Transforming Government using Open Standards
description
Transcript of Transforming Government using Open Standards
Transforming Government using Open Standards
Jagdip GrewalChief Technical Architect
29th October 2007
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
To deliver a 21st century health service through efficient use of technology to:• Enable and improve Access and Choice• Enable care pathways and patient focus• Improve accuracy in treatment• Create opportunities for improved efficiency• Create opportunities for real NHS reform
Our Objectives
Ageing Population
2001 – over 60s > than under 18s
2050 – 4 times as many needing care
At 4 times the current cost
…while the number available as carers declines
Demographic Challenge
Life expectancy increased to 75 years 9 million people over 65 and increasingPopulation more mobileGreater long term chronic illnessPatients more educated on health and want greater involvement
1,200 Patients dying each year from medication errors5,000 procedures cancelled each year 5% of patient safety incidents due to documentation errors
Has overburdened the system
The NHS in 2002• Patient records held on paper
• Highly variable usage of IT• Lots of home-grown specialist systems
• Continuing reliance on 1970s mainframes
A Changing Health Environment
1
The need for changeThe need for change
• Local procurement of IS/IT Systems by GPs, Trusts etc• Disparate Technologies, 1000s of suppliers• Limited data sharing• Lack of standardisation• Lots of paper• Little leverage of NHS buying power
Challenges
National Programme for ITNational Programme for IT• Launched Spring 2002 by “21st Century IT”
policy document
• Mobilisation from Q1 2003
• Procurement completed Q1 2004• ‘Services’ based contracts
• Local and National Suppliers
• £6bn of IT services contracted over ten years
The answer…The answer…
• Largest civil IT project in the world
• 40,000 GPs• 80,000 other doctors• 350,000 nurses• 300+ hospitals• 10 year programme• 50m+ patients• 1.344m healthcare
workers
chooseandbook
Electronic Prescriptions Service
NHSmail
National & Local Care Record Services
Healthspace
Picture Archiving & Communications Service
Secure E-mail for all NHS workersWeb Access for Patients
Secondary Uses Service
Analysing National Health Trends
New National Network
Patient Choice
Scope
N3
……and what does it look likeand what does it look like
Enterprise Services (NxSPs)
Electronic Booking Service
Transaction & Messaging Spine
Health System Users
GPNHS DirectPatient ClinicianPharmacists Child Protection National & Trust Managers
Health Care Workers
N3 Network Services
Personal Demographics
Service
Electronic Transmission of
Prescriptions
Other Accredited Systems
Personal Spine Information System
Secondary Uses Service
Local Services LSPs
Spine Directory Service
Access Control Framework
Diagram file: VisioDocument
National and Legacy systems
120 Different Supplier
Accredited Systems to integrate
3 Suppliers with differing Architectures
Multiple and
Disparate Channels
Integration required with
set of common services
Programme Challenges• Hundreds of different applications and suppliers• Large scale systems e.g. Prescriptions at 500tps• End Users with differing requirements and geographically
distributed• Diverse (often ‘legacy’) Supplier Technologies• Lack of Standards• Desire to Use COTS packages – avoid bespoke• Evolution in requirements and functionality • Data availability, quality and integrity is critical
• Enterprise Architecture required to define overall End to End approach
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
Business Services
IS Services
Technology Services
Enterprise Architecture
EA - Context
Policy
NASP
NHS CFH
MedicalAdvances
PatientDemand
LSP/ESP
We may all have different perspectives but we can make our lives much easier by ‘talking’ the same language.
