From Field to Fed II March 9th, 2011 Wednesday’s Presentations
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From Field to Fed IIMarch 9th, 2011
Wednesday’s Presentations
Building Interoperability To Scale: Strategic Considerations
Linda GibbsNew York City Deputy Mayor
NYC HHS Connect
William A. Hazel, Jr., MDSecretary of Health & Human Resources
Commonwealth of Virginia
Stewards of Change ConferenceMarch 9, 2011
Linda GibbsDeputy Mayor for Health and Human Services
HHS-Connect Vision
Guiding Principles• Establish a Client-Centric Approach• Increase and Manage Accessibility of Information• Improve Accountability• Utilize Modern and Flexible Technology
Roadmap• Published December 2007
To break information silos through the use of modernized technology and coordinated agency practices to more efficiently and effectively provide
Health and Human Services to New Yorkers.
• Over 130 people from 17 different agencies participated in this intensive three month process to develop a Roadmap with specific projects.
The Process
HHS-Connect Governance
Mayoral Executive Order #114 signed March 18, 2008– Formalizes Bloomberg Administration’s commitment
Created an Office of the CIO under the Deputy Mayor– Eight HHS agencies in three sub-domains: Human
Services, Health and Criminal Justice– Technology strategy and architecture for the domain
Created an Executive Board– Includes all HHS Commissioners and OMB and DOITT– Signed charter document committing to full participation
and advancing goals
The program focuses on technology solutions to “connect the dots” between agencies, providers, and clients.
HHS-Connect Governance
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HHS Agency Commissioners DoITT and OMB
HHS-Connect Team
DM Linda Gibbs, Chair/SponsorExecutive Steering Committee
Executive Leadership
Enterprise Solutions Delivery
Enterprise Architecture
NPV
Executive Director/Co-Chairand HHS CIO
HHS Software Architect
SI Team:Project ManagementTechnology SupportFunctional Support
PMQA Team:Project MonitoringQuality AssuranceTechnical and Functional Advice
Policy & Legal
Key City Positions
Director ofAdministration
Director ofClient Solutions
Outcome Model
Cross-Agency Workgroups and Subcommittees
Policy & Legal
Business Intelligence
Performance Management
Budget & Finance
Project Managers
Initiatives
Foundational Delivery Case Management Delivery
Worker Connect
Common Client Index Document Management
Access NYC/ Online Applications
Security Project n
DHS
DOC Project n
ACS
Director of Policy and Legal
Accomplishments to Date
7
Quick WinsClient Portal
• 311 Content Integration• Online benefits screening• Select online applications
Worker Connect6200 + Provisioned
Users
Common Client Index
5 Source Systems
Federated Document
Management32 Million Documents
Enterprise Case Management
Build/test underway (DHS)
Foundational ProgramsEnterprise Architecture•Application, Business, Technical, and Information Architecture
•Solution Architecture and Demand Management Governance
Security•User Provisioning
•Access Management
•Security Architecture Framework
•Data Classification
•NIEM/standard
Infrastructure•Build out of ACCESS NYC
•Use of highly virtualized infrastructure
Program Management Office•HHS-Connect Outcome Model
•Net Present Value (NPV) model developed
Policy & Legal•Policy and Legal Sub-committee established
•Policy and Legal framework identified
Worker Connect: Integrating HHS-Connect Initiatives
8
Worker Connect
CCI
Doc. Mgmt.
Document Management
• Improve quality, timeliness and consistency of information about a person, family or household
• Reduce requests for clients to provide documents at multiple agencies
• Enable worker access to documents related to a client collected by HHS agencies
• Improve the quality of client service by providing a more complete view of the person, family or household and the services they receive
• Improve timeliness of action based on client provided documents
Common Client Index (CCI)
• Enable agencies to utilize CCI as a central source of client information
• Identify common clients across CCI affiliated agency systems
• Improve collaboration and communication between agencies that provide services or assistance to a person or a family
• Provide administrators with access to alerts about client data changes and matches
• Support data consistency between agencies, enable eventual convergence of data
• Link up with Worker Portal and Document Management, to provide client data to Case Workers.
Worker Connect
9
The Worker Connect System is a Web-based system developed by HHS-Connect that enables employees of the City of New York’s Health and Human Services agencies to share client data. Client search uses CCI matching methods, then permits real-time retrieval of program data or documents.
10 Agencies currently accessing information from 5 contributing agencies:• Administration for Children Services – Child Care• Department of Homeless Services – Families in Shelter• Department of Finance – Senior/Disabled Rent Increase Exemption• New York City Housing Authority – Public Housing• Human Resources Administration – Food Stamps, Cash Assistance,
Worker Connect allows workers access to 15 client-provided document types from HRA’s repository.
