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Summary and Recommendations
Pages 1-18

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From page 1...
... Recent legislation has given CMS new and expanded responsibilities for driving national improvements in areas such as the greater efficiency of health care services, the elimination of health disparities, the support of health care quality, the adoption of health information technology, a drive toward value-based purchasing, and the collection and analysis of data to promote health and wellness. CMS also has responsibility for test ing innovative care and payment models and for overseeing the newly established state-based insurance exchanges.
From page 2...
... CMS asked the National Research Council to review its plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands. The recommendations and conclusions offered by the Committee on Future Information Architectures, Processes, and Strategies for the Centers for Medicare and Medicad Services cluster around the follow ing themes: (1)
From page 3...
... RECOGNIZE THAT A COMPREHENSIVE STRATEGIC TECHNOLOGY PLAN IS CENTRAL TO CMS'S MISSION AND EFFECTIVENESS The committee agrees with views it heard from CMS and others over the course of the study that the status quo is not a realistic option.
From page 4...
... In concert with the agency's strategic plan, a wellaligned strategic technology plan is also needed. A comprehensive strategic technology plan provides a vision to help guide an organization as it executes on programs and projects with a clear sense of strategic priorities, while minimizing the risk of wasting resources on applications and projects that are redundant.
From page 5...
... To balance the many crucial and changing demands to move the organization forward, strategic technology planning, coupled with a business-driven IT governance process, will be needed. Instituting strategic technology planning integrated with CMS business planning can serve as a catalyst that effec tively brings together the dynamics of cross-enterprise communication and summarizes key, relevant data to inform decision making.
From page 6...
... • Include an enterprise architecture framework; explicit prioritization and a roadmap; an assessment of human capital requirements; and periodic planned review and iteration of the plan itself. A strategic technology plan for CMS is needed against which to plan, act, and make ongoing refinements based on experience.
From page 7...
... These efforts should be well defined and constrained in scope and, to the extent possible, serve as a testing ground for longer-term strategic choices. EMBRACE A COMPREHENSIVE, INCREMENTAL, ITERATIVE, AND PHASED APPROACH A strategic technology plan lays a foundation and articulates a vision.
From page 8...
... Representatives of the relevant business roles and functions, as well as those with relevant technical specializations, should be involved in the process. Recommendation: CMS should plan and execute the incremental, iterative, and phased modernizations and/or transformations of its business systems and their corresponding information systems, documenting and integrating business and information technol ogy requirements within a comprehensive enterprise architecture framework.
From page 9...
... Recommendation: CMS should develop, implement, and maintain -- revising and updating on an ongoing basis -- an enterprise-wide health information model as the agency's authoritative information model representing the structure and content of all shared infor mation that is created, collected, maintained, used, and exchanged across the organization and with external partners. EMPHASIZE ACHIEVING CULTURAL AND ORGANIZATIONAL TRANSFORMATION The organizational environment and cultural acceptance of major changes in the roles, use, and architectural assumptions of IT systems and processes bear significantly on the success and effectiveness of mod ernization and transformation efforts.
From page 10...
... Recommendation: CMS should integrate high-level IT leadership into CMS's general strategic planning to ensure participation of IT and harmonization between the strategic technology plan and CMS's overall strategy at the highest levels of the agency. IT strategic planning requires engagement and ownership at the highest levels of the CMS organization and cannot be effectively driven by CMS's IT organizations alone.
From page 11...
... The governing body that serves this function should be led by a senior business leader at the agency, and members of the body should be drawn from the senior leadership team.1 The governance function should include business integration, alignment of business and IT, col laboration, strategic coordination, and planning -- rather than focusing solely on operational and technology considerations. This function should have primary responsibility for developing CMS's strategic technology plan, implementing the proposed meta-methodology, and managing the change process.
From page 12...
... Recommendation: CMS should rapidly and coherently continue to improve its overall information technology and business process governance structures and to better integrate them as follows: • The Office of Information Services should be fully involved from the start in discussions with CMS business units regarding new requirements, programs, and processes. • OIS should assume and be given more direct oversight and coordinating responsibility over the agency's enterprise IT resources, including coordination and communication of business requirements.
From page 13...
... To enable an effective response to the near and intermediate demands of payment reform and other responsibilities placed on CMS, these existing competencies should be strengthened. The evolving CMS mission hinges on public trust, and maintaining patient privacy and data security is one component of that trust.
From page 14...
... Informatics experts bring both technical knowledge of computing and communica tions and a health professional orientation -- many are also trained in one of the health professions, and all have substantial exposure to the processes, workflow, sources of error, and culture of health care as well as an understanding of the subtleties of real-world applications and their implications for quality of care and patient safety. Informatics organiza tions generally exist separately from the related IT organization and typically provide internal support in the form of analytical capabilities, taking into account the broad mandates and functions of an organization and tying them together both tactically and strategically, and they can help to bridge the technical and business functions of an enterprise.
From page 15...
... Data are essential to and underpin nearly all of the efforts CMS is undertaking -- and are an essential driver for the development of a CMS strategic technology plan, motivate the recommended meta-methodology, and are a key impetus for the organizational changes discussed above.
From page 16...
... Doing that incremental and ongo ing engagement is part of the committee's recommended approach and is essential to devising future mechanisms for data management. Recommendation: CMS's strategic technology plan should support CMS's own needs for data and also take into account use of CMS data by other authorized users for research and analytic purposes.
From page 17...
... Critically embedding IT in strategic conversations and planning at the agency is also essential. CMS should develop a comprehensive strategic technology plan that is well aligned with the agency's overall strategy and that embraces a comprehensive flexible, incremental, iterative, and phased approach to business process and system transformation, in the service of its important national mission.


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