1. North Carolina Public Health Information Network
PHIN Conference Best Practices and Lessons Learned in NC PHIN Systems Integration
Presenter: John McLamb, MSIA Presentation ID: Monday, August 25, 2008: 10:30 AM International Room B
NC PHIN
North Carolina Public Health Information Network

2. Interoperability & Data Sharing: Best Practices & Lessons Learned
John McLamb, MSIA, PHDM
Topics
IT & Data Governance
Architecture Framework
NC PHIN Interoperability “Best Practices” and “Lessons Learned”
Thank you very much Awal and thank you CDC for allowing me to share with other PHIN stakeholders important best practices and ideas for PHIN 2.0 implementation and compliance. Also, I’d like to invite all of you to provide some constructive feedback on the topics presented today for developing a public health common tool set of methods and measurements that we all can share. This toolset will be very valuable for public health stakeholders and data sharing initiatives.
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North Carolina Public Health Information Network

3. What is IT/Data Governance?
“READY….FIRE…. AIM”
Greek word “to steer”
“The leadership and organizational structures and processes that ensure that the organization’s IT sustains and extends the organization's strategies and objectives.” IT Governance Institute
“The system by which the current and future use of IT is directed and controlled….includes the strategy and policies for using IT within an organization.” Australian Standard for Corporate Governance of IT
In the past, many organizations, including public health, approach IT projects with a “READY….FIRE…..AIM” scenario.
Here are some commonly accepted definitions of governance.
In this presentation I will be talking about how public health should setup the organizational structures to align IT to public health processes, not the other way around
the product of Information Technology is DATA to meet the goals and objectives defined by the public health enterprise. In the context of this session, I will focus of governance of IT and data as it applies to interoperability with internal and external partners of public health So, what is data or IT governance? Data governance is actually a fairly new discipline that has emerged to overcome the chaos resulting from new technology and bridge the gap from organizational stovepipes that have emerged. .
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4. North Carolina Public Health Information Network
Whom Does IT / Data Governance Concern?
Whom does IT Governance concern? All Public Health Stakeholders
Who is Responsible for IT Governance?
Management and those with decision making authority
Best Practice:
Senior management should put organizational structures in place
Roles and responsibilities must be defined
Program / unit managers should take an active role in IT strategy, steering or similar committees
Public health CIOs or IT directors must be public health program-oriented and provide a bridge between IT and the public health programs
All public health stakeholders are effected by IT and Data Governance today. This includes:
The public health stakeholders and its partners both internal and external
Public / citizens served
Tax payers
Since IT is so pervasive throughout the public health departments, programs and user groups, governance or the lack of it will effect almost all public health stakeholders. Executive, senior level management and those with decision making authority are responsible for governance. There are also increasing calls from various compliancy other authorities for a broader governance role during audits to assure that there are appropriate and effective processes to:
monitor risk
Ensure internal controls are effective in reducing those risks to an acceptable level
It is important for executive and senior management to take charge and lead IT and Data governance public health initiatives to set direction and ensure goals for IT alignment strategies. .
It is critical for the roles and responsibilities for IT governance be defined.
While Data and IT governance is the responsibility of executive and board members, governance at the highest level, governance activities must flow through the various levels of the public health enterprise. As a result, good practices in IT governance need to be applied throughout the public health enterprise and especially between the IT functions and the program units. The program units have a responsibility to work in partnership with IT to ensure that their business requirements are met. To help enable this:
• Senior management should provide organizational structures to support the implementation of IT strategy.
