A

Statement of Task

The Centers for Medicare and Medicaid Services (CMS) face enormous challenges related to their information systems. They must meet challenging day-to-day operational requirements and make frequent adjustments to their business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements. Increasingly, their core mission is expanding from one focused on prompt claims payment to one that is more broadly involved in improving health care quality and efficiency. And all of this is being done with old, and arguably antiquated, information technology even as CMS is increasingly engaged in efforts to modernize the nation’s health care information technology.

An ad hoc committee will conduct a study that will, in the foregoing context, 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. It will review the current state of CMS’s technical infrastructure and systems architecture and current plans for its evolution, and make recommendations to CMS on modernizing its business processes, practices, and information systems to meet today’s and tomorrow’s demands, including how to build in the flexibility to cope with changing requirements. The study will anticipate ever-broadening mandates for CMS to deal with data on outcomes, performance, and clinical procedures—perhaps even extending to electronic health records themselves—and requirements for interacting directly with beneficiaries, both to manage claims and to manage health. It will also



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 127
A Statement of Task T he Centers for Medicare and Medicaid Services (CMS) face enor- mous challenges related to their information systems. They must meet challenging day-to-day operational requirements and make frequent adjustments to their business processes, code, databases, and systems in response to changing statutory, regulatory, and policy require - ments. Increasingly, their core mission is expanding from one focused on prompt claims payment to one that is more broadly involved in improv - ing health care quality and efficiency. And all of this is being done with old, and arguably antiquated, information technology even as CMS is increasingly engaged in efforts to modernize the nation’s health care information technology. An ad hoc committee will conduct a study that will, in the foregoing context, lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS’s mission, business pro - cesses, and information technology requirements. It will review the cur- rent state of CMS’s technical infrastructure and systems architecture and current plans for its evolution, and make recommendations to CMS on modernizing its business processes, practices, and information systems to meet today’s and tomorrow’s demands, including how to build in the flexibility to cope with changing requirements. The study will anticipate ever-broadening mandates for CMS to deal with data on outcomes, per- formance, and clinical procedures—perhaps even extending to electronic health records themselves—and requirements for interacting directly with beneficiaries, both to manage claims and to manage health. It will also 127

OCR for page 127
128 STRATEGIES AND PRIORITIES FOR INFORMATION TECHNOLOGY AT CMS consider the financial and human resources necessary to implement this modernization. The study will take place in 2 phases. The first phase, drawing largely on a workshop (centered on the current CMS landscape and emerging strategy to match its information technology to changing mission require- ments), will result in an interim report to be issued 6-9 months after the project start. The second phase, drawing on the workshop and additional briefings, site visits, and committee deliberations, will result in a final report to be issued by the end of the project.