Telecommunication Standards and Policy

A Scenario

Background: Minnesota Consulting Group

The Minnesota Computer Consulting Group (MCC) is a 50-person consulting services practice focusing on telecommunications and systems administration that includes Minnesota offices in Minneapolis, St. Paul, and Rochester. MCG has had some business opportunities in Wisconsin and Iowa and is considering branching out further within those states by adding offices in Madison, WI and Cedar Rapids, IA. Much of its project and ongoing account work, particularly in today's economy, has been in the medical hospital and health insurance industries.

As a telecommunications practice, MCC has assisted organizations in business and market planning, technological evaluations, and education for IT organizations that are looking to expand their own telecommunications infrastructure services and support. MCC began with technical specialists and, over time, an increasing amount of MCC business consists of auditing, governance, and business advisory activities.

MCCs published areas of expertise include the following:

Network Assessment
System Architecture Assessment
Risk Assessment & Business Impact Analysis
Information Technology Governance
System Administration Staffing
Minnesota Consulting Group: Key Personnel

Principal Consultant-Amy Smith
Business Process Consultant-Becky Fredrickson
Business Process Consultant-George Conrad
Sr. System Administrator-Dave Baker
Sr. Technology Consultant-Mary Williams
Background: Central Medical Group

One of MCCs larger clients is the 560-bed Central Medical Group (CMG)-a not-for-profit managed health care organization that provides an entire spectrum of health care services, including health insurance, primary care, and specialty care. Along with a primary care facility and teaching hospital, physicians and affiliated staff travel to more than 60 satellite primary care clinics to provide medical coverage across a 15-county region in the state of Minnesota. CMG is affiliated with specialty clinics and medical networks for pharmacy, dental, and employee assistance counseling services. CMG is presently considering expansion into additional counties in Minnesota and may be interested in branching into Western Wisconsin and Northern Iowa to provide a broader range of coverage for its members. Their mission as a not-for-profit is to provide the community and regions that they serve with high quality, cost-effective, accessible health care.

CMG's IT department consists of about 70 people. The department is broken up into a Technical Services group and an Application Development group. Project managers, business analysts, and application developers are within the application development group. Software applications (primarily .NET and Informatica Data Warehousing) that are developed in-house are also supported by the same developers who built the applications.

Technical Services contains a database and applications team, infrastructure team, and quality control team each with a department manager. Quality Control consists of testing and defect management, test data management, and internal auditing/compliance. Infrastructure includes disaster recovery planning, desktop support, security, and data center management. Database and Applications consists of EDI coordination, database administration, data and code migrations, and application support for third-party purchased applications and tools. EDI coordination is an important role with claims processing and enrollment integration with 80 trading partners, 3,000 providers, secured transactions, and approximately 5 million electronic claims per year.

From CMGs perspective, Minnesota Consulting Group handles telecommunications installation, after hours support to handle telecommunications issues, and staff augmentation to support the infrastructure team by adding resources for special, unstaffed data center or disaster recovery projects. Staff augmentation can also provide support coverage for 2-3 months when staff turnover occurs. Minnesota Consulting Group has provided these services for 3 years through an annual support contract along with statements of work for project and staff augmentation. As CMG IT staff gains expertise and additional personnel, an annual evaluation is held to determine whether or not to renew MCC services for the following year. MCC won this work through a competitive bid process, and Central Medical Group is not looking to replace MCC with another vendor but may bring those services completely in-house as CMG continues to grow and mature.

CMG's IT Department: Key Personnel for this Scenario (out of 70 people)

VP of Technology-Fred Moore
Director of Technical Services-Brian Walters
Manager of Database/Applications-Jim Hanson
Lead Database Administrator-Diane Lau
Manager of Infrastructure-Julie Nelson
Lead System Administrator-Toby Johnson
External Forces Driving Projects

Regarding governance, risk, and compliance, both MCC and CMG have been recently focused on Information Technology Infrastructure Library (ITIL) policies and HIPAA 4010 compliance. However, CMG is taking steps to prepare for the National Association of Insurance Commissioners (NAIC) Model Audit Rule (MAR) compliance in 2010. Model Audit Rule is similar to the Sarbanes Oxley Act with an expanded focus on key business process controls, general computer controls, and the financial reporting process.

Both organizations are adding additional resources in the areas of governance, auditing, and process redesign for compliance. HIPAA 5010 updates are planned for 2009 and ICD-10 updates planned for 2010. State government programs and mandates also create business opportunities along with operational challenges to responding to those mandates. CMG is systematically improving its internal processes and is looking to be more proactive than reactive in handling work assignments around infrastructure improvements.

Infrastructure, Network and Application Architecture

Medical claims processing and insurance operations is the most dynamic part of the operation, and we will focus our time on those areas. The primary database platform is primarily Oracle running under AIX with some SQL Server running under NT based on third-party application purchases that only run under NT. Application and Web servers are NT servers with VMware (roughly 50 processors) running under Microsoft Windows. VMware has demonstrated some clear advantages for this organization, but one of the challenges with VMware is that SQL Server software vendors want to run their application on their own hardware instead of a virtual machine. A storage area network (SAN) environment is used to provide direct access storage at about 3,000 Gb, and it is operating at near (85%) capacity.

The current environment consists of Development (sized at about 30% of production), Disaster Recover /Operational Recovery servers, and Production servers. The business area consists of about 300 Wintel desktop and laptop computers. The VP of Technology is interested in replacing AIX with Linux and is considering some proof of concept projects to evaluate that option.

Project Overview

You are a principal consultant for Minnesota Consulting Group, and this is your first assignment where you will be responsible for the entire client engagement. The environment is consultant friendly but dynamic with frequent organizational and business changes. CMG is a growing organization and staff reductions are not being discussed so morale is high. However, 25% of the technical services department has been with CMG for less than 1 year due to that growth. The training budget is respectable and everyone has typically 5-10 days annually planned for training. Process improvements and document management could be expanded to help the teams handle the increased business volume, an increasing need for governance, and the expansion of individual and team responsibilities.

The organization has some plans to become even more diverse with a tentative acquisition of a pharmacy benefit plan system. Discussions are at the preliminary stages, but this could provide integration opportunities along with the potential to sell ownership shares of a pharmacy benefit plan to other regional nonprofit entities that did not provide pharmacy benefits to their members.

CMG is also considering expansion into other markets, and its current environment and infrastructure may not be sized appropriately to handle an increase in both staff and membership that a new market would bring. Direct growth through acquiring another smaller medical claims and insurance entity is not currently being considered, but the management team is open to the possibility if the right opportunity became available. Again, this organization is not-for-profit, but it is run in a business-like manner regarding cost containment and providing quality service for CMG members. Geographical growth is a part of the organization's long-term goals and objectives to extend services to those members.

Assignment:

In this assignment, you will be in the role of Mary Williams, the Senior Technology Consultant for Minnesota Consulting Group.
Amy Smith (project manager at MCG) has given you the following assignment:

In the context of telecommunications standards and policy, prepare a 3-5 page white paper that describes current standards and policies that are relevant to MCG's work with Central Medical Group.
Include discussion of Electronic Data Interchange (EDI) and Information Technology Infrastructure Library (ITIL) standards. ITIL standards are considered by many people to encompass telecommunications systems, so this should be included in your paper.
The document should be comprehensive enough to serve as a general guide on emerging telecommunications standards.
The main focus should be a guide to direct Central Medical Group's technological philosophy and infrastructure practices.
Outside research supported with citations and references is essential to demonstrate currency and relevance of this material for MCG's clients.