Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services (2012) / Chapter Skim
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4 Achieving Cultural and Organizational Transformation
4 Achieving Cultural and Organizational Transformation
Pages 77-106
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From page 77... ...
If the need for modernization or outright transformation is poorly understood, especially by orga nizational leaders as well as by the users and stakeholders who will be most affected, even the best-intended and well-designed projects can be unsuccessful. Achieving the kinds of changes in CMS's business and information ecosystems outlined in previous chapters will require both internal CMS organizational adaptations and a cultural adaptation embracing the notion that CMS's business functions are intrinsically tied to IT.
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From page 78... ...
. Considering the centrality of IT as an element in, and enhancement to, a transformation in CMS's organization and culture, the committee in this chapter summarizes CMS's current organization and relationships and describes what an IT-enhanced enterprise within CMS might look like, offers suggestions for aligning overall strategic goals and resources to achieve the needed organizational transformation, discusses the importance of leadership and innovation, and outlines some guiding principles along with a roadmap for cultural and organizational transformation at CMS.
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From page 79... ...
in just over 6 weeks; • Implemented the Health Insurance Portability and Accountability Act-com pliant eligibility transaction system, which processes and responds to more than 300 million eligibility requests annually; • Implemented the CMS Virtual Call Center strategy in support of users of the toll-free number 1-800-Medicare; and • Developed and implemented numerous "compare" tools for the Medicare websites. the Department of Veterans Affairs' clinical services at all its hospitals and clinics as a result of the federal program's effective design, development, and deployment of its transformational electronic health record system known as VISTA.3 The past 10 years have also seen a number of important CMS achievements in the IT arena, several of which are listed in Box 4.1.
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From page 80... ...
, and technology -- all while under intense public scrutiny, and coping with federal funding idiosyncrasies and frequent transitions in leadership. In the committee's view, five related cultural and organizational transitions at CMS would have positive repercussions for nearly all of CMS's activities, given the centrality of data, IT, information, and information management to the agency's mission: • A cultural shift from viewing IT as simply an operational necessity to embracing IT as a critical strategic element; • A cultural shift away from viewing IT leadership as overseeing a support group, complementing but not an integral part of the leadership mainstream, and toward viewing IT leadership as playing a key role in planning, designing solutions, and advising CMS business leaders regarding suitable approaches to their own responsibilities; • An organizational shift from a mission centered on transaction processing to a mission centered on data, information, and information management; • An organizational shift from a focus on paying claims to a focus on driving a combination of payment with improvements in quality, safety, and equity of health care and outcomes for individuals and populations; and • An organizational shift from relying on heroics from IT staff to securing a sustained investment in and commitment to infrastructure, resources, and staff.
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From page 81... ...
, headed by a director who also serves as the agency's chief information officer. The OIS is orga nized into several units, including enterprise data, business applications management, information services design and development, an enterprise data center, an enterprise architecture and strategy group, consumer information and insurance systems, and resource and acquisition man agement.
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From page 82... ...
82 STRATEGIES AND PRIORITIES FOR INFORMATION TECHNOLOGY AT CMS BOX 4.2 CMS Regions, Centers, and Offices Regions • Region I -- Boston (Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont) • Region II -- New York City (New Jersey, New York, U.S.
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From page 83... ...
In addition to the Center for Medicare and the Center for Medicaid, CHIP and Survey & Certification, other centers and offices with a significant role in IT include:7 • Center for Strategic Planning, which provides senior leadership across the organization for strategic planning and the development of CMS strategic goals, using metrics to facilitate plans for IT integration of data resources. The center is also responsible for providing leadership in the development of performance dashboards and databases for key agency initiatives; maintaining and ensuring the quality of data resources 7 CMS, 2011, "Overview: CMS Leadership," website, available at http://www.cms.gov/ CMSLeadership/Downloads/CMS_Organizational_Chart.pdf, last accessed August 1, 2011.
