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A New Business Model for Human Services

November 22, 2009
by David Raths
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If you are a hospital CIO wondering how you are going to cope with the meaningful use matrix or the interoperability issues around joining a health information exchange, just remember that things could be worse. You could be the CIO of a state department of human services.

Because of how funding is channeled from the federal government to state health programs, these departments end up with huge computing headaches that can hamper their ability to communicate with each other or serve the public.

I recently saw an inspiring presentation by Rick Howard, CIO of the Oregon Department of Human Services, who is determined to make incremental changes to infrastructure to provide a comprehensive view of clients and populations that Oregon DHS serves.

Describing the current state of affairs, Howard noted that individual applications within the department grew up independently with dedicated funding from the federal government. So, for instance, applications for public health and child welfare are siloed, making it difficult to get data from one system to the next. Over the years, custom interfaces have been written, but that just makes making any changes a complex and expensive task.

In the current setup, only a limited amount of client information is accessible in a central location. The upshot is that there's little service coordination between agencies, which can frustrate employees and the stakeholders they serve.

Howard has an ambitious plan to shift to a more modern architecture over the next six years that involves a data warehouse and shared web services. Among the goals would be to track common clients across multiple systems, integrate case management services and share common business processes.

But, he said, information technology won't solve any problems unless business practices also change. In fact, Howard argued that all state human services departments and the federal government need to focus not just on the computing aspect, but on a common set of technology-neutral business practices that lead to agency interoperability. Because what these state-level departments do is pretty similar in all 50 states, he believes the United States would benefit from the development of a national business architecture for health and human services. He said that such business blueprints for how these departments work should be "person-centric" and service-oriented, rather than program-centric as they are now. "That would allow for the creation of an IT infrastructure that supports improved outcomes," he said, "by providing a comprehensive view of the clients and populations we serve."

I was impressed by how much change management Howard is willing to take on. I was also struck by how his comments about changing business processes at the state level mirrored what so many others in IT in the provider space have told me: that technology will only take us so far if the underlying business processes and incentives remain broken.



Howard didn't talk as much specifically about the NHIN architecture as he did about the idea that human service departments should standardize around a business model. But his presentation was part of a session on "The Federal Government's Role in Promoting the National Health Information Network" and he was introduced by Vish Sankaran, director of ONC's Federal Health Architecture. I think Howard believes that a national HHS business architecture supported by the federal government would play a role similar to the Medicaid IT Architecture (MITA) Framework. And perhaps both could set up the organizational framework that the NHIN architecture could then enable from a tech standpoint.

Thanks David.

During the Q & A part of Harris Corporation's presentation at the HIMSS 2009 annual meeting on the NHIN connector, an interesting issue was raised (presenters Col Bart Harmon, and James Traficant). Some agencies were willing to effectively download information but not upload (provide patient information, subject to the NHIN policy which requires a degree is symmetry.)

Governance related to sharing is a complicated thing just at the inter-federal agency level. I'm interested in following the evolution with NHIN (whatever we end up calling it!). I cannot imagine how state's rights will be reconciled. I like how the feds have dealt with change management.

I was surprised to read about Rick Howard's plight without a few references to the NHIN. Was that part of his presentation? Did the NHIN's modern architecture, the availability of an open-source connector, and the existence of others who have gone before, including SSA help inform his roadmap?

It sounds like Rick Howard is espousing a Services-Oriented Architectural approach heavily supported by Enterprise Architectural efforts. If so, Rick Howard is a smart man who has the opportunity to revolutionize many state agencies and to pave the way for many large, siloed non-governmental organizations to follow.

When "rip-and-replace" is not feasible (and really, for any significant investment which is providing net present value, it shouldn't be feasible), SOA and EA are the best existing, rational and proven approaches. They are not easy, they require a mind-set and skill-set change and a requisite deftness with politics, communication and persuasion, but when implemented successfully, they are paradigm-changing, quantal improvements in value.