promotion of the meaningful use of electronic health records (EHRs), and it charges CMS with monitoring and auditing the implementation of associated meaningful-use criteria.3

Meeting historical, emerging, and future requirements will depend heavily on the ability of CMS to evolve its information systems and software to provide the needed functionality, fraud prevention, assurance of information security and confidentiality, and interoperability—internally as well as with current and future external IT systems. In working to meet historical, emerging, and future requirements, CMS faces a clear tension between its continuing mission to be an efficient claims-payment organization and its newly mandated mission to be a significant driver in transforming the U.S. health care system. This challenge and tension play out at multiple levels—from the policy level to the levels of management structure and business process and system architecture.

In terms of ongoing operational requirements, CMS must continue to handle a very large volume of claims and other activities in a timely and secure manner even as regular changes to statutes and regulations mean that business processes, software code, databases, and systems must be adjusted frequently, and sometimes substantially. These ongoing operational requirements are currently being met with a very large and complex information technology infrastructure that incorporates hardware, software, and communications systems that vary considerably in age, capability, and sophistication. The ability of this infrastructure to continue to keep up with the ongoing changes demanded of it—particularly as the agency takes on its newly mandated leading role in modernizing the nation’s health care system and underlying health information technology—is an understandable source of concern.

For strategic advice on addressing these and future challenges, CMS requested that the National Research Council (NRC) conduct a study that would lay out a long-term, forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and IT requirements. This interim report, presented at the conclusion of the first of the study’s two phases, presents the very preliminary observations of the study committee—the NRC’s Committee on Future Information Architectures, Processes, and Strategies for the Centers for Medicare and Medicaid Services—with respect to the new demands on CMS and areas in which changes will be needed. These observations are organized in three broad categories: (1) emerging requirements for information; (2) challenges involving the transformation of enterprise data and technology management; and (3) organizational, administrative, and cultural challenges.


 The HITECH Act of 2009 promotes the adoption and “meaningful use” of EHRs by eligible professionals and hospitals. Professionals and hospitals receive incentive payments if they adopt the use of electronic health records and carry out a series of measurable objectives intended to ensure that the systems are used to improve the quality and efficiency of care. The meaningful-use objectives are framed as being relevant to quality, safety, efficiency, and the reduction of disparities; patient and family engagement; care coordination; population and public health; and privacy and security. Examples of these objectives include using computerized provider order entries, reporting on specific clinical quality metrics, and providing clinical information to patients. Professionals and hospitals can request incentive payments in 2011 by attesting to achieving the objectives, and they must submit their measures to CMS electronically by 2012. Starting in 2015, penalties are to be assessed against those not meeting the objectives.

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