ClinicalProcesses
OutcomesBetter Patient Care
Reduced CostLower waiting Times
The bigger picture - In support of traceability (simplified view)
Contract
Schedule
Requirements
Non-functional requirement
Functional requirement
contains
Bundle
contains
Release
Are delivered by
Conceptual Services
Physical Application
Care Setting
Use Case
Which is supported by
Logical Applications
Are represented as
Service Provider
And is implemented by a
In a
Policy & Strategy, medical
advances, other factors
Creates additional
May be elaborated in a
From TA
This seems to be equivalent to the “project” concept from TA
Acceptance Status
“Strategic Tracking” on TA slides
Benefits
Artefacts
Test Cases
Whi
ch c
olle
ctiv
ly c
reat
e
Which may be used to validate
Implements
Have an
Are Structured in a
Are implemented in a
Has an
Implements
NHS – relationship map
NHS
OtherGovernment
DeptsExternal Support Services
Direct ServiceDelivery Links
Local Authority Services
DCAfMOD
DoH
LogisticsEstates Management
Audit Commission
Other NHS Organistiaons
Connecting for Health
PublicHealth
Education Departments
Housing
Social Services
HomeOffice
v
Courts
Police
Young Offenders
Teams
NPSA
Healthcare Commission
Schools
Higher / Further
Education
Education Psychology
DomicillaryCare
Mental Health & LD
Adult Services
Older People
Services
Children’s Services
PPA
Drug Companies
Prosthetics / Appliance Suppliers
Prison Service
DFES
ManagementServices
Non-StatutoryOrganisations
IndependentService
Providers
Charities
Patients
Relatives & Carers
SpecialEducation
Needs
Research
Private Hospitals
Forces Healthcare
NICE
NHS - includes:Primary Care
Acute CareMental Health& Ambulance
Services
TribunalsService
Dentists
Opticians
InformationCentre
Chiropodists
Physio-therapists
Other HealthServices
Pharmacies
DeFRA
Prison Healthcare
DWP
Home OfficeService
Contacts
NHS Service Contacts High-level Map
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
Enterprise Architecture – Domain View
Secu
rity
Inte
grat
ion
Infrastructure
Enterprise Services
Channels and Presentation
Local Services
Views
Conceptual Services: what we do
Local Services
Enterprise Services
Inf rastructure
Channels and PresentationSecurity Integration
Care Management Services Manage User ServicesNSF Support Local ReportingManagement
Access Management
Audit and HistoryView Management
Digital ImagingSetting Specific
ServicesMedication
ManagementServices
Management Services
Reporting Services
Strategy
Integration ConstructionServices
Configuration andManagement Services
Demographics
Identity ServicesClinical NarrativeServices
Financ ial Services
Clinical SummaryAccess
Clinical SummaryRecords
Hosting Services Service Management
Integrity &Non Rep Services
Integration ProcessingServices
Message Level Security
Disaster Recovery
Local StructuredCare Mangement
Diagnostic & Resul tsServices
Directory Services
Local ContentManagement
Knowledge ManagementServices
TerminologyServices
Decision Supportand Alerts
MedicationsManagement (EPS)
Platforms & Devices
EnvironmentalServices
NetworkServicesStorage
ScreeningManagement Manage Scheduled
Bookings
NHS Direct
DeploymentSchedulingServices
LegacyPatient Personal
Health Informationmanagement
Data QualityServices
Clinical MessagingServices
Governance
Requesting Services Manage Alert & EventNotifications
Strategy
Business ProcessManagement
Managee Booking
Local Workflow
Session &Context
ManagementVideo
ConferencingDevice and media
repurposingScanning User Interface
Services
Manage DecisionSupport Rules
(Active DecisionSupport)
ManageAdministrationof Acts giving
Compulsory Powers
Profiling &personalisation
Manage Consent toShare General &Specific Record
Informat ion
Virtual Visi ting
CertificateManagement
Homemonitoring
Manage Patient RecordCoding, Grouping and
Terming
Manage Incidentsand
Complaint Recording
Manage Local(pseudo)
