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.)



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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.) 15

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