From Field to Fed IIMarch 9th, 2011

Wednesday’s Presentations

Building Interoperability To Scale: Strategic Considerations

Linda GibbsNew York City Deputy Mayor

NYC HHS Connect

William A. Hazel, Jr., MDSecretary of Health & Human Resources

Commonwealth of Virginia

Stewards of Change ConferenceMarch 9, 2011

Linda GibbsDeputy Mayor for Health and Human Services

HHS-Connect Vision

Guiding Principles• Establish a Client-Centric Approach• Increase and Manage Accessibility of Information• Improve Accountability• Utilize Modern and Flexible Technology

Roadmap• Published December 2007

To break information silos through the use of modernized technology and coordinated agency practices to more efficiently and effectively provide

Health and Human Services to New Yorkers.

• Over 130 people from 17 different agencies participated in this intensive three month process to develop a Roadmap with specific projects.

The Process

HHS-Connect Governance

Mayoral Executive Order #114 signed March 18, 2008– Formalizes Bloomberg Administration’s commitment

Created an Office of the CIO under the Deputy Mayor– Eight HHS agencies in three sub-domains: Human

Services, Health and Criminal Justice– Technology strategy and architecture for the domain

Created an Executive Board– Includes all HHS Commissioners and OMB and DOITT– Signed charter document committing to full participation

and advancing goals

The program focuses on technology solutions to “connect the dots” between agencies, providers, and clients.

HHS-Connect Governance

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HHS Agency Commissioners DoITT and OMB

HHS-Connect Team

DM Linda Gibbs, Chair/SponsorExecutive Steering Committee

Executive Leadership

Enterprise Solutions Delivery

Enterprise Architecture

NPV

Executive Director/Co-Chairand HHS CIO

HHS Software Architect

SI Team:Project ManagementTechnology SupportFunctional Support

PMQA Team:Project MonitoringQuality AssuranceTechnical and Functional Advice

Policy & Legal

Key City Positions

Director ofAdministration

Director ofClient Solutions

Outcome Model

Cross-Agency Workgroups and Subcommittees

Policy & Legal

Business Intelligence

Performance Management

Budget & Finance

Project Managers

Initiatives

Foundational Delivery Case Management Delivery

Worker Connect

Common Client Index Document Management

Access NYC/ Online Applications

Security Project n

DHS

DOC Project n

ACS

Director of Policy and Legal

Accomplishments to Date

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Quick WinsClient Portal

• 311 Content Integration• Online benefits screening• Select online applications

Worker Connect6200 + Provisioned

Users

Common Client Index

5 Source Systems

Federated Document

Management32 Million Documents

Enterprise Case Management

Build/test underway (DHS)

Foundational ProgramsEnterprise Architecture•Application, Business, Technical, and Information Architecture

•Solution Architecture and Demand Management Governance

Security•User Provisioning

•Access Management

•Security Architecture Framework

•Data Classification

•NIEM/standard

Infrastructure•Build out of ACCESS NYC

•Use of highly virtualized infrastructure

Program Management Office•HHS-Connect Outcome Model

•Net Present Value (NPV) model developed

Policy & Legal•Policy and Legal Sub-committee established

•Policy and Legal framework identified

Worker Connect: Integrating HHS-Connect Initiatives

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Worker Connect

CCI

Doc. Mgmt.

Document Management

• Improve quality, timeliness and consistency of information about a person, family or household

• Reduce requests for clients to provide documents at multiple agencies

• Enable worker access to documents related to a client collected by HHS agencies

• Improve the quality of client service by providing a more complete view of the person, family or household and the services they receive

• Improve timeliness of action based on client provided documents

Common Client Index (CCI)

• Enable agencies to utilize CCI as a central source of client information

• Identify common clients across CCI affiliated agency systems

• Improve collaboration and communication between agencies that provide services or assistance to a person or a family

• Provide administrators with access to alerts about client data changes and matches

• Support data consistency between agencies, enable eventual convergence of data

• Link up with Worker Portal and Document Management, to provide client data to Case Workers.

Worker Connect

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The Worker Connect System is a Web-based system developed by HHS-Connect that enables employees of the City of New York’s Health and Human Services agencies to share client data. Client search uses CCI matching methods, then permits real-time retrieval of program data or documents.