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From page 84... ...
Dir. DEPUTY CHIEF OPERATING OFFICER Vish Sankaran SENIOR ADVISOR OFFICE OF CLINICAL STANDARDS AND QUALITY TRIBAL AFFAIRS Joseph McCannon Patrick Conway, M.D., Director GROUP SENIOR ADVISOR & CMS Chief Medical Officer Wesley Perich, Dep.
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From page 85... ...
• Develops application development platform standards and policies for use by internal CMS staff and contractor agents in such areas as applications development and the use of infrastructure resources. • Manages and directs the operation of CMS hardware infrastructure, includ ing the agency's data center, data communications networks, enterprise infrastruc ture, voice/data switch, audio conferencing, and other data centers supporting CMS programs.
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From page 86... ...
• Office of e-Health Standards and Services, which, in addition to having primary responsibility for developing regulations and guidance materials related to the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPPA; P.L.
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serve as management authorities, providing senior management leadership for the successful and timely completion of IT projects to meet business needs. Each ESC provides management oversight and guidance to project owners/man agers and project officers and makes final decisions on the priority, risk, 8 ThePatient Protection and Affordable Care Act of 2010 (P.L.
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From page 88... ...
chief information officer calls for a series of concrete steps to improve how IT projects are staffed, managed, and completed and urges the elimination of barriers to agencies' ability to leverage IT 10 Vivek Kundra, 2010, 25 Point Implementation Plan to Reform Federal Information Technology Management, December 9, Washington, D.C.: White House, Office of the Chief Information Officer, available at http://www.cio.gov/documents/25-Point-Implementation-Plan-toReform-Federal%20IT.pdf, last accessed July 28, 2011.
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From page 89... ...
The committee believes that embracing the spirit of these steps, in particular in the areas of strengthening program management and streamlining government and improving accountability, may assist CMS in achieving needed cultural and organi zational transformation. A number of the strategic goals and objectives contained in the 20102015 HHS Strategic Plan11 may also assist CMS's cultural and organizational transformation -- in particular, strategic goals 4 and 5: • Strategic Goal 4 -- Increasing efficiency, transparency, and accountability of HHS programs, including ensuring program integrity and responsible stewardship of resources, fighting fraud and working to eliminate improper payments, using HHS data to improve the health and well-being of the American people, and improving HHS environmental, energy, and economic performance to promote sustainability.
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From page 90... ...
Concrete examples of how such a transition will manifest itself include increased general knowledge across CMS about the types of data that are available, enhanced ability to access the data, and deepened knowledge of how to use CMS IT systems to implement programmatic changes. As discussed in Chapters 2 and 3, CMS should develop a comprehensive strategic technology plan to help drive its enterprise architecture framework.
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From page 91... ...
If all such tasks cannot be accomplished in the desired time frames, an IT department may be viewed by business units as unresponsive, failing to serve its "custom ers," and obstructing progress. Unlike the case in industry, many of CMS's most important strategic goals are set legislatively, with mission and timeline mandated across all CMS units, including IT.
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From page 92... ...
Both planning meetings about long-term strategic goals and day-to-day planning meetings regarding business requirements and the feasibility of particular IT solutions should involve and expect the contributions of IT leadership. As with development of the strategic tech nology plan as a whole, these processes must be iterative as experience is gained and as new requirements arise.
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From page 93... ...
Informaticians are a new breed of health professionals imbued with the culture of health care who understand the decision-making processes in health care environments and the subtleties of real-world applications, culture, workflow, and ultimately quality and safety issues, and their understanding is enhanced by a technology perspective that a quality-focused group alone might not bring. As is the case in academic health centers and large health systems that have invested heavily in the development of informatics expertise, the informatics group should interact closely with the IT organization, but it should serve a design, planning, and cultural function, helping to define, maintain, and execute an enterprise-wide informatics agenda that is closely coupled with the organization's overall mission and goals.18 Synergies between informatics experts and the IT organization have been broadly recognized, leading, for example, to the creation of the chief medical information officer (CMIO)
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From page 94... ...
