epidemiology history and introduction nhs insight hipaa and finance norwegian perspective medical...
Post on 19-Dec-2015
216 views
TRANSCRIPT
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Norwegian Perspective
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Electronic PRocess for
Home Healthcare
Dan PattynChief Technical Officer
Forum 9000Quality Systems for
Quality Care
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
The Electronic PRocess (EPR)Pilots
• Extending the ebXML Model to eGovernment Service Solutions– e-Healthcare for the Home– e-Government in local communities– e-Building
• Deliverables– Templates and Specifications for eprXML based
implementations of semantic interoperability in different Communities of Interest
– Open Implementation Framework– Legacy System Migration and/or Integration
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
EPR Pilot 1: Hjemmebasert Pleie&OmsorgIntegrert tjenesteplanlegging og rapportering.(Oppgavebeskrivelse/Rapportering med PDA-phone. SIM-kort = Digital signatur )
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
EPR Pilot 2: Digitalt ByggesakskontorElektronisk samarbeidsarena
(Oppgavebeskrivelse/Rapportering/Inspeksjon med PDA-phone. SIM-kort = Digital signatur )
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
EPR Uses Workcards as a GUI Metaphor
Participant and Context
Based Architecture
Participant can be:1. Traditional User2. Machine or Device acting
as a Proxy for a User
Environmental Context dynamically modifies Declarative Display Metaphor
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
e-Healthcare Pilot Participants
Business CentricMethodology TC
SemanticRegistry TC
USAForum 9000
BCM-EPR SCNorway
EPR Forum
Home HealthcarePilot
Semantic ContentMgmt. SC
NorwaySINTEF
OMG
W3C
eGOVNorway
eGOV TC
Informatics Stds.OpenEHR, HL7, etc.
Content AssemblyMechanism TC
METU
CUNY
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Perspective
Perspective
Tools
The eGovernment Challenge
Experience Enablers MiniaturizationEnvironmental SensingEmbedded IntelligenceAdaptive LearningNetworked Communication
Experience Innovation LeversGranularityExtensibilityLinkageEvolvabilityEventsEvent Context
1. Need Structured Specifications2. Medical EcoSystem Centric3. Collaborative Services Centric4. Dynamic Contextual Information5. Context Control Mechanisms6. Shift from “System” to
“Workspace” Focus7. Occasionally Connected
Workspaces
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Medtronic CareLink Patient Co-Creation Experience
Primary Doctor
Medical Specialists
Patients with Similar
Condition
Pacemaker Manufacturer
Emergency Services
Doctor on Call at Out-of-Town
Hospital
Scan and Diagnostics
Clinic
Source: The Future of Competition, Figure 1-1, Page 9
Patient
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Vo ca bula r ie s
E v e nts
W orkflow
W ordprocessor
Spreadsheet
Outliner
Da i ly P ro c e d u re s P e r io d -E n d P ro c e d ure s F in a n c ia l R e p o r t ing P ro c e d u re s
Work Order
PrepareSource
DocumentPost
Journals,Ledg ers
PrepareJournalVoucher
Journal Voucher
Post GeneralLedg er
Journal Voucher
Obtain AccountBalances forWorksheet
Worksheet
PrepareTria l
Balance
Trial Balance
Analyze AccountBalances. PrepareAdjusting Entries
and Adjusted TrialBalance
Journal VoucherPostGeneralLedg er
Journal VoucherAdjustableTrial Bar
PrepareFinancial
Statements
FinancialStatements
Obtain PostC lo sing Tria l
Balance
Post C losing TB
J.V. File
Journal VoucherPostGeneralLedg er
Journal Voucher
PrepareC lo sing
Entries andPost to GL
Tabulations
Artifacts
Exam ples:PowerpointGraphics toolHTML fram es
Models
Co lla bo ra tio nA gre e m e nt ( CPA )
Pattern(s)
Com m unity ofInterest
Do cum e nts
Rule s
Transactions
Exam ples:Graphics toolCASE toolStructure Tool
Exam ples:WordOpen OfficeDocum ent tool
Exam ples:ExcelLotusHTML tables
Collaboration
Cla ss ifi ca tio ns
Vocabularies
Exam ples:RegistryLotus NotesHTML / PortalsGroove
Step 2 :Build Templates with
Familiar Business Tools
