isn’t everybody doing it?” is the antithesis of leadership and has no place there. In fact, if everybody is doing something, a leader would be better off asking, “How do we get ahead of what everybody is doing?”

Leaders must be on the forefront of pushing for better, faster, cheaper. Questioning the status quo, looking for new opportunities, seeking to leapfrog the competition, those are key foci for leadership.

As a leader, the next time you find yourself limiting your willingness to explore an option because everybody isn’t doing it, keep in mind that calculators, computers, automobiles, elevators, white boards, LED light bulbs, Google maps, telephones, the Internet, 3-D printing, open heart surgery, and many more concepts that are accepted or gaining traction, had a day when only one person or organization was “doing it.” Challenge yourself and your organization to find new options, new best practices and new paradigms for advancing your strategy and goals.

I routinely receive emails, tweets and snail mail from IT vendors that focus on how their solution accelerates the creation of business applications. They will quote executives and technology leaders, citing case studies that compare the time to build an application on their platform versus others. They will make the claim that this speed to release proves that their platform, tool or solution is “better” than the competition. Further, they claim that it will provide similar value for my business’ application needs. The focus of these advertisements is consistently, “how long did it take to initially create some application.”

This speed-to-create metric is pointless for a couple of reasons. First, an experienced developer will be fast when throwing together a solution using his or her preferred tools. Second, an application spends years in maintenance versus the time spent to build its first version.

Build it fast!

Years ago I built applications for GE in C. I was fast. Once I had a good set of libraries, I could build applications for turbine parts catalogs in days. This was before windowing operating systems. There were frameworks from companies like Borland that made it trivial to create an interactive interface. I moved on to Visual Basic and SQLWindows development and was equally fast at creating client-server applications for GE’s field engineering team. I progressed to C++ and created CGI-based web applications. Again, building and deploying applications in days. Java followed, and I created and deployed applications using the leading edge Netscape browser and Java Applets in days and eventually hours for trivial interfaces.

Since 2000 I’ve used BPM and BRM platforms such as PegaRULES, Corticon, Appian and ILOG. I’ve developed applications using frameworks like Struts, JSF, Spring, Hibernate and the list goes on. Through all of this, I’ve lived the euphoria of the initial release and the pain of refactoring for release 2. In my experience not one of these platforms has simplified the refactoring of a weak design without a significant investment of time.

Speed to initial release is not a meaningful measure of a platform’s ability to support business agility. There is little pain in version 1 regardless of the design thought that goes into it. Agility is about versions 2 and beyond. Specifically, we need to understand what planning and practices during prior versions is necessary to promote agility in future versions.

(more…)

There has been a lot of information flying about on the Internet concerning the Heartbleed vulnerability in the OpenSSL library. Among system administrators and software developers there is a good understanding of exactly what happened, the potential data losses and proper mitigation processes. However, I’ve seen some inaccurate descriptions and discussion in less technical settings.

I thought I would attempt to explain the Heartbleed issue at a high level without focusing on the implementation details. My goal is to help IT and business leaders understand a little bit about how the vulnerability is exploited, why it puts sensitive information at risk and how this relates to their own software development shops.

Heartbleed is a good case study for developers who don’t always worry about data security, feeling that attacks are hard and vulnerabilities are rare. This should serve as a wake-up-call that programs need to be tested in two ways – for use cases and misuse cases. We often focus on use cases, “does the program do what we want it to do?” Less frequently do we test for misuse cases, “does the program do things we don’t want it to do?” We need to do more of the latter.

I’ve created a 10 minute video to walk through Heartbleed. It includes the parable of a “trusting change machine.” The parable is meant to explain the Heartbleed mechanics without requiring that the viewer be an expert in programming or data encryption.

If you have thoughts about ways to clarify concepts like Heartbleed to a wider audience, please feel free to comment. Data security requires cooperation throughout an organization. Effective and accurate communication is vital to achieving that cooperation.

Here are the links mentioned in the video:

• SANS Internet Storm Center: https://isc.sans.edu/
• SANS Webcast on Heartbleed: http://digital-forensics.sans.org/blog/2014/04/10/heartbleed-links-simulcast-etc
• Blue Slate’s Business Security Brief on Heartbleed (Video): http://www.blueslate.net/Dave/BusinessSecurityBrief/20140412-Heartbleed/
• OWASP Top 10 Web Vulnerabilities List: https://www.owasp.org/index.php/Category:OWASP_Top_Ten_Project

Data Unleashed™. The name expresses a vision of data freed from its shackles so that it can be quickly and iteratively accessed, related, studied and expanded. In order to achieve that vision, the process of combining, or federating, the data must be lightweight. That is, the approach must facilitate rapid data set expansion and on-the-fly relationship changes so that we may quickly derive insights. Conversely, the process must not include a significant investment in data structure design since agility requires that we avoid a rigid structure.