Chapter 3 presents a meta-methodology for CMS's modernization or transformation of its business and information ecosystems over the coming years. As noted there, one element in that process, which extends beyond current work on data modeling, will be a consistent health information model that can guide all work and ensure uniform conventions to support system integration and standardization, such as the Veterans Health Administration health information model that underlies a broad array of health-related applications and services.20 The development and maintenance of a health information model that meets the needs of CMS and its stakeholders is a complex informatics task that highlights the need for informatics expertise within CMS.
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From page 95... ...
require not only policy makers but also experts on clinical data management, the advent of genomic medicine, electronic health records, standards, integration, data protection and security, privacy, and models for secondary data use and stewardship. This is the purview of the field of informatics, and the Innovation Center would benefit greatly from enhancing its portfolio of projects and available expertise in this area, ideally through relationships with a new CMS informatics unit as suggested above.
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From page 96... ...
CMS IT transformation is not solely a technical issue but is also a critical business issue and thus must be owned by CMS top management. Emphasized above in this chapter are the roles of CMS leadership in the modernization and transformation of CMS business and information ecosystems.
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From page 97... ...
? High-level governance should ensure that the efforts toward business and information ecosystems modernization and transformation achieve CMS's goals.
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From page 98... ...
Enterprise architecture and health information model governance defines the architecture and model, monitors conformance, and evolves the architecture and model as appropriate. The enterprise architecture governance defines the enterprise architecture framework, including all relevant standards, monitors conformance to standards, and evolves the framework.
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From page 99... ...
Regardless, given the importance of the transformation, the CMS business leadership should be an integral part of the IT governance function. Organizations cannot accomplish the large-scale modernization or transformation of core business and information ecosystems without the effective utilization of outside expertise.
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The roles of the technology strategy function and chief information officer should be strengthened, and they should be responsible for guiding and managing the enterprise techni cal architecture and contributing to the strategic and tactical decisions
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From page 101... ...
Appropriate leadership and strategic guidance from within the agency are critical to ensuring that the needed cultural changes propagate through CMS's contractor community as well. The ability to manage subcontractors is critical, but so is the ability to manage and respond to internal CMS organizational and cultural issues.
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From page 102... ...
These three areas -- formal design, political considerations, and culture -- need to change in concert for significant organizational change to be effective. Organizational change need not be precipitated by the implementation of an information ecosystem, but invariably new information ecosystems are required to enable the change.26 Managing significant change has several necessary aspects: 27 • Leadership.
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From page 103... ...
Plans describe the tasks and task sequences necessary to effect a change. Tasks, which can range from redesigning forms to managing the staged implementation of information ecosystems to retraining staff, must be allotted resources, and staff accountable for the performance of the tasks must be designated.
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From page 104... ...
These basic steps in managing large-scale change will require the focused attention of the CMS leadership and the involvement of all CMS staff and its contractors. Factors That Contribute to Successful Organizational Transformations Transformation of the role and contribution of IT at CMS requires that the leadership skillfully manage the necessary changes in processes, cul ture, and technology.
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From page 105... ...
105 ACHIEVING CULTURAL AND ORGANIZATIONAL TRANSFORMATION ship changes over the course of a transformation, such as those experi enced by CMS, are an impediment to success. Resources Sufficient for the Task The transition of major application systems and infrastructure has costs that include the new system infrastructure, external implementa tion assistance, and the time and management attention of organization members who have been assigned the tasks of guiding and designing the new system.
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From page 106... ...
106 STRATEGIES AND PRIORITIES FOR INFORMATION TECHNOLOGY AT CMS An analysis of the risks associated with an initiative should be con ducted and frequently updated. Such an analysis would identify the more significant risks, develop plans to mitigate risk should it occur, and devise means to track whether a risk is materializing.
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