Eve n tsR u le s
T ra n sa ctio nT ra n sa ctio n
Sch e maSch e ma
C on tractC on tractA g reem en t P a ttern
W ork f lowW ork f lowM o d elin g &B u sin ess P a ttern s
re q u e st
p ro ce ss
re q u e st
p ro ce ss
re sp o n se
p ro ce ss
re je ct
a cce p tp ro p o se
co u n te r
E x cha n g eE x cha n g e
Specif ica tionSpecif ica tionM o d el & S ch em a s
N o u n s
Ve rb sT ra n sp o rt
R o le sC oncep tC oncep tR eg istry
Tem
plat
eTe
mpl
ate
--dri
ven
driv
en
B us ines s G oa lsB us ines s G oa lsG o a l P a ttern
CAM templateAsse mb ly
C o n te xt
Step 3 :Deploy with DeclarativeComponent Operations
Business Layer
Conceptual Layer
Business Drivers: Model / Process / ConstraintsTarget Constructs & Patterns Target Constructs & Patterns
Implementation Layer
Physical - Message & PresentationPhysical - Message & Presentation
Extension Layer
Contract -Collaboration Partner Specific Constraints
Publ
ish
Baseline Specification per CoIBaseline Specification per CoI
Concepts in OntologyConcepts in Ontology
Business Goals
Frameworks & Standards
Legacy
Authoritative Sources
1
2
3
4
Step 1 :Use Layers to Define
Business Needs
While Referencing the Information Architecture
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Motivation Time People
Specifications Schema
Workflow
Contract
Directory S
ervices
Presentation
Artifact relationships
Data/Codes Services/Functions Network
Source: BCM Lubash Pyramid
Core Components
Core Components WSDLWSDL
XFormsXForms
TransportRouting, Packaging
TransportRouting, Packaging
Collaboration PartnerAgreements- CPA
Collaboration PartnerAgreements- CPA
MSHSOAP
MSHSOAP
MessagesMessages
RolesRoles
Collaboration PartnerProfiles - CPP
Collaboration PartnerProfiles - CPP
NounsNouns
EventsEvents
Digital Bag
RulesRules
VerbsVerbs
Content Assembly Mechanism - CAM
Content Assembly Mechanism - CAM
BP SpecificationBP Specification
ProcessProcess
Semantic Interoperability Standards Stack
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Commitment Pattern Template
Request Dialysis
Accept Alter
Accept
Contract Patterns - Agreement Patterns - Commitment Patterns
SendAgentPrimary Care Physician
RecieveAgentDialysis Clinic
Action Event
Information RuleWhat Why
How When
Two Hours from Receipt of Request
ResponseByDate
Priority: UrgentPriority
Friday 4 Apr 04 2 pmProvisional Schedule
Dialysis TreatmentTask
Dialysis TreatmentRequest
Priority: Urgent
Friday 4 Apr 04 2 pmAccepted Schedule
Dialysis TreatmentTask
Dialysis TreatmentAccept
ActionEvent
InformationRuleWhatWhy
HowWhen
Priority: UrgentProposed New Schedule
Friday 4 Apr 04 2 pmAccepted Schedule
Dialysis TreatmentTask
Dialysis TreatmentAlter
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Open Implementation Framework Services for Occasionally Connected Applications
Where / Who
Action Event
Information RuleWhat Why
How When
Action Event
Information RuleWhat Why
How WhenService Oriented
Open Implementation Framework
(Autonomous Portal Agent)
Where / Who
ProcessServices
Collaboration Services
Digital Bag
Metadata Services
Digital Bag
Digital Bag
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Social Network Aspects of Digital Bags
Home Dialysis Equipment
ProcessServices
Collaboration Services
Digital Bag
Metadata Services
Digital Bag
Digital Bag Digital Bag
Collaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration Services
Collaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration Services
Social Network
Primary Care Physician Social Worker
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
EventsRules
TransactionTransaction
SchemaSchema
ContractContractAgreement Pattern
WorkflowWorkflowModeling & Business Patterns
request
process
request
process
response
process
reject
accept propose
counter
Exchange Exchange
SpecificationSpecificationModel & Schemas
Nouns
VerbsTransport
RolesConceptConceptRegistry
Tem
plat
eT
empl
ate --
driv
en
driv
en
Business GoalsBusiness GoalsGoal Pattern
CAM templateCAM template
Context
Business Agreement Languages (RINs)
Choreography & Coordination Lang.