• Public health CIOs/IT Directors must be public health program-oriented and provide a bridge between IT and the public health programs.
• All executives should become involved in IT steering or similar committees.
Those involved in Data and IT governance activities should engage in a cooperative manner. However, due to complexity and specialization, the board and executive managers must set direction and insist on control, while relying on the lower management layers in the enterprise to provide the information required in decision-making and evaluation activities.
To have effective IT governance in the enterprise, the lower layers need to apply the same principles of setting objectives, providing and getting
direction, and providing and evaluating performance measures
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5. Why is IT Governance Important?
Primary Importance
Delivers value: Strategic alignment of IT
Risks are mitigated: Embeds accountability into IT
Value Added
Enabling public health goals
Planning growth
Ensuring goals
Using IT resources responsibility
Maximizing efficiency
Providing strategic direction
Risks Mitigated
Reducing negative experiences
IT accountability
Managing risks
Providing due diligence
With IT now so essential and pervasive within public health, management needs to pay special attention to IT and data, assessing how strongly public health relies on IT and how critical IT is for the execution of the strategy to meet public health goals and objectives, since:
• IT and data are critical in supporting and enabling goals.
• IT and data are strategic to the new public health activity needs and interoperability
IT and data are essential for efficiency and cost savings
• Due diligence is increasingly required that are relative to the IT
Ineffective IT governance is likely to be a root cause of the negative experiences many public health organizations have had with IT:
• Financial losses and damaged reputations
• Deadlines not met, costs higher than expected and quality lower than anticipated
• Public health efficiency and core processes negatively impacted by poor quality of IT deliverables
• Failures of IT initiatives to bring innovation or deliver the promised benefits
Talking Points:
Without proper IT governance system develop becomes a “Ready, Fire, Aim” scenario.
Information Technology is only recently focused on governance. Because of the lack of governance, many organizations, including public health enterprises have become aligned with IT, instead of the desired outcome of IT aligned with the Public Health.
In other words, Conformance and Performance.
But, successful public health IT governance must properly balance conformance and performance to be successful.
While no governance creates chaos, ineffective or too much can create excessive work and inefficiencies that distract the project team from tangible results
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6. Public Health Stakeholder Value
How is Governance Implemented?
Identify Focus Areas of IT / Data Governance
Resource
Management IT
Value
Delivery
Public Health Stakeholder Value
Drivers
Risk
Management IT
Strategy
Alignment
The IT Governance Institute defines five main focus areas for IT governance, all driven by the values held by stakeholder. I’ve research some other IT industry resources that have defined more areas but are basically a more detailed breakdown of these five. For simplicity sake, we use these areas to address public health IT / Data Governance for now.
According to the IT Governance Institute, Fundamentally, IT governance is concerned about two things which are also outcomes in blue:
Value Delivered by IT
Risk Mitigation or Management
Value delivery- is optimizing expenses and proving the value provided by IT
Risk management – addressing the safeguarding of IT assets, disaster recovery and continuity of operations
The other areas in yellow are all drivers for those two outcome areas.
3. strategic alignment – focuses on aligning IT with the business and collaborative solutions
4. resource management – optimizing data, information and IT infrastructure (overlays all areas)
5. performance measurement – tracking project delivery and monitoring IT services and operations
So, once the stakeholders’ values, goals, objectives have been defined, then an IT strategy developed. IT value delivery is driven by the IT strategic alignment. Risk Mitigation or Management is driven by embedding accountability into IT initiatives to deliver the value. Both the IT Value Initiatives and Risk Management need to be supported by adequate resources and measured to ensure that the results are obtained.
Performance Measurement
IT Governance Institute 2003
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North Carolina Public Health Information Network