anonymised data
Manage Local SUSdata review prior to
submission
Manage Whiteboardsand
Patient Tracking
Manage SUS datareview prior tosubmission
Manage ClinicalDocumentation
Templates
Manage Screeningand PreventionProgrammes
Non-repudiation
BusinessOrchestration
Encryption Authentication
LRS
RBAC
Sealing
Access Validation
Evidence Collation
User Directory
Service Directory
Record Audit Event
System Identification
Record Retrieval
Event SecurityAssessment
Scenario Recreation
Request Assessment
Ambulance
Ambulatory Care Mgmt
Assessment services
Cancer NSF
Chronic ObstructivePilmonary Disease NSF
Coronary NSF
Children's NSF
Long Term Care NSF
Mental Health NSF
Older People's NSF
Create and ManageLocal Reports
Dental
Image Archive
Image Retrieval
Image Viewing
Hardcopy Production
Domiciliary Care Mgmt
NSF InformationServices
Emergency Services Image Acquisition
Diabetes NSF
Renal NSF
ManageDigital Signatures
Manage Interventions
Manage LegalRequirements
Manage MaterialsManage Mobile
Working
Manage PatientRecord Presentation
Manage PatientRegisters
Manage PatientRegistration
Manage Patient Stays
Paediatric IntensiveCare NSF
Address lookup& validation
Prescribing Alerts
Prescription Transfer
Manage Blood
Privacy
Confidentiality
Authorisat ion
Integrity
Message Encryption
MessageAuthorisation
Message Integrity
MessageAuthentication
Interaction Patterns
Message ContractPropert ies
Message Channels
Adapters
Transport Protocols
InteroperabilityFramework
Execution
Validation
Transformation
TechnicalOrchestration
Configurationand Design
Platform Regist ration
Metadata andRepository
Service Managment
Quality of Service
Service Discovery
Imaging History
Image Export
Image Purge
Manage PatientRecord Presentation
Theatre management
Single Sign- on
Local Translation(Language)
Translation (Language)
Service RegistrationMaintenance
SAR Collation
Mental health
Manage ProfessionalCarer Relationships
Monitoring
Help desk Support
Incident & ProblemmanagementBackup Mgt
Change & ConfigMgmt
Systems MgtStorage Mgt
Network Mgt
Asset Mgt
Restore Services
Replacement IS andIT resources
Data BackupAssistive Technology
Service Hosting
Print Services
File Services
Data Management
Manage (pseudo)anonymised data
Manage Reports
Manage Reports Types
Manage ReportsGroups
External Interfaces
Regist ration &Maintenance
Patient trace & info
NHS No. Services
Update stored data types
Duplicate Record mgmt
Create event,workflow or alert
Store, maintain, ret rievesummary etc data
Print prescription
View Spine data
Update Spine data
Manage Clinicaldocument tools
Manage Messages
List management
Local Authoring
Local Publishing
Major IncidentManagement
Manage care deliverybreach times
Manage Care period
Manage Care Spells
ManageCommissioning
Manage carepathways
Manage care plans
Manage CostingCare Delivery
Manage Death
Manage DuplicateRecords
Manage Expenses
Manage ExternalDocuments
Manage HealthIssues & types
Manage HealthcareOrganisation
Manage InternalSupport Tools
ManageKnowledge Bases
Manage Local ExternalReporting Tools
Manage LocalReports Groups
Manage LocalReports Types
Manage medicationadministration
Manage medicationcharts
Manage medicat ionrecord
Manage MedicalDevice Integrat ion
Manage Multi-Resource Scheduling
Manage non-pharmacy dispensing
Manage Objects inClinical Documents
Manage PatientDemographic Details
Manage PatientDocumentation
Manage PatientEncounters
Manage PatientEpisodes
Manage PatientIdentif ication
Manage PatientProperty
Manage PharmacyDispensing
Manage prescribingmedications
Manage prescriptions
Manage PrivateFinance
Manage People
Manage Referral
Manage Resources
Manage Risks& Warnings
Manage services
Manage Third PartySupport Tools
Manage User Devices
Manage user interface
Manage WaitingLists
Manage Wards,Rooms and Beds
Maternity Services
Reimbursement
RequestManagement
Result Management
