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From page 9...
... The complex constellation of legislation and regulation to which CMS must be responsive will present continuing challenges; new rules and legislation prompt frequent updates to systems and processes, and major changes and whole new programs have been called for in recent legislation. Health care reform has accelerated the pace of change, and ongoing legislative activity and the development of regulations suggest that the business requirements for CMS are unlikely to stabilize.
From page 10...
... In part because of their coarse granularity and location in multiple data stores, the data available today are likely not well suited for tracking health outcomes or conducting comparative-effectiveness research, and significant effort is required to produce needed data sets. Indeed, the most successful private-sector users of IT at comparable scales reengineered their approaches to data more than a decade ago.
From page 11...
... (See, for example, Stavros Harizopoulos, Daniel J Abadi, Samuel Madden, and Michael Stonebraker, "OLTP Through the Looking Glass, and What We Found There," Proceedings of the 2008 ACM SIGMOD International Conference on Management of Data, Association for Computing Machinery, New York, 2008; and Surajit Chaudhuri and Umeshwar Dayal, "An Overview of Data Warehousing and OLAP Technology," SIGMOD Record 26(1)
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