7. Stakeholder Objectives / Value Drivers
How is Governance Implemented?
Best Practice: IT Governance Process Life Cycle IT
Processes
Use & Measure
Directs
Resources
Knowledge
Compatibility
Information
Stakeholder Objectives / Value Drivers IT
Strategy
Improves
Reports
Drive
IT governance is also a continuous life cycle, which can be entered at any point. Usually one starts with the strategy and its alignment throughout the enterprise. Then implementation occurs, delivering the value the strategy promised and addressing the risks that need mitigation. At regular intervals (some recommend continuously) the strategy needs to be monitored and the results measured, reported and acted upon. Generally on an annual basis, the strategy is reevaluated and realigned, if needed.
This life cycle is driven by:
• Stakeholder values
• The mission, vision and values of the public health organization
• Applicable laws, regulations and policies (i.e., PHIN, NHIN, HITSP, HIPAA, etc.)
Best Practices
IT governance is also a process in which the IT strategy directs the IT processes, which obtain resources necessary to execute their responsibilities.
The IT processes report against these responsibilities on process outcome, performance, risks mitigated and accepted, and resources consumed. These
reports should either confirm that the strategy is properly executed or provide indications that strategic redirection is required.
Confirm or Change
Results
Outcomes
Performance
Risk
Assets
“IT alignment is a journey, not a destination”
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North Carolina Public Health Information Network
IT Governance Institute 2003

