Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services (2012) / Chapter Skim
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2 Toward a Comprehensive Strategic Technology Plan
2 Toward a Comprehensive Strategic Technology Plan
Pages 45-64
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From page 45... ...
and are increasing at a rate 1.1 percent above the rate of growth of GDP.2 Issues of health care quality, access, safety, and equity remain pressing concerns as well. Further, compared with health care delivery in other developed economies, the U.S.
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From page 46... ...
Central to the effort is that CMS develop a vision of its role in modern health care and strategies for realizing it -- an overall strategy for CMS as a whole, along with a strategic technology plan for comprehensive, incre mental development of effective information systems, and strategies for quickly addressing near-term issues. MOTIVATING MODERNIZATION AND TRANSFORMATION AT CMS For the purposes of this report the terms "modernization" and "transformation" refer to two ends of a spectrum of possible transitions for components and subcomponents of an information system.
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From page 47... ...
In order to continue to provide payments according to current requirements, to meet growing requirements for health-care-related data and analysis, and to support new payment models, CMS will have to modernize or transform at least some of its information systems. Complexity and Dynamism of the Health Care Enterprise Originally designed to perform straightforward Medicare eligibility determination and to manage and disburse health claim payments to hospitals and medical professionals,7 CMS's systems are now expected 6 Considered a successful implementation, the Medicare Part D program entailed complicated interconnections between several federal agencies and deployment of complex websites for users, and was implemented with all statutorily mandated functionality within the statutory deadlines.
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From page 48... ...
CMS's programs are thus entering a very dynamic phase, with many changes expected or anticipated, including: • A shift toward pay for performance or value and away from fee for service; • The need to manage and report on multiple "experiments" in reforming payment for delivery for health care, and potentially to scale them up more broadly depending on the results of the innovations; • The incorporation and use of some clinical data, and even population health data, obtained from a variety of sources such as electronic medical devices and electronic health record data whose collection is facilitated through HITECH; ally, MACs perform these functions for Parts A and B providers, FIs for Part A providers, and carriers for Part B providers. In 2003, the Medicare Modernization Act required the secretary to implement FFS contracting reform and to replace FIs and carriers with MACs by 2011.
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So-called coordination of care is central to all meaningful health care delivery models that are attempting to address cost issues, including patient-centered medical homes,8 accountable care organizations,9 and global payments.10 Coordination of care is key whether health care delivery models are sponsored by employers, private payers, public payers, or provider organizations. Any practical and scalable implementation of these models requires the exchange of electronic medical data.
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Although CMS's role and specific responsibilities with respect to such data are in flux, the agency clearly will have to be able to cope with changes in the broader health care system of which it is a part. In addition to anticipated changes to CMS's own programs are the significant changes that the broader health care, practice, and public policy environments are undergoing, including: • Ongoing evolution and increasing sophistication of technology and a constantly changing set of technical options; • An increasing need to manage the delivery of care based on medical advances empowered by genomics and proteomics; • An infrastructure involving widespread use of electronic health records and regional data repositories; 11 Institute of Medicine, 2011, Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary , Washington, D.C.: The National Academies Press, available at http://www.nap.edu/ catalog.php?
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From page 51... ...
. Increased efforts to reduce payment errors and fraud, among other needs, 14 Examples include updates to the various fee schedules used to determine provider payments such as for ambulance services; clinical laboratory testing; durable medical equipment, prosthetics, orthotics, and supplies; pharmaceutical reimbursements; and physicians fees schedule.
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From page 52... ...
In the past, researchers analyzing data files were required to perform extensive analysis related to beneficiary matching, deduplication, and merging of the files in preparation for their study analysis. With the CCW data, this preliminary linkage work is already accomplished and delivered as part of the data files sent to researchers." 16 See, for example, Edward Cone, 2002, "The Ugly History of Tool Development at the FAA," website "Baseline," available at http://www.baselinemag.com/c/a/ProjectsProcesses/The-Ugly-History-of-Tool-Development-at-the-FAA/, last accessed August 1, 2011; NRC, 2004, A Review of the FBI's Trilogy Information Technology Modernization Program, Washington, D.C.: The National Academies Press, available at http://www.nap.
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From page 53... ...
In recognition of the drawbacks and risks of the big bang approach, the committee urges that CMS pursue an incremental approach to the development of the information systems that will be needed. But the nature of this incremental approach requires careful consideration and planning.
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A strategy that emphasizes pursuing a comprehensive incremental approach to understanding and ultimately meeting the needs and requirements of CMS stakeholder communities and CMS internal business units will, in the committee's view, serve CMS and the country well. To be most effective, modernization and transformation efforts need to be focused on specific and concrete business issues and objectives, not on information technology per se.
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From page 55... ...
This new emphasis will likely entail developing new capabilities, such as mechanisms for devising and assessing approaches to defining and collecting the measurements that will be needed to support effective comparisons of cost and quality. More evidence-based medicine within a large-scale learning health care system17 may mean that CMS will have to be prepared to handle growing amounts of clinical information (Chapter 5 addresses this issue in more detail)
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This can be done most effectively through an incremental approach in which stakeholder communities are identified and engaged increasingly effectively over time. DEVELOPMENT OF A COMPREHENSIVE STRATEGIC TECHNOLOGY PLAN FOR CMS Information technology, medical technology, the shape and form of the U.S.
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The plan, which will of necessity be iterated as CMS's mission and the broader environment within which it operates continue to change, should be developed incrementally, guided in part by the impacts, results, and acceptance within the relevant stakeholder communities of initial efforts and systems. In the committee's view, development of a CMS strategic technology plan is critical.
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In addition to incorporating the principles outlined above, a strategic technology plan should also include four key components: an enterprise architecture framework, explicit priorities and a roadmap, human capital requirements, and periodic planned review and iteration of the plan itself -- each discussed in more detail below. Enterprise Architecture Framework The environment in which CMS operates is large, complex, and challenging.
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-- and the committee's recommended approach reflects some of the foundational concepts articulated by Zachman, namely: begin with an overall CMS strategic plan, translate its priorities to a set of future target/re-engineered business processes, and ensure that the business processes drive the information ecosystems' modernization or transformation. It is the complexity of ensuring that different aspects of an enterprise maintain an overall integrated approach that drives the need for a dis ciplined and coherent approach to IT modernization or transformation.
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A CMS strategic technology plan should outline what types of personnel will be needed for the future (for example, clinical informaticians, data architects, and so on) and articu late a strategy for obtaining those skills.
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Periodic Planned Review Multiyear plans are inevitably subject to modification based on changing priorities and a changing landscape of technology, policy, and on-the-ground exigencies. A strategic technology plan must account for uncertainties and evolution in a rapidly evolving health care delivery and payment system as well as changes to and uncertainties about CMS's role.
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CMS should instead plan for continuous iteration, and should be guided by the continuous pursuit of an increasingly broad and well-articulated global view -- expressed as its strategic technology plan -- of both its business and the systems that support the satisfaction of its business requirements. Chapter 3 addresses operationalizing this approach in more detail.
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From page 63... ...
• Develop and implement processes for CMS to collect needed data from clinical registries, electronic health records where they exist, and patient surveys.
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From page 64... ...
64 STRATEGIES AND PRIORITIES FOR INFORMATION TECHNOLOGY AT CMS The enormous challenge of moving from a siloed set of information ecosystems to information ecosystems that can support the needs of new applications and new requirements cannot be underestimated. Chapter 3 provides guidance in the form of a meta-methodology for planning a comprehensive incremental modernization and transformation of CMS systems.
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