10 Agencies currently accessing information from 5 contributing agencies:• Administration for Children Services – Child Care• Department of Homeless Services – Families in Shelter• Department of Finance – Senior/Disabled Rent Increase Exemption• New York City Housing Authority – Public Housing• Human Resources Administration – Food Stamps, Cash Assistance,

Worker Connect allows workers access to 15 client-provided document types from HRA’s repository.

Worker Connect Adoption Progress: Users

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Worker Connect Adoption Progress: Transactions

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Future: Roadmap 2.0 Published December 2010

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• Increasing the power and utility of Worker Connect

• Expanding access to online applications via ACCESS NYC

• Expanding enterprise case management

• Developing a social enterprise analytics capability

• Facilitating cross-agency service coordination

• Integrating the procure-to-claim process through cross-enterprise data exchange

Roadmap 2.0 – Key Initiatives

Governance: Cross-agency team to deal with the most complex and high priority cases.

Executive buy-in and supports. A team overseeing the technology and data integrity

Customers: Case workers: Decision-making support through the use of the “early identification alerts” (EIA)Policy Makers: More timely, complete information available for decision-makingClients: improved outcomes, more integrated services. Easier navigation of City. Taxpayers: Efficient use of City tax levy.

Information: Data sharing policies across agencies (not just between) with a common MOU. Best practices charter to ensure the appropriate analytical approach.

Future: Center for Innovation through Data Intelligence

Strategy and VisionUtilizing historical and real-time data across agencies to drive

more efficient and effective policy and practice

People: CIDI needs to impact front-line practice for case workers. (Example: early identification alerts available to case workers.)

Empower HHS agencies to provide more strategic services across multiple agencies to the clients most at-risk.

1. Develop risk models to identify high risk and high priority clients.

2. Break down the legal and regulatory barriers to sharing data across agencies

High Level Conceptual Architecture

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Building Interoperability To Scale: Strategic Considerations

William A. Hazel, Jr., MDSecretary of Health & Human Resources

Commonwealth of Virginia

As-Is: Today’s Challenges…

To-Be: Transitional Next Step

Workflow Engine

Business Rules

Engine

Enterprise Service Bus

Master Data Management

Data Warehouse

DocumentManagement

Agency Legacy

SystemsAgency Data

Agency Legacy

SystemsAgency Data

Agency Legacy

SystemsAgency Data

Agency Legacy

SystemsAgency Data

Agency Legacy

SystemsAgency Data

Commercial Service Oriented Architecture products

Standards Compliant Interfaces

Health Benefit Exchange

Citizen Centric Portal

Self-Directed Services

Agencies Assisted Services

System Supported

Health Information Exchange

To-Be

Workflow Engine

Business Rules

Engine

Enterprise Service Bus

Master Data Management

Data Warehouse

DocumentManagement

Commercial Service Oriented Architecture products

Health Benefit Exchange

Citizen Centric Portal

Self-Directed Services

Agencies Assisted Services

Health Information Exchange

Local Government

Non-Government Organization

Commercial Trading Partners

Federal Government

Agency DataAgency

Data Agency Web Application/

ServicesAgency Web Application/

ServicesAgency Web Application/

Services

Interoperability Trends and Strategies Within Health and Human Services and the Expected Impact on the Future of Services Integration,

Operations and Client Outcomes

John TeeterDeputy Chief Information Officer

Department of Health and Human Services

CHIEF INFORMATION OFFICERDEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF THE

U . S . D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S

John TeeterDeputy Chief Information OfficerU.S. Department of Health and Human Services

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Interoperability, Information Sharing,

and Governance at HHS

Transform Health Care Implement the Recovery Act Promote Early Childhood Health and Development Help Americans Achieve and Maintain Healthy Weight Prevent and Reduce Tobacco Use Protect the Health and Safety of Americans in Public Health Emergencies Accelerate the Process of Scientific Discovery to Improve Patient Care Implement a 21st Century Food Safety System Ensure Program Integrity and Responsible Stewardship

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HHS’ Priorities

• Interoperability and information sharing is key to many of HHS’ priorities

• HHS should lead the way in promoting interoperability in the Federal, State, and Public sector

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How do we manage our large and complex business areas that impact how we do business, the industry we interact

with, and ultimately the American people?