Manage User Sessions
E.g. DemographicsWithin local Services Domain
• Set of services required to be implemented by local systems
Within Enterprise Services Domain
• Set of services required to be implemented by national service provider for all 60m patients
Set of compliance docs from NHS CFH
• Covering requirements to be met by systems implementing those services
• MIM for message definitions and example process flows • Principles - loose coupling, search local first, update local first• What is to be tested and verified during integration testing
Logical Applications…
Enterprise Services
Local Services
Channels and Presentation
Infrastructure
IntegrationSecurity
Legacy Services
Demographics Clinical Summary
Information,Knowledge and
Research Services
LocalApplicationIntegration
EnterpriseApplicationIntegration
Assessmentsand Clinical
Documentation
NWCS
NSTS
NN4B
CHRIS
NHAIS
Blood
HealthSpace
QMAS
Access ControlFramework Demographics
DataClinical
Summary Data
Gazetteer
ElectronicPrescriptions
Choose andBook
DemographicBack Office
Clinical SummaryApplication
Data Feeds
Workflowand Rules
Terminology
SecondaryData Uses
DocumentManagement Prescribing Emergency
Requesting &Results
Maternity
DentalRadiologyPatient
Administration Pathology GP Systems Reporting
CommunityServices Legacy Systems Pharmacy Theatres Ambulance Data Warehouse
ImageManagement
LocalInfrastructure Devices Networks Hosting
SystemManagement
Client IdentityAgent (IA)
SecurityServices
DirectoryServices
LegacyChannels
Web
ChannelManagement Phone SMS(text) Paper DTV
Web Service AssistiveTechnology
Local Services
Assessmentsand Clinical
Documentation
Theatres
Information,Knowledge and
Research Services
PatientAdministration
Requesting &Results
ImageManagement GP Systems
Emergency
Maternity
CommunityServices
Prescribing
Ambulance
Radiology
Data Warehouse
DocumentManagement
Map of Medicine
Pathology
Blood
Dental Reporting
Legacy Systems
i.CM
i.CM
SAP
Lorenzo R1
Lorenzo R1
Lifenet ECS
CRIS
Child Health(HSW)
i.PM
Lorenzo R4Lorenzo R2
Lorenzo R2
Lorenzo R2
SystmOnePACS (GE)
Pharmacy
Evolution[Maternity]
PACS (Agfa)
Lifenet ECSScantrack
ORMIS
Lorenzo R3
TMS
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
The role for standards• Explicit from the outset. • The standards base evolves and grows• Standards chosen to maximise interoperability and to meet different
integration requirements
• Use of ebXML, (https, SOAP, XML) - reliable asynchronous messaging for patient demographic updates
• Web Services and WS standards e.g. WS-A – lightweight synchronous messaging for patient demographic queries
• Use of SNOMED CT• Use of HL7 v3 (ETP, C&B, PDS) and CDA v2 (Clinical Documents)• Lots more….
• Objective is to federate the design responsibility to the systems providers, working within a framework of standards and specifications
Not just technical standards • Common User Interface (CUI) - Microsoft and NHS CFH (http://www.mscui.org/)
• Knowledge authorship to allow Knowledge Support (KBS) and Decision Support into all aspects of the implementation
• The International Health Terminology Standards Development Organisation• SNOMED CT• Charter Members (Australia, Canada, Denmark, Lithuania, New Zealand, United
Kingdom United States)
• A drug database – The Dictionary of Medication and Devices (dm+d)
• Standards by which we accredit systems as safe to implement and exchange information
Elective / Passive Decision Support – same component in all local solutions
Standard drug dictionary
A standard drug dictionary for all systems We (and Australia) have chosen to make and
maintain a new one called dm+d (The dictionary of medications and devices)
NB. This is NOT decision support but a standard way of naming and structuring medication and devices so that decision support and complex rules based content can be added with predictable results.