Worker Connect Adoption Progress: Users
10
Worker Connect Adoption Progress: Transactions
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Future: Roadmap 2.0 Published December 2010
12
• Increasing the power and utility of Worker Connect
• Expanding access to online applications via ACCESS NYC
• Expanding enterprise case management
• Developing a social enterprise analytics capability
• Facilitating cross-agency service coordination
• Integrating the procure-to-claim process through cross-enterprise data exchange
Roadmap 2.0 – Key Initiatives
Governance: Cross-agency team to deal with the most complex and high priority cases.
Executive buy-in and supports. A team overseeing the technology and data integrity
Customers: Case workers: Decision-making support through the use of the “early identification alerts” (EIA)Policy Makers: More timely, complete information available for decision-makingClients: improved outcomes, more integrated services. Easier navigation of City. Taxpayers: Efficient use of City tax levy.
Information: Data sharing policies across agencies (not just between) with a common MOU. Best practices charter to ensure the appropriate analytical approach.
Future: Center for Innovation through Data Intelligence
Strategy and VisionUtilizing historical and real-time data across agencies to drive
more efficient and effective policy and practice
People: CIDI needs to impact front-line practice for case workers. (Example: early identification alerts available to case workers.)
Empower HHS agencies to provide more strategic services across multiple agencies to the clients most at-risk.
1. Develop risk models to identify high risk and high priority clients.
2. Break down the legal and regulatory barriers to sharing data across agencies
High Level Conceptual Architecture
14
Building Interoperability To Scale: Strategic Considerations
William A. Hazel, Jr., MDSecretary of Health & Human Resources
Commonwealth of Virginia
As-Is: Today’s Challenges…
To-Be: Transitional Next Step
Workflow Engine
Business Rules
Engine
Enterprise Service Bus
Master Data Management
Data Warehouse
DocumentManagement
Agency Legacy
SystemsAgency Data
Agency Legacy
SystemsAgency Data
Agency Legacy
SystemsAgency Data
Agency Legacy
SystemsAgency Data
Agency Legacy
SystemsAgency Data
Commercial Service Oriented Architecture products
Standards Compliant Interfaces
Health Benefit Exchange
Citizen Centric Portal
Self-Directed Services
Agencies Assisted Services
System Supported
Health Information Exchange
To-Be
Workflow Engine
Business Rules
Engine
Enterprise Service Bus
Master Data Management
Data Warehouse
DocumentManagement
Commercial Service Oriented Architecture products
Health Benefit Exchange
Citizen Centric Portal
Self-Directed Services
Agencies Assisted Services
Health Information Exchange
Local Government
Non-Government Organization
Commercial Trading Partners
Federal Government
Agency DataAgency
Data Agency Web Application/
ServicesAgency Web Application/
ServicesAgency Web Application/
Services
Interoperability Trends and Strategies Within Health and Human Services and the Expected Impact on the Future of Services Integration,
Operations and Client Outcomes
John TeeterDeputy Chief Information Officer
Department of Health and Human Services
CHIEF INFORMATION OFFICERDEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF THE
U . S . D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S
John TeeterDeputy Chief Information OfficerU.S. Department of Health and Human Services
20
Interoperability, Information Sharing,
and Governance at HHS
Transform Health Care Implement the Recovery Act Promote Early Childhood Health and Development Help Americans Achieve and Maintain Healthy Weight Prevent and Reduce Tobacco Use Protect the Health and Safety of Americans in Public Health Emergencies Accelerate the Process of Scientific Discovery to Improve Patient Care Implement a 21st Century Food Safety System Ensure Program Integrity and Responsible Stewardship
21
HHS’ Priorities
• Interoperability and information sharing is key to many of HHS’ priorities
• HHS should lead the way in promoting interoperability in the Federal, State, and Public sector
22
How do we manage our large and complex business areas that impact how we do business, the industry we interact
with, and ultimately the American people?
The HHS Domains
Domain: A domain can be defined as a sphere of
activity, concern, or function.
For purposes of NIEM, a domain refers to a business enterprise
broadly reflecting the agencies, units of government, operational
functions, services, and information systems which are
more or less organized or affiliated to meet common
objectives.23
Introduce, define, and build HHS
domains
National Information Exchange Model
• Establish Health Domain• Coordinating Committee• Health IT Steering Committee• Define NIEM Health Domain
• Evolve metadata specification standards (Semantic web)
• Leverage the Standard Web API
• Establish NIEM Human Services Domain• Coordinating Committee• Human Services IT Steering Committee• Define NIEM Human Services Domain
24
25
Example: the Health Domain – Concept view
Health Domain Governance Framework
Enterprise Performance Life Cycle (EPLC)
26
Promote the advancement of the Health, Safety, and Well-Being of the American People. Propose IT initiatives across HHS that effectively support the successful implementation of the
Secretary’s strategic priorities for health transformation; including policy implementation and cross-agency issues.