Over the past year Blue Slate Solutions has been advancing its processes and technology to support this vision, which comprises the integration between components in our Cognitive Corporation® framework. More recently we have invested in an innovation development project to take our data integration experiences and semantic technology expertise and create a service offering backed by a lightweight data federation platform. Our platform, Data Unleashed™, enables us to partner with customers who are seeking an agile, lightweight enhancement to traditional data warehousing.

I want to emphasize that we believe that the Data Unleashed™ approach to data federation works in tandem with traditional Data Warehouses (DW) and other well-defined data federation options. It offers agility around data federation, benefiting focused data needs for which warehouses are overkill while supporting a process for iteratively deriving value using a lightweight data warehouse™ approach that informs a broader warehousing solution.

At a couple of points below I emphasize differences between Data Unleashed™ and a traditional DW. This is not meant to disparage the value of a DW but to explain why we feel that Data Unleashed™ adds a set of data federation capabilities to those of the DW.

As an aside, Blue Slate is producing a set of videos specifically about semantic technology, which is a core component of Data Unleashed™. The video series, “Semantic Technology, An Enterprise Introduction,” will be organized in two tracks, business-centric and technology-centric. Our purpose in creating these is to promote a holistic understanding of the value that semantics brings to an organization. The initial video provides an overview of the series.

What is Data Unleashed™ All About?

Data Unleashed™ is based on four key premises:

1. the variety of data and data sources that are valuable to a business continue to grow;
2. only a subset of the available data is valuable for a specific reporting or analytic need;
3. integration and federation of data must be based on meaning in order to support new insights and understanding; and
4. lightweight data federation, which supports rapid feedback regarding data value, quality and relationships speeds the process of developing a valuable data set.

I’ll briefly describe our thinking around each of these points. Future posts will go into more depth about Data Unleashed™ as well. In addition, several Blue Slate leaders will be posting their thoughts about this offering and platform.

(more…)

At this year’s Semantic Technology and Business Conference in San Francisco, Mike Delaney and I presented a session discussing Semantic Technology adoption in the enterprise entitled, When to Consider Semantic Technology for Your Enterprise. Our focus in the talk was centered on 3 key messages: 1) describe semantic technology as it relates to enterprise data and applications; 2) discuss where semantic technology augments current data persistence and access technologies; and 3) highlight situations that should lead an enterprise to begin using semantic technology as part of their enterprise architecture.

In order to allow a broader audience to benefit from our session we are creating a set of videos based on our original presentation. These are being released as part of Blue Slate Solutions’ Experts Exchange Series.  Each video will be 5 to 10 minutes in length and will focus on one of the sub-topics from the presentation.

Here is the overall agenda for the video series:

We’ll release a couple of videos every other week so be on the lookout during July and August for this series to be completed. We would appreciate your feedback on the information as well as hearing about your experiences deploying semantic technology as part of an enterprise’s application architecture.

The playlist for the series is located at: http://www.youtube.com/playlist?list=PLyQYGnkKpiugIl0Tz0_ZlmeFhbWQ4XE1I The playlist will be updated with the new videos as they are released.

When depicting the Cognitive Corporation™ as a graphic, the use of semantic technology is not highlighted.  Semantic technology serves two key roles in the Cognitive Corporation™ – data storage (part of Know) and data integration, which connects all of the concepts.  I’ll explore the integration role since it is a vital part of supporting a learning organization.

In my last post I talked about the fact that integration between components has to be based on the meaning of the data, not simply passing compatible data types between systems.  Semantic technology supports this need through its design.  What key capabilities does semantic technology offer in support of integration?  Here I’ll highlight a few.

Logical and Physical Structures are (largely) Separate

Semantic technology reduces the tie between the logical and physical structures of the data versus a relational database.  In a relational database it is the physical structure (columns and tables) along with the foreign keys that maintain the relationships in the data.  Just think back to relational database design class, in a normalized database all of the column values are related to the table’s key.

