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Suggested Citation:"5 Concluding Observations." National Research Council. 2010. Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services: An Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/13061.
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5
Concluding Observations

Following are the preliminary observations of the committee at the conclusion of the first phase of its study on information technology needs and priorities at the Centers for Medicare and Medicaid Services. The observations address three broad categories: (1) emerging requirements for information, (2) challenges involving the transformation of enterprise data and technology management, and (3) organization, administrative, and cultural changes.

  • The collection, management, dissemination, and analysis of data and information products on clinical care and health care outcomes are fundamentally different from CMS’s historical claims-processing and claims-payment activities. Neither the current business process of CMS nor its information technology systems appear to have been architected to support these new activities effectively.

  • In particular, the IT systems of CMS do not appear to have been designed to provide the flexibility or evolvability that are likely to be necessary for CMS to meet its significant new and characteristically different obligations even as it maintains and improves service levels for its traditional functions.

  • Large-scale transformations of the sort that CMS is expected to undertake require both substantial organizational commitment and the full integration of the IT leadership of the transformation process into the highest levels of strategic planning.

  • Organizations that successfully transform themselves tend to focus on reengineering their processes at least as much as on re-architecting their systems.

  • Even the best-managed and best-resourced transformation of large-scale IT systems is well known to be risky.1 The risk grows only if the resources available to support the transformation are insufficient or if the requirements for the transformation are poorly understood or unstable.

1

An example of a government program of similar scope that has experienced significant cost overruns and failure to meet any objectives on deadline is the Federal Aviation Administration’s systems modernization program, which began in 1981 and has yet to be completed. Although this program has recently been moved from the Government Accountability Office’s “high risk” list, it has a long way to go to meet its goals. Among the shortcomings of this program were a lack of an institutionalized architecture, incomplete investment management processes, and an organizational culture that impaired modernization efforts. (See, Government Accountability Office, High Risk Series: An Update, GAO-09-271, Washington, D.C., January 2009.)

Suggested Citation:"5 Concluding Observations." National Research Council. 2010. Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services: An Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/13061.
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Suggested Citation:"5 Concluding Observations." National Research Council. 2010. Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services: An Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/13061.
×
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Suggested Citation:"5 Concluding Observations." National Research Council. 2010. Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services: An Interim Report. Washington, DC: The National Academies Press. doi: 10.17226/13061.
×
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Increasingly, the core mission of the Centers for Medicare and Medicaid Services (CMS), an agency of the Department of Health and Human Services, is expanding from one of focusing on prompt claims payment to one of becoming more broadly involved in improving health care quality and efficiency. The requirements for the information technology (IT) systems of CMS are changing as its mission changes, and the efforts to evolve its systems from those designed to support the agency's historical mission come in the midst of a push to modernize the nation's health care IT more broadly. These new challenges arise even as CMS must meet challenging day-to-day operational requirements and make frequent adjustments to its business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements.

In light of these and other emerging challenges, CMS asked the National Research Council to conduct a study that would lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and information technology requirements.

The study is being conducted in two phases. The first, resulting in the present volume, draws on a series of teleconferences, briefings, and an information-gathering workshop held in Washington, D.C., on September 27-28, 2010. The second phase, drawing on that workshop and on additional briefings, site visits, and committee deliberations, will result in a final report with recommendations, to be issued at the end of the project in 2011.

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