Propose and approve the health reform architecture, technology products, services, and programs to benefit HHS, Health Reform, and the Health Domain at large.
Maintain a controlled process for evaluating IT investments and prioritizing the investments against the organizational mission.
Serve as the IT Review Board for the Health Domain.
Advance IT related investments to support the Health Domain. Supports the HRITSC through evaluations of IT investments based on business need,
alternatives, value, cost, architectural impact and required support. Reviews and approves OPDIV and STAFFDIV IT investments and projects at key points in the
EPLC to ensure optimization of effort and investment in support of interoperability, shared services and data management across HHS
Perform business, technology, security, and architecture reviews at the Operating Division level and coordinate with the Health Reform IT PMO.
Comply with EPLC and the architecture approved by the HRITSC Work with Project Teams to refine business needs and adjust investment priorities at the
Operating Division level
Develop project plans that satisfy defined business needs and complies with the HRITSC approved architecture.
Manage projects within the cost and schedule approved by the HRITSC Coordinate with other project teams across the health domain
Health Reform IT PMO
Health Reform IT Steering Committee
(HRITSC)
Health Vision Strategy Group
REQUIREMENTS
HHS
OPD
IVs &
STA
FFDI
Vs
Project TeamProject TeamProject Team
Integrated Project Teams
Integrated Project Teams
Integrated Project Teams
Other Critical Partners: CIO Council Data Review Team
Service Oriented Architecture Review Team Business Process Review Team
Example: Health Domain Mission
• Promote the advancement of the Health, Safety, and Well-Being of the American People.
• Propose IT initiatives across HHS that effectively support the successful implementation of the Secretary’s strategic priorities for health transformation; including policy implementation and cross-agency issues.
• Ensures accountability for health IT programs in the effort to advance interoperability
• Ensure process streamlining through the application of enterprise architecture
• Coordinate and improve services
• Foster health IT collaboration and participation
2727
What Are We Striving For?
• A Nationwide electronic health information exchange capability that provides the best opportunity for each patient to receive optimal care.• Complete, accurate, and searchable health information,
available at point of diagnosis and care, allowing for more informed decision-making
• Better communication between clinicians and patients
• More efficient and convenient delivery of care
• Earlier diagnosis and characterization of disease, with the potential to improve outcomes and reduce costs
• Reductions in adverse events
• Increased efficiencies related to administrative tasks
2828
Nationwide Health Information Network
Expansion of standards and specifications definitions Implementation guides Testing frameworks
• Health community can utilize NHIN deliverables to accelerate health information capacity
• Adopt data and technical standards for health IT• Participate in efforts to prove capabilities and fill solution
gaps• Work to promote interoperability among regional, state,
and local health exchanges• Provide service built on standards & specifications• Add industry services to service library
29
National Information Exchange Model
• Partnership of the Department of Justice and the Department of Homeland Security
• Develop and support enterprise-wide information exchange by:
– Standards: data formatted in a semantically consistent way
– Processes: common semantic understanding among participating organizations
– Result: information sharing, focusing on information exchanged among organizations as part of their business practices
30
http://www.niem.gov/ http://it.ojp.gov/default.aspx
31
Relevance to HHS
Medicare fraud prevention and detection, child support enforcement
Health Care Eligibility Benefit Inquiry and Response (Medicare), Immunization data and patient charts (Indian Health Service)
“Child Support Order”, “Prescription Drug Monitoring Information Exchange”, “Psychiatric Assessment”
Department of Justice, Department of Homeland Security, state, local, tribal governments
Health IT Standards Committee, “Planning and Accountability” Domain
Improve sharing of critical information
Develop standardized automated information exchanges with their partners
Save time and resources by reusing existing information exchange specifications
Engage new information exchange partners in the future
Contribute to shaping nationwide standards for information sharing
NIEM Value Proposition
Evolution of NIEM
32
• Evolve metadata specification standards– To embrace the Semantic Web languages
• That provide a Uniform Data Model • Across all Gov info domains
– Enabling easier Dataset Assimilation• Realizing cross domain correlation via ‘bridge’ ontologies or
‘connector’ metadata• Uniform processing and persistence of any info domain
• Leverage the Standard Web API– Add REST to existing RPC service implementations
• Uniform interface for metadata and dataset access (via HTTP)• Uniform query points (via SPARQL endpoints)