Atenolol50mg
Tablet x28(VMPP)
Atenolol 50mgTablet(COX)(AMP)
Atenolol 50mgTablet(Cox)X28
(AMPP)
Atenolol 50mgTablet(VMP)
Atenolol(drug product)
(VTM)
Cardioselective beta-blockerIS_A
Beta-blocker drug
IS_A
etc etc
IS_A
Snomed CT drug core
NHS dm+d
Dm+d and SNOMED CT (300,000 terms)
•Both dm+d and SNOMED have a
central core with local additions
Standards enable supplier expansion
• The use of Open Standards for integration (ebXML, HL7) has enabled an expansion in number of suppliers to the programme• Leverages existing knowledge capital and established
standards • Allows suppliers to build COTS packages based upon
industry standards. Move away of bespoke development• Allows plug and play of new services• Standardisation reduces overall testing complexity
• To meet business objectives we have integrated• 100s of supplier applications• Access from private corporate WAN (N3) as well as internet
aggregators for high street access
What have we achieved so far? … - some “numbers” (at 08/10/07)
• 17,454 instances of systems connected into the national services which allows in a typical day• 190,000 prescription messages issued electronically (18%
of all prescriptions)• 19,000 Choose and Book electronic bookings• 1,400,000 queries to be recorded on the patient
demographic system enabling letters to be posted to the correct address and patient information to be handled more efficiently
• These are deployed via the 20,662 connections to N3 (the national NHS WAN)
• 380,350,622 images have been stored using PACS from NHS CFH
• There are 394,367 Smartcard holders who are registered and approved for access to systems
Acute System
Patient info
Broken Leg
Patient visits Emergency Dept
Emergency Dept
Discharge
GP System
Back Pain
Patient visits GP
Acute System
Patient info
Chest infection
Patient visits hospital
Summary Care Record
What’s next - more clinical Information flows between systems
Enabled by standards (HL7v3 and HL7 CDA v2 over ebXML (https/SOAP/XML) and central messaging services (TMS)
Update GP Summary
Emergency Dept
Discharge
Discharge
Discharge
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
Integration – The Challenges• Large number of suppliers – and growing• Each supplier footprint is different & can consume
different services• Suppliers in different phases of development• Business critical services – cannot be stopped for more
than a few hours• We cannot ‘lose’ data• Data must only flow from accredited applications running
from authorised endpoints originating from users with the relevant roles
• Large numbers of endpoints, systems and users• Strict Information Governance Rules
Challenges – Service Definition• Right Granularity ? To high and they are subject to constant
change. To Low and it can result in significant increases in message flow.
• Generic or Specific business process ? The level of business logic can impact the re-usability of the service.
• What SLAs ? Services that are used for many business functions may have varying SLA needs – these must be balanced against cost
• Trade off between performance and extensibility• What security model ? Whilst some aspects of information
security can be centralised – others must be federated
Challenges – Compatibility• FORWARD and BACKWARD
• A change to a service can impact many applications and suppliers- Each system needs to be fully tested before it is
accredited for deployment !!!• The more ‘versions’ we support the less scope
we have to add new capabilities• Translation services are required to
accommodate supplier applications running at different versions
Services usage can be different to expectation• All local systems will integrate with Summary Care
Record• SCR provides a set of services to enable this in
different ways
Summary Care Record
CSA
Req
uest
Res
pons
e
ESPOn-demand …
Req
uest
Res
pons
e
LSPPre-fetch
Req
uest
Res
pons
e
Agenda
• Business Context• Enterprise Architecture Context• Services in an Enterprise Architecture• Using standards to enable integrated
healthcare • Integration challenges• UK Government Enterprise Architecture
Cross Government Enterprise Architecture
• CTO Council formed in Sept 2005. The aim is to support the CIO Council through the optimisation of the use of IT resources across the public sector.
