Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

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Increasingly, the core mission of the Centers for Medicare and Medicaid Services (CMS), an agency of the Department of Health and Human Services, is expanding from one of focusing on prompt claims payment to one of becoming more broadly involved in improving health care quality and efficiency. The requirements for the information technology (IT) systems of CMS are changing as its mission changes, and the efforts to evolve its systems from those designed to support the agency’s historical mission come in the midst of a push to modernize the nation’s health care IT more broadly. These new challenges arise even as CMS must meet challenging day-to-day operational requirements and make frequent adjustments to its business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements.

In light of these and other emerging challenges, CMS asked the National Research Council (NRC) to conduct a study that would lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and information technology requirements. The statement of task for the project is presented in Appendix A.

The study is being conducted by the NRC Committee on Future Information Architectures, Processes, and Strategies for the Centers for Medicare and Medicaid Services. The committee’s 16 members possess a broad range of expertise and backgrounds, including specific knowledge of CMS itself, large-scale enterprise computing, health care policy, health care quality, health care outcomes, large-scale data use and database operations, and health IT. Biosketches of the committee members are given in Appendix B.

The study is being conducted in two phases. The first, which resulted in this interim report, draws on a series of teleconferences, briefings, and an information-gathering workshop held in Washington, D.C., on September 27-28, 2010. The second phase, drawing on that workshop and on additional briefings, site visits, and committee deliberations, will result in a final report with recommendations, to be issued at the end of the project in 2011.

It is challenging for an external committee to learn about the complex environment and challenges that characterize an agency with the breadth of responsibilities and scope of CMS. The committee has benefited from the written materials provided by CMS staff and from their presentations and engagement both on telephone conference calls and at the workshop. The committee is accordingly grateful to the CMS staff who have contributed their time and insights to the study, and also thanks all of those individuals who participated in the September workshop and contributed their insights and experiences to the discussion. The committee thanks the reviewers of this report for their constructive feedback. And finally, the committee appreciates the work of the NRC staff members who have contributed to the process to date.

Lynette Millett and Emily Ann Meyer, in particular, have demonstrated an intellectual engagement, a commitment to the task, and an ability to capture and integrate the wide-ranging discussions of a heterogeneous committee. We are indebted to them for their contributions to documenting the committee’s deliberations and to the writing of this report.

Edward H. Shortliffe, Chair

Committee on Future Information Architectures, Processes, and Strategies for the Centers for Medicare and Medicaid Services

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was coordinated by Susan Graham, University of California at Berkeley Appointed by the NRC, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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