Semantics (Ontology, Metamodel)
33
• Domain specific standards evolve independently– Each authoritative domain stewards their published metadata standards and
corresponding instance datasets on the Web– Metadata and instance datasets are cumulative, where one publisher reuses
and extends other published metadata and datasets• The Federated Data Portfolio implements a shared storage service
– Aggregating independently published datasets from agency.gov/open sites – Assimilating their instance data via bridge or connector metadata for cross
domain correlation• Open Gov Directive
– Participation with and by external dataset consumers– Collaboration for domain and cross domain correlation standards
• NIEM Governance and Momentum– Leverages existing NIEM constructs but lowers coordination cost
34
NIEM & Standards for the Health Domain
Context (Information Model) Standards
Information Interchange
Terminology
Security & Privacy
Functionality and Process
Identifier Standards for Individuals and Organizations34
ACA: Community Living Assistance Service & Support (CLASS) View
Enrollment
SSAAuthoritative data source
35
THIRD PARTYEmployer/Broker
HHSAuthoritative data source
CUSTOMERS
EducationAuthoritative data source
TREASURYIRS & FMS
Authoritative data source
NIEM: Help define IEPD’s information content & structure
ACA: Health Insurance Exchange View
Enrollment
SSAAuthoritative data source
36
THIRD PARTY
TREASURYIRS & FMS
Authoritative data source
HHSAuthoritative data source
CUSTOMERS
DHSAuthoritative data source
Improve service architecture
• Documented current architecture• Catalog current services• Standardize, consolidate, automate,
move to the cloud• Improve service performance
37
Electronic Health Records
• Encourage adoption and use of electronic health records by care providers, and of personal health records by individuals.
• Complete, accurate, and searchable health information, available at point of diagnosis and care, allowing for more informed decision-making
• Facilitate better communication between clinicians and patients
• Make delivery of care more efficient and convenient
• Earlier diagnosis and characterization of disease, with the potential to improve outcomes and reduce costs
• Nationwide health information exchange capability to provide the best opportunity for each patient to receive optimal care – if data cannot be accessed and exchanged, it isn’t useful
38
The Electronic Health Records challenge
Source: CDC NCHS Health E-Stat - Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm#fig1
Percentage of office-based physicians with electronic medical records/EHR 2001-2009 and preliminary 2010
39 39
Public Health (Food/Product Safety)
• Data comes from many sources (surveillance, research, cohort, non-human, payer/provider, etc.) and huge variation in scope, definition, methodology, etc.
• High degree of data manipulation, documentation and quality assurance involved in order to prepare data for analysis
• High-degree of duplication and lack of coordination
Better collaboration
40
Public Health (Food/Product Safety)
41
Apply Open Government to Domains
42
• Foster transparency within:– Continue to publish data by embedding the identification,
prioritization, and publishing of datasets and tools in existing HHS’s processes
• Encourage collaboration & participation with other agencies, industry, and the public
• Semantic Web• Flagship initiatives:
– CMS Dashboard– FDA Basics & FDA TRACK (performance management system)
• Community Health Data Initiative
Improve IT Governance for Domains
• Implement 25 Point IT reform– Improve efficiency and effectiveness of IT management in
government• Enterprise Performance Life Cycle (EPLC)
– Continue to standardize effective processes, to improve project execution and performance
– Flexibility required to accommodate legacy as well as new technologies and solutions
• Risk Management– Adopt formal risk-based decision making processes– Designate executive risk management role (potentially
multiple individuals)
43
Program Goals & Objectives
HHS IT Portfolio
C&A Maintenance
Select / Reselect EvaluateControl
Security Testing, C&ASecurity Planning
EA
Security
CPIC
EPLC
Stage Gates
Preliminary MaintenanceAcquisition DevelopmentACQ
Planning Requirements Analysis Design TestDevelopment Implementation Operations &
Maintenance DispositionConceptInitiation
Follow the EPLC within Domains
The EPLC includes Other Critical Partner / Stakeholder Functions
1 3 42Preliminary
Design ReviewSelection Review
Baseline Review
Operational Design Review
OperationsSolution Development RetirementSolution Architecture Development
INTE
GR
ATI
ON
PROGRAM GOALS & OBJECTIVESHHS IT PORTFOLIO
44Can be delegatedIT Governance Organization Led
Common Themes• Encourage compliant and interoperable
services and tools• Be proactive with voluntary standards and
initiatives• Seek innovative ideas• Get the public and industry involved:
– Collaborate– Participate– Provide Feedback
45
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QUESTIONS ?
John TeeterDeputy Chief Information OfficerU.S. Department of Health and Human Services
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