This tight tie between data relationships (logical) and data structure (physical) imposes a steep cost if a different set of logical data relationships is desired.  Traditionally, we create data marts and data warehouses to allow us to represent multiple logical data relationships.  These are copies of the data with differing physical structures and foreign key relationships.  We may need these new structures to allow us to report differently on our data or to integrate with different systems which need the altered logical representations.

With semantic data we can take a physical representation of the data (our triples) and apply different logical representations in the form of ontologies.  To be fair, the physical structure (subject->predicate->object) forces certain constrains on the ontology but a logical transformation is far simpler than a physical one even with such constraints.

(more…)

I am excited to share the news that Blue Slate Solutions has kicked off a formal innovation program, creating a lab environment which will leverage the Cognitive Corporation™ framework and apply it to a suite of processes, tools and techniques.  The lab will use a broad set of enterprise technologies, applying the learning organization concepts implicit in the Cognitive Corporation’s™ feedback loop.

I’ve blogged a couple of times (see references at the end of this blog entry) about the Cognitive Corporation™.  The depiction has changed slightly but the fundamentals of the framework are unchanged.

The focus is to create a learning enterprise, where the learning is built into the system integrations and interactions. Enterprises have been investing in these individual components for several years; however they have not truly been integrating them in a way to promote learning.

By “integrating” I mean allowing the system to understand the meaning of the data being passed between them.  Creating a screen in a workflow (BPM) system that presents data from a database to a user is not “integration” in my opinion.  It is simply passing data around.  This prevents the enterprise ecosystem (all the components) from working together and collectively learning.

I liken such connections to my taking a hand-written note in a foreign language, which I don’t understand, and typing the text into an email for someone who does understand the original language.  Sure, the recipient can read it, but I, representing the workflow tool passing the information from database (note) to screen (email) in this case, have no idea what the data means and cannot possibly participate in learning from it.  Integration requires understanding.  Understanding requires defined and agreed-upon semantics.

This is just one of the Cognitive Corporation™ concepts that we will be exploring in the lab environment.  We will also be looking at the value of these technologies within different horizontal and vertical domains.  Given our expertise in healthcare, finance and insurance, our team is well positioned to use the lab to explore the use of learning BPM in many contexts.

(more…)

I had the pleasure of attending the Semantic Technology and Business Conference in Washington, DC last week.  I have a strong interest in semantic technology and its capabilities to enhance the way in which we leverage information systems.  There was a good selection of topics discussed by people with a variety of  backgrounds working in different verticals.

To begin the conference I attended the half day “Ontology 101” presented by Elisa Kendall and Deborah McGuinness.  They indicated that this presentation has been given at each semantic technology conference and the interest is still strong.  The implication being that new people continue to want to understand this art.

Their material was very useful and if you are someone looking to get a grounding in ontologies (what are they?  how do you go about creating them?) I recommend attending this session the next time it is offered.  Both leaders clearly have deep experience and expertise in this field.  Also, the discussion was not tied to a technology (e.g. RDF) so it was applicable regardless of underlying implementation details.

I wrapped up the first day with Richard Ordowich who discussed the process of reverse engineering semantics (meaning) from legacy data.  The goal of such projects being to achieve a data harmonization of information across the enterprise.

A point he stressed was that a business really needs to be ready to start such a journey.  This type of work is very hard and very time consuming.  It requires an enterprise wide discipline.  He suggests that before working with a company on such an initiative one should ask for examples of prior enterprise program success (e.g. something like BPM, SDLC).

Fundamentally, a project that seeks to harmonize the meaning of data across an enterprise requires organization readiness to go beyond project execution.  The enterprise must put effective governance in place to operate and maintain the resulting ontologies, taxonomies and metadata.

The full conference kicked off the following day.  One aspect that jumped out for me was that a lot of the presentations dealt with government-related projects.  This could have been a side-effect of the conference being held in Washington, DC but I think it is more indicative that spending in this technology is more heavily weighted to public rather than private industry.

Being government-centric I found any claims of “value” suspect.  A project can be valuable, or show value, without being cost effective.  Commercial businesses have gone bankrupt even though they delivered value to their customers.  More exposure of positive-ROI commercial projects will be important to help accelerate the adoption of these technologies.

Other than the financial aspect, the presentations were incredibly valuable in terms of presenting lessons learned, best practices and in-depth tool discussions.  I’ll highlight a few of the sessions and key thoughts that I believe will assist as we continue to apply semantic technology to business system challenges.

(more…)