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State Health IT Progress: Glass Half Empty or Half Full?

April 4, 2014
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'We can build things. We just can’t hook them together,' says one California IT exec

I just returned from a great summit meeting of state government health IT leaders from around the country. The State Healthcare IT Connect Summit in Baltimore featured engaging panel discussions with CIOs and state health IT coordinators. Although I was impressed by how smart and dedicated the speakers were, I couldn’t decide whether to be encouraged or discouraged by the rate of progress they described in re-engineering systems and processes in state government to make sharing health data more of the rule than the exception.

On one hand, several executives talked about improvements to the mammoth Medicaid Management Information Systems (MMIS) projects. State health IT execs described their efforts to modernize MMIS using service-oriented architectures to break down silos between agencies to allow a holistic view of citizens to emerge, no matter which state services they are accessing. Many are linking MMIS to the state health information exchange.

“We were determined not to rebuild siloed systems,” said Montana CIO Ron Baldwin. Data can reside where it needs to, but it should be able to pass through service layers and be easily shared between systems. “One of the key requirements for the MMS we are implementing was to be able to adapt to new benefit plans,” he said. “The architecture allows us to adapt quickly to federal and state policy changes.”

Rex Plouck, the portfolio manager in the Ohio Governor’s Office of Health Transformation, sees the flurry or activity around the Affordable Care Act as an opportunity to prove that state governments can build large systems effectively. “We were late to the game in terms of integrated eligibility systems, but now we are fully connected to the federal hub and have real-time connection to the MMIS through a SOA architecture. And we are rolling out new functionalities as quickly as we can,” he said. “We went from nothing to that in one year. You can do these kinds of things in state government if you do it the right way.”

Referring to the challenges around setting up insurance exchanges, Manu Tandon, secretariat CIO and HIT coordinator in the Executive Office of Health and Human Services for the Commonwealth of Massachusetts, noted that nothing worth doing is easy. “Are we surprised it was hard and complex? Or that people rolled up their sleeves to fix it? I was not surprised. I expect that. That is who we are.” He noted that 70 percent of all IT projects fail. “In the private sector we don’t hear about it. In the public sector we do hear about it. We should make sure we act, not over-react.”

These comments were encouraging. Yet several speakers talked about how challenging the cultural problems around sharing data have been to overcome.

Ramdas Menon, Medicaid HIT director for the Texas Health & Human Services Commission, said access to data is still a major issue. Getting an agreement about sharing data can take two years to solve. “The biggest resistance comes from sister agencies within state government,” he said. “It is part culture, part protection of turf.”

Perhaps the most eloquent comments — and the most discouraging — came from Shell Culp, chief deputy in the California Office of System Integration, which manages IT projects for the state of California’s Health and Human Services Agency. She noted that very little progress has been made to share what has been built in one agency with others. “We have ID management solutions, but they don’t filter over to other organizations that might be able to use them.”

She mentioned the introduction of a fraud detection system in one California agency. “Currently there is absolutely no way to share that,” she said. The state has worked on IT governance, and what has to be in place to share things, for instance to handle ID management in a federated way. “All of us approached that from a different perspective on the continuum, and none of us is in a position to effectuate it,” she said.

“The thing that stands in our way is us,” Culp said. “It is the organizational change management piece. We can build things. We just can’t hook them together.”