(BPSS)
Business Collaboration Specification
Collaboration Profile Agreement (CPA)
Context Driven Information
Exchanges (CAM)
Semantic Registry
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Perspective
Perspective
Tools
The eGovernment Challenge
1. Federated Registry Services2. Informational and Terminological
Model Integration3. e-ID Services4. e-Authentication Services5. Declarative Access Rights
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
eGOV SuperStructure Portal
Digital BagCollaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration Services
Collaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration ServicesCollaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration Services
Digital Bag
eGOVNorwayRegistry
Digital BagDigital Bag
Collaboration Services
ProcessServices
Digital Bag
Metadata Services
Collaboration Services
AccessPoint
CredentialServiceProvider
E-Authentication Service hands off Authenticated User
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Issues
• Secure Authenticated Delivery and Tracking: – Messaging system, envelope format and payload with
exchange source profile controls– PKI Adoption Challenges (from PKI Action Plan)
• Software Applications Don’t Support It• Costs Too High• PKI Poorly Understood• Too Much Focus on Technology, Not Enough On Need• Poor Interoperability
PKI Challenges Source:
http://www.oasis-open.org/committees/pki/pkiactionplan.pdf
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
• Integration of BCM Choice Point technology to provide flow control and linking and switching for EPR.
• Create BPSS of discrete workflow components – especially intra-enterprise exchanges.
• Create BCM contract and CPA templates for EPR participant roles and agreements.
• Look at applicability of CAM templates for formalizing information quality control and context rules.
BCM-EPR Tasks
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Additonal Information and Contacts
• OASIS ebXML Business Centric Methodology TC– http://www.oasis-open.org/committees/tc_home.php?wg_abbrev=bcm– http://www.oasis-open.org/ committees/download.php/5931/BCM%20Executive
%20Brochure.pdf – http://www.businesscentricmethodology.com
• OASIS ebXML Registry Semantic Content SC – http://www.oasis-open.org/ committees/sc_home.php?wg_abbrev=regrep
-semantic
• OASIS Content Assembly Mechanism TC– http://oasis-open.org/committees/cam/
• EPR Forum– http://www.eprForum.org
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
OASIS Business Centric Methodology Technical Committee (TC) Chairs: Mike Lubash – [email protected] Mattocks - [email protected]
OASIS Business Centric Methodology EPR Subcommittee (SC) Chairs: Hans A. Aanesen – [email protected] ; eprXML System ArchitectDan Pattyn – [email protected] ; BCM MethodologistDavid Webber – [email protected] ; XML Specialist
OASIS ebXML Registry Semantic Content Management Subcommittee (SC) Chairs: Carl Mattocks - [email protected]
Norway EPR ForumHans A. Aanesen – [email protected]
Additional Information and Contacts
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Value Co-Creation via Customer Centric Collaboration
• Customer relationships based on experiences rather than products
• The product is no longer the basis of value
• Real-time customer experiences on-the-fly, shaped by the customer "context" is the value proposition
• Real-time insights required to deliver on-demand customer value and service that's meaningful to individuals within the context of their day and location
(Feb 2004)
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Backup Slides
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
1994 Cooperative Clinical Information Systems
1988-1992 Role Interaction Networks (RINs)
2002 Open Source Commodity Portals
1990-1992 Agility Forum
1994 World Wide Web
1999 W3C XML, RDF
Metaprocess ArchitecturalFramework
1996 Foundation for Intelligent Physical Agents (FIPA)
2000-2003 FIPA AgentCities Project
1997 SINTEF WORKWARE Interactive Process Modeling 2000 ebXML, Semantic
Registry and OASIS Stds.
