seems likely that in many cases it will not be sufficient for new data and information products to be viewed as just add-on features to, say, an existing claims-processing system.

To start to address the sorts of demands described above, CMS might begin to consider information that it provides as a new set of “products.” More generally, the current and prospective roles of CMS and the consequent needs for data and information raise the following kinds of fundamental questions for the agency:

  • What kinds of information can and should CMS provide?

  • What is the market for such information, and what does that market expect in terms of data and information products?

  • How can CMS processes and systems be restructured or replaced to support easier generation of such information and data?

  • How should CMS track and manage provenance information associated with the data that it is using?

  • What protections will be in place for assuring compliance with legally mandated and emerging confidentiality and security requirements for patient data while also ensuring sufficient access for legitimate biomedical and health research?

  • What is the role of CMS relative to other stakeholders—for example, in setting standards and in data collection, data management, and data and information extraction and distribution?

  • How should CMS design, manage, make available, and recover the costs of its information products?

In short, CMS is faced with significant growth in the complexity of requirements, some of which may conflict with one another when quality constraints are applied. In such circumstances, evolving the scope of change incrementally to control complexity is important. Furthermore, the requirements and demands on the infrastructure (hardware, middleware, software architecture) need to be understood and specified. In particular, the future growth and change scenarios ought to be explicitly characterized as part of the process of gathering requirements. Modern IT solutions such as data warehousing, identity management, business process management, and business intelligence—and associated new architectural approaches—all have the potential to play important roles in meeting CMS’s future data and information requirements. Chapter 3 briefly discusses enterprise transformation—in terms of both business process and information systems.

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