8. Conclusions: IT/Data Governance Best Practices
IT/Data Governance should be Integrated with the Public Health Governance Program
IT Governance Roles and Responsibilities Need to be Defined
The IT/Data Governance Life Cycle
Set up a governance organizational framework
Align IT strategy with Public Health Goals
Understand / define the risks
Define target areas
Assess capabilities and identify gaps
Develop improvement strategies
Measure results
Repeat steps 2-7 on a regular basis
10.1 IT Governance Should Be Integrated within Enterprise Governance
An IT governance framework helps boards and management understand the issues and strategic importance of IT, and assists in ensuring that the
enterprise can sustain its operations and implement the strategies required to extend its activities into the future. It provides assurance that expectations for
IT are met and IT risks are addressed.
IT governance fits in the broader governance arrangements that cover relationships between the entity’s management and its governing body, its
owners and its other stakeholders. It provides the structure through which the entity’s overall objectives are set, the method of attaining those objectives is outlined and the manner in which performance will be monitored is described.
In summary, IT governance ensures that IT goals are met and IT risks are mitigated such that IT delivers value to sustain and grow the enterprise. IT governance drives strategic alignment between IT and the business and must judiciously measure performance.
IT is an integral part of the business. IT governance is an integral part of enterprise governance.
10.2 IT Governance Roles and Responsibilities Need to be Defined
This document extensively points out the responsibilities of the board, executive and IT strategy committee. Appendix F (IT Strategy Committee),
which further documents the workings of the IT strategy committee, also covers the IT steering committee, which operates at executive level and
usually focuses on priority setting, resource allocation and project tracking. A more complete picture of the roles of the business and IT executives, and
for the two other committees that typically support the CEO and the CIO in setting and controlling technology (technology council) and architecture
standards (architecture review board), is provided in appendix E, Roles and Responsibilities for IT Governance. These two committees drive the standardisation, reuse and optimisation of IT resources. Together with the IT strategy and IT steering committees, they complete the emerging best practice of a three-tier IT governance structure: strategy, steering and standards.
The addendum slides in this presentation provides an overview of roles and responsibilities for board of directors, IT strategy committee, CEO, business executives, CIO, IT steering committee, technology council and architecture review board, defined for each of the five IT governance domains. These suggested roles and responsibilities are best practices as defined by the IT Governance Institute.
10.3 An IT Governance Implementation Plan Is Required
To get its IT governance initiatives headed in the right direction, the public health organization needs an effective action plan that suits its particular
circumstances and needs. First, it is important for the senior executive management to take ownership of IT governance and set the direction other management levels should follow. • Making sure IT is on the board agenda
• Challenging management’s activities with regard to IT, to make sure IT issues are uncovered
• Guiding management by helping it to align IT initiatives with real public health needs, and ensuring that it appreciates the potential impact on the business of IT-related risks
• Insisting that IT performance be measured and reported to the board
• Establishing an IT strategy committee with responsibility for communicating IT issues between the board and management
• Insisting that there be a management framework for IT governance based on a common approach (hopefully the toolset develop by PHIN partners based on industry best practices) With this mandate and direction in place, management then can initiate and put into action an IT governance approach. To help management decide where to begin and to ensure that the IT governance process delivers positive results where they are needed most, the following steps are suggested:
1. Set up a governance organizational framework that will take IT governance forward and own it as an initiative, with clear responsibilities
and objectives and participation from all interested parties.
Align IT strategy with business goals. What are the current business concerns and issues where IT has a significant influence, e.g., cost
reduction, competitive advantage and/or merger/acquisition? Obtain a good understanding of the business environment, risk appetite and business strategy as they relate to IT. Identify the top IT issues on management’s agenda.
3. Understand/define the risks. Given top management’s business concerns, what are the risk indicators relating to IT’s ability to deliver against these concerns? Consider:
– Previous history and patterns of performance
– Current IT organizational factors
– Complexity and size/scope of the existing or planned IT environment
– Inherent vulnerability of the current and planned IT environment
– Nature of the IT initiatives being considered, e.g., new systems projects, outsourcing considerations, architectural changes
4. Define target areas. Identify the process areas in IT that are critical to managing these risk areas.
5. Analyze current capability and identify gaps. Perform a maturity capability assessment to find out where improvements are needed most.
6. Develop improvement strategies. Decide which are the highest priority projects that will help improve the management and governance
of these significant areas. This decision should be based on most potential benefit and ease of implementation, and a focus on important
IT processes and core competencies. Define specific IT governance projects as the first step in the IT governance continuous improvement
initiative.
7. Measure results. Establish a balanced scorecard mechanism for measuring current performance. Monitor the results of new
improvements considering, as a minimum, the following key considerations:
– Will the organizational structures support strategy implementation?
– Are responsibilities for risk management embedded in the organisation?
– Do infrastructures exist that will facilitate and support the creation
and sharing of vital business information?
– Have strategies and goals been communicated effectively to everyone
who needs to know within the organization?
8. Repeat steps 2-7 on a regular basis.
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9. Architecture Framework
A second important topic of my presentation that is very important for PHIN 2.0, interoperability and sharing data is on Architecture Frameworks. Before I address architecture frameworks I think it is important to understand exactly what is meant by an architecture or enterprise architecture (EA).
An enterprise architecture is:
Translation of pubic health vision and strategy
a process AND a thing
The “thing” is a product and strategic information asset that defines the organization mission and goals and activities supporting the mission and goals. The EA provides graphical and textual information and descriptions necessary for business processes and the technologies necessary to support processes.
EA are becoming increasing important due to the complexity of real time data systems and interoperability demands.
EA are key to communicating to stakeholders the business processes and systems that support them
EA are critical to management and strategic decision making.
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10. Architecture Framework
What:
A logical structure for classifying and organizing complex information
Established frameworks: Zachman, DoDAF, FEAF, TEAF, TOGAF
Purpose:
Integrated view of PH business processes and IT systems that support them
Guide for managing architecture activities
Why:
Guiding architecture development
Managing the architecture artifacts/assets
Aligning IT with public health goals
An architectural framework is a logical structure for classifying and organizing complex information. Just as Enterprise Architectures describe complex business processes and information systems and their relationships, the Architecture Framework guides development of the architecture and describes the hardware, network and software operational and development environments representing those components through different views.
An Architecture Framework defines how to organize the architecture products and provides different views to help understand organizations that tend to be large and complex. Just as in building a house, different views or blueprints are required for the owners, designers, plumbers, electricians, etc.
A framework is essential in building an enterprise architecture to provide a structure for producing an architecture and managing the architecture assets.
There are a number of already established frameworks in use today, some were developed for very specific areas. Some were developed for a broader functionality. In this presentation I will use the NC PHIN Architecture Framework that is being developed from these establish architectures to best fit our organization. I hope this presentation will facilitate interest and feedback for a common public health architecture and participation in the PHIN Architecture CoP.
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North Carolina Public Health Information Network