2003 OASIS Business Centric Methodology (BCM)
2001 IOM Crossing the Chasm Report
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Open Implementation Framework Prototype
-Workflow Form Debugger / Stepper- Execution Workflow Tracking and Workflow Resumption after interruption- Reactive ECA Rule Engine integrated with Schedule and Workflow (Sharable Schedules among users who are patients)
Metadata Services
Patients are Users-Plug & Play Web Forms for portable medical records- Plug & Play Workflows, Medical Protocols, Clinical Guidelines- User-Defined Patient Lists and PopulationsCustomizable Workflows- Hierarchical Modeling: Question ItemsFormsWorkflowsComplex Workflows- Automatic Creation of Web Forms Automatic Generation of DBMS Schema Automatic Linking of Code Between Forms and Data- Five Minutes to LearnPreview / Test forms during editing Forms Repository
Care Team Collaboration Services
Digital Bag
Traditional Architecture- Mozilla Web Browser- Apache with SSL Web Server- ZOPE Application Server- PostgreSQL RDBMS- Linux, Windows OS-Skinnable User Interface
Simple-to-U
se Developm
ent Tools ZO
PE Web M
anagement Interface,
DTM
L/SQL/Python
MetaData Engineering Architecture- Meta Meta Model Support- Deployment Metadata for Introspection- Web Browser Metadata Creation Tools- Systematic Method of Metadata Management for Interactive Process Models (SINTEF)- Portable via Simple XML upload / download- Separation of patient identifiers from other data
Pro
cess Services Process Virtual Machine
- jCAM, Blackboard, ruleCore RuleEngine, etc.
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
OASIS Business Case
$
Time
Semantic Interoperability Barrier
Structuring Barrier
$
$Data
Exchange Costs
Data Quality Costs
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Value Stream Management in a Co-Creation Environment
• “Artifacts with Durable Business Value” can be re-sequenced for more value extraction
• If Value is created by Context, how much infrastructure investment is needed for definition, capture, and movement of Context– Distributed Context Management with Persistent State Information
– Distributed Decision Support based on Environmental Context
• Currently need Standards Effort focused on a Collaboration Environment with ebXML business primitives that add value to Service Oriented Architecture (SOA)
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Specification Value Stream Management
• Current Practice– Monolithic “blob” of linear text in
proprietary word processor format - “ignorance wrapper”
– Little focus on Business Protocols• Little emphasis on sequence
and interactions• Roles and Responsibilities• Exception Handling
– Focus on Documents• No common and controlled
vocabularies• No fine granularity
configuration management• No Structured Documentation
– Product Planning by looking in the “Rear View Mirror”
• Value Barriers– No common understanding– No packaging of business operational
procedures (services)– No accountability based on roles and
responsibilities– Artifacts have no Durable Business
Value because of the lack of re-composable document fragments
• No Reuse• No Reconfiguration
– Scaleability Problems• Data Scale Barriers• Structuring Barriers• Integration Barriers
– Precludes Automation & Outsourcing– IT / Business Alignment Issues
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Cross-Enterprise Service Centric Digitization
Transaction Centric Digitization of Simple Task & Processes
Process Re-Engineering
Process Improvement
Value Co-Creation via Customer Centric Collaboration
Extreme Mobility Infrastructure
Occasionally Connected Application
Wearable Computing
Business Process Evolution
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
The Digital Bag- A Universal Nomadic Work Object -
• A Digital Bag is an architectural model for a universal nomadic work object that maintains data, process and work context independently from any one system.
• In technical terms, a Digital Bag is a compound XML document that exists independently from all applications, persistent data stores and processing technologies.
The Patient and Family Journey
EpidemiologyHistory andIntroductionNHS Insight
HIPAA andFinance
NorwegianPerspective
Medical BusinessProcess Map
EpidemiologyPilot
EpidemiologyPanel
OASIS eHealthTechnical
Committee
Provider and HL7
Perspective
Digital Bag Architectural Model
• directory services information• data in appropriate format and structure for the collective intent of participants
• work flow processes
• work process metadata, which determine what work steps are intended for the current instance of the digital bag, the genealogy of the instance as created, and the recent history of interactions executed between the current digital bag instance and any participant.