• Strategic value of xGEA is to identify opportunities for collaboration and reuse across government.
• Without a business and IT Blueprint for Government – an Enterprise Architecture – avoidable cost would be incurred as IT is developed in ‘islands.’
So where do the CTO Council sit?
Ministerial Leadership
Business Leadership
Technical Leadership
Deep Business and technical knowledge
Ministerial Group
Leadership Groups
Technical Steering Group
Working Groups Working Groups
Working Groups
DA (PED)
CIO Council PGSSBDelivery Council
CTO Council
xGOV EA Domains and Leads
CHANNEL DOMAINTerry Hawes (HMRC)
INFRASTRUCTURE DOMAINAndrew Bull (HMRC)
APPLICATION DOMAINTBD
PROCESS DOMAINJohn Wailing (Home Office)
INFORMATION DOMAINPete Desmond (DWP)
STRATEGYAndrew Stott (Cabinet Office)
SER
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AN
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OM
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(DW
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INIn
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gh (N
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CfH
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INFO
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ATI
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ASS
UR
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DO
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king
(Cab
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Offi
ce)
xGov EA Context
• The majority of the work of the CTO council is structured around the xGov EA through the Domain Teams.
• The Domain Team leads collectively form the Architecture Review Board (ARB) whose purpose is to: • Oversee the development of cross-Government
Enterprise Architecture – xGEA• Oversee the development and operation of the clearing
house process for exemplars• Assesses the fitness for purpose of proposed exemplars
(managed services and solutions) for reuse across the public sector
• Resolves overlaps between domains• Provides a forum for peer reviews
Capturing EXEMPLARS at various levels
Managed Service
Solution
Pattern
Lessons Learned
Potential Value
Number of assets found
• A hosted service that is offered to others
• A packaged service including: code, design that can be rebuilt
• The approach to providing the service
• Experiences gained implementing the service
Clearing House Process and Domain ToR Detailed Process Flow
Organisation
Organisations’(Technical)ArchitectureTeam
Organisation
Organisations’(Technical)ArchitectureTeam
Organisation
Organisations’(Technical)ArchitectureTeam
Organisation
Organisations’(Technical)ArchitectureTeam
Organisation
Organisations’(Technical)ArchitectureTeam
Entry
Viability
Definition
Design
BusinessJustification
Build
Go Live
Benefits
Generate Idea
Test Feasibility
Define Proposition
Design Service
Complete business case
Build Service
Live Running
Live Running
Test Service
Define Idea
Match Reqs
Reuse & IdentifyNew
Harvest to Exemplar
Organisations’ Architecture TeamInterface Process
Domain Teams
Clearing House
ARB
CTO Council
CHANNEL DOMAIN
INFRASTRUCTURE DOMAIN
COMMON APPLICATION DOMAIN
PROCESS
DOMAIN
INFORMATION
DOMAIN
STRATEGY
SER
VIC
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MA
NA
GE
ME
NT
DO
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DO
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IN
SEC
UR
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DO
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Future / WIP Existing
Delivery and Transformation Group
Business Idea X
Business Idea XArchitecture Priority : 1CIO Gate Status: ViabilityPrimary Domain : InfrastructureSecondary Domain : Channels
Business Idea XArchitecture Priority : 1CIO Gate Status : ViabilityPrimary Domain : InfrastructureSecondary Domain : Channels
Check keywordsagainst ‘Metadata’
ExemplarExist
Record as WIP
Re-useas-is
Enhanceand re-use
Organisation
Organisations’(Technical)ArchitectureTeam
Organisation
Organisations’(Technical)ArchitectureTeam
Re-usedBusiness ‘artefact’
eRoom
Summary• Use a service based Enterprise Architecture to
enable a common language
• Set standards and frameworks that permit increasing levels of interoperability and interaction across multiple suppliers
• Be aware of the challenges of integrating multiple suppliers