11. Architecture Framework OverviewEA
Accomplishments
Direction
Description
VIEWS
DRIVERS
Policies
Legislation
Roadmaps
Program Goals
Measure
Standards
(PHIN 2.0, HL7, NIST,
HITSP, HIPPA, etc.)
Functional
Information
Organization
Infrastructure
Planner
Owner
Designer
Builder
Work
Products
Work Products
Perspectives
This is the framework NC PHIN is analyzing for use. It is primarily based on the TEAF. (Treasury Enterprise Architecture Framework)
A primary reason for selecting TEAF is its primary goals of facilitating :
integration
information sharing,
exploitation of common requirements across the organization
It also includes descriptions of work products for documenting and modeling enterprise architectures
This matrix Consists of fours views (in columns) for fours different perspectives of stakeholders (in rows)
The views are:
Functional
Information
Organization
Infrastructure
Views are a representation of a whole system from the prospective of a related set of concerns
The perspectives are:
Planner
Owner
Designer
Builder
Perspectives are a point of view of the overall architecture representing a particular role
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North Carolina Public Health Information Network
*TEAF v1

12. North Carolina Public Health Information Network
NC PHIN Work Products
VIEWS
Functional
Information
Organization
Infrastructure
Public Health functions, processes & activities that capture, manipulate and manage the information to support business operations
Information needed to perform public health operations and relationships among that information
Structure of Public Health, major operations performed by entities, types of workers and locations
Hardware, software, telecomm and general services that make up the operating environment in which business applications operate
Functional:
Public Health functions, processes & activities that capture, manipulate and manage the information to support business operations
Information:
Information needed to perform public health operations and relationships among that information
Organization:
Structure of Public Health, major operations performed by entities, types of workers and locations
Infrastructure:
Hardware, software, telecomm and general services that make up the operating environment in which business applications operate
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North Carolina Public Health Information Network

13. Architecture Framework Overview
Rows = Perspectives
Planner
Focuses on strategic plans. high-level processes, key information and infrastructure, structure of the organization and operating locations
Owner
Focuses on conceptual-level models of public health processes, information, logistics, and IT infrastructure
Designer
Focuses on logical business process design, logical information models, component and application design, and system distribution and deployment
Builder
Considers the constraints of tools, technology, and materials. The Builder must translate the designer’s specifications into plans for physical implementation. The builders also focuses on integration and Test
This is the framework NC PHIN is analyzing for use. It is primarily based on the TEAF. (Treasury Enterprise Architecture Framework)
A primary reason for selecting TEAF is its primary goals of facilitating :
integration
information sharing,
exploitation of common requirements across the organization
It also includes descriptions of work products for documenting and modeling enterprise architectures
This matrix Consists of fours views (in columns) for fours different perspectives of stakeholders (in rows)
The views are:
Functional
Information
Organization
Infrastructure
Views are a representation of a whole system from the prospective of a related set of concerns
The perspectives are:
Planner
Owner
Designer
Builder
Perspectives are a point of view of the overall architecture representing a particular role
NC PHIN
North Carolina Public Health Information Network
*TEAF v1

14. North Carolina Public Health Information Network
NC PHIN Work Products
Required Work Products
Supporting Work Products
VIEWS
Functional
Information
Organization
Infrastructure
Planner
Vision Statements
Mission Statement
Information Dictionary
Organization Chart
Standards Profile
Technical Reference Model
Owner
NC PHIN Process Model
Information Attributes
Assurance Trust Model
Exchange Matrix
Node Connectivity Description
(conceptual)
Risk Assessment
System Interface Description
Physical Network Layout
Designer
Business Process Functional Matrix
Event Trace Diagrams
State Charts
information Exchange Matrix
Data Crud Matrix
(logical)
Builder
System Functionality Description
Information Exchange Matrix
physical Data Model
Node Connectivity Description (Physical)
System Performance matrix
Audience Perspectives
Here are some of the work products from the Framework. A complete definition and description of each product is in the TEAF document. The products include both graphical and textual descriptions.
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15. NC PHIN Architecture Work Product Examples
North Carolina Public Health Information Network

16. Architecture Work Product Examples
NC PHIN Vision Statement:
Provide a secure, flexible, highly available, fully capable and interoperable information system that support all public health activities and programs.
View: Functional Perspective: Planner
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17. North Carolina Public Health Information Network
View: Functional Perspective: Owner
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18. North Carolina Public Health Information Network
Technical Reference Model: Infrastructure View
This is the Software development environment infrastructure view for the Planner
View: Infrastructure Perspective: Planner
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19. North Carolina Public Health Information Network
Clustered - Redundant, Fault Tolerant
Hot Site - Geographically disbursed
Flexible/Expandable Architecture
Designation by CDC as a model
View: Functional Perspective: Planner
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20. North Carolina Public Health Information Network
NC PHIN Physical Network
Note the duplicate hardware device to build in redundancy
View: Infrastructure Perspective: Builder
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21. Public Health IT/Data Governance Common Tool Set
Methods
IT Strategy Committee
IT Governance Steering Committee
Measurements
Outcomes
Governance Assessments Tools
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North Carolina Public Health Information Network

