technology (IT) systems. These new challenges arise even as CMS must cope with the growth of the “baby boom” Medicare population and continue to meet challenging day-to-day operational requirements and to make frequent adjustments to its business processes, software code, databases, and systems in response to changing statutory, regulatory, and policy requirements. Complicating matters further, the efforts to evolve its systems come in the midst of changes to the nation’s health care IT more broadly.

CMS’s ongoing operational requirements are currently being met with a very large and complex set of hardware, software, and communications systems that vary considerably in age, capability, and sophistication. The ability of these systems to continue to keep up with the ongoing changes and new missions demanded of them is an understandable source of concern. CMS asked the National Research Council to review its plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today’s and tomorrow’s demands.

The recommendations and conclusions offered by the Committee on Future Information Architectures, Processes, and Strategies for the Centers for Medicare and Medicad Services cluster around the following themes: (1) the need for a comprehensive strategic technology plan; (2) the application of an appropriate meta-methodology to guide an iterative, incremental, and phased transition of business and information systems; (3) the criticality of IT to high-level strategic planning and its implications for CMS’s internal organization and culture; and (4) the increasing importance of data and analytical efforts to stakeholders inside and outside CMS.

The committee notes the significant benefits of modernizing and transforming CMS IT and the costs of not doing so. CMS has an opportunity now to plan strategically for necessary advances and needs to move quickly. Given the complexity of CMS’s IT systems, there will be no simple solution. Although external contractors and advisory organizations will play important roles, CMS needs to assert well-informed technical and strategic leadership. The committee argues that the only way for CMS to succeed in these efforts is for the agency, with its stakeholders and Congress, to recognize resolutely that action must be taken, to begin the needed cultural and organizational transformations, and to develop the appropriate internal expertise to lead the initiative with a comprehensive, incremental, iterative, and integrated approach that effectively and strategically integrates business requirements and IT capabilities. CMS has an opportunity now to effect these needed transformations—the technology exists to do what must be done.

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