22. End of Presentation Questions?
Contact Info: John McLamb, MSIA, PHDM office cell
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23. North Carolina Public Health Information Network
Resources:
Governance:
ISACA-
ITGI –
Architecture Framework
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North Carolina Public Health Information Network

24. North Carolina Public Health Information Network
NC PHIN
Best Practices and Lessons Learned for Interoperability and Sharing Data
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North Carolina Public Health Information Network

25. NC PHIN Key Steps for EAI
Build decoupled and Distributed Architectures
Identify Common Services
Plan for Common Objects
Create a common vocabulary (taxonomy)
Design for business processes, change, and control
Build templates for business process and human workflows
Use Standards for Messaging and Public Health Processes
Build a Development, Test, and Production environment
Build with Deployment in Mind
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North Carolina Public Health Information Network

26. North Carolina Public Health Information Network
Interoperability Best Practices NC PHIN Interoperability Case Study (Time Permitting)
A brief overview and discussion of IT/Data governance “best practices” and “lessons learned” in a NC PHIN program that electronically collects emergency department patient data from over 100 hospitals in North Carolina for providing a public health web portal early event detection and disease surveillance.
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27. North Carolina Public Health Information Network
Appendix Slides
NC PHIN Infrastructure
Governance Tools
Best Practices Interoperability
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North Carolina Public Health Information Network

28. How is IT Governance (Process) Implemented?
IT Governance Process Steps
1. Set-up life cycle
2. Align IT with public health goals
3. Understand/define the risks
4. Define target areas (i.e., PHIN Certificate Goal: TB Case Notification Message)
5. Analyze current capabilities and identify gaps
6. Develop improvement strategies
7. Measures results
8. Repeat steps 2-7 on a regular basis
“IT alignment is a journey, not a destination”
NC PHIN
North Carolina Public Health Information Network

29. Other Governance “Best Practices” for Management to Follow
Treat the IT governance implementation initiative as a project activity
Remember that IT governance is a cultural change
Make sure that objectives are clear and understood
Manage expectations
Focus first on where it is easiest to make changes and deliver improvement
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30. North Carolina Public Health Information Network
How to Implement Governance Best Practice: IT Strategy and/or Steering Committee Implements Governance
Responsibilities
May differ depending on organization structure, culture, etc.
Define a charter and establish life cycle
Coveys requirements to the IT director/CIO
Composed of department or program senior management with decision making authority & CIO
Strategic Alignment
Value
Delivery
IT Resource Management
Risk Management
Performance Management
Provide strategic direction
Policy guidance
Compliance
Define project priorities
Ensures design of IT drives maximum PH value
Oversees delivery
Oversees IT funding
Provide high-level resource use & sourcing
Oversees that IT risk are managed
Confirms critical risks are managed
Verifies compliance
Verifies goals, strategic objectives met
Reviews IT measurements & contribution to PH
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31. North Carolina Public Health Information Network
NC PHIN Architecture Work Product Examples: Process Model Information Attributes
Outbreak Management, Surveillance , Countermeasure & Response (NC EDSS)
Electronic Disease Reporting
Hospital Data (ICD-9, UB92 Admin. Data)
Early Event Detection & Syndromic Surveillance (NC DETECT)
Emergency Dept. Data (NC EDDS & NCHESS)
Poison Control Center
EMS Data (PreMis)
Vet Lab Data
Wildlife Data
Aberrations (CUSUM)
Health Alert Network (HAN)
Secure Data Exchange (PHIN-MS)
Messaging/Interoperability (Rhapsody)
Enterprise Reporting
Immunization Registry (NCIR)
Electronic Laboratory Results (NC LIMS)
Vital Records Automation
NC PHIN Infrastructure
Some of the applications involved in the PHIN concept are outlined here
NC HAN application--which is completed and runs
Health Alert Network
Enhanced (Automated) Alerting - HAN
Secure web based to partners
24x7x365
Phone, fax, pager, voice mail
Designation by CDC as a model
NC EDSS:
NC DETECT:
Immunization Registry-- which is currently under contract for implementation
Health Information System--Currently in requirements and RFP status
NC PHIN Infrastructure is what we are primarily addresses today
View:
Perspective:
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32. North Carolina Public Health Information Network
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