The HHS Domains

Domain: A domain can be defined as a sphere of

activity, concern, or function.

For purposes of NIEM, a domain refers to a business enterprise

broadly reflecting the agencies, units of government, operational

functions, services, and information systems which are

more or less organized or affiliated to meet common

objectives.23

Introduce, define, and build HHS

domains

National Information Exchange Model

• Establish Health Domain• Coordinating Committee• Health IT Steering Committee• Define NIEM Health Domain

• Evolve metadata specification standards (Semantic web)

• Leverage the Standard Web API

• Establish NIEM Human Services Domain• Coordinating Committee• Human Services IT Steering Committee• Define NIEM Human Services Domain

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Example: the Health Domain – Concept view

Health Domain Governance Framework

Enterprise Performance Life Cycle (EPLC)

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Promote the advancement of the Health, Safety, and Well-Being of the American People. Propose IT initiatives across HHS that effectively support the successful implementation of the

Secretary’s strategic priorities for health transformation; including policy implementation and cross-agency issues.

Propose and approve the health reform architecture, technology products, services, and programs to benefit HHS, Health Reform, and the Health Domain at large.

Maintain a controlled process for evaluating IT investments and prioritizing the investments against the organizational mission.

Serve as the IT Review Board for the Health Domain.

Advance IT related investments to support the Health Domain. Supports the HRITSC through evaluations of IT investments based on business need,

alternatives, value, cost, architectural impact and required support. Reviews and approves OPDIV and STAFFDIV IT investments and projects at key points in the

EPLC to ensure optimization of effort and investment in support of interoperability, shared services and data management across HHS

Perform business, technology, security, and architecture reviews at the Operating Division level and coordinate with the Health Reform IT PMO.

Comply with EPLC and the architecture approved by the HRITSC Work with Project Teams to refine business needs and adjust investment priorities at the

Operating Division level

Develop project plans that satisfy defined business needs and complies with the HRITSC approved architecture.

Manage projects within the cost and schedule approved by the HRITSC Coordinate with other project teams across the health domain

Health Reform IT PMO

Health Reform IT Steering Committee

(HRITSC)

Health Vision Strategy Group

REQUIREMENTS

HHS

OPD

IVs &

STA

FFDI

Vs

Project TeamProject TeamProject Team

Integrated Project Teams

Integrated Project Teams

Integrated Project Teams

Other Critical Partners: CIO Council Data Review Team

Service Oriented Architecture Review Team Business Process Review Team

Example: Health Domain Mission

• Promote the advancement of the Health, Safety, and Well-Being of the American People.

• Propose IT initiatives across HHS that effectively support the successful implementation of the Secretary’s strategic priorities for health transformation; including policy implementation and cross-agency issues.

• Ensures accountability for health IT programs in the effort to advance interoperability

• Ensure process streamlining through the application of enterprise architecture

• Coordinate and improve services

• Foster health IT collaboration and participation

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What Are We Striving For?

• A Nationwide electronic health information exchange capability that provides the best opportunity for each patient to receive optimal care.• Complete, accurate, and searchable health information,

available at point of diagnosis and care, allowing for more informed decision-making

• Better communication between clinicians and patients

• More efficient and convenient delivery of care

• Earlier diagnosis and characterization of disease, with the potential to improve outcomes and reduce costs

• Reductions in adverse events

• Increased efficiencies related to administrative tasks

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Nationwide Health Information Network

Expansion of standards and specifications definitions Implementation guides Testing frameworks

• Health community can utilize NHIN deliverables to accelerate health information capacity

• Adopt data and technical standards for health IT• Participate in efforts to prove capabilities and fill solution

gaps• Work to promote interoperability among regional, state,

and local health exchanges• Provide service built on standards & specifications• Add industry services to service library

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National Information Exchange Model

• Partnership of the Department of Justice and the Department of Homeland Security

• Develop and support enterprise-wide information exchange by:

– Standards: data formatted in a semantically consistent way

– Processes: common semantic understanding among participating organizations

– Result: information sharing, focusing on information exchanged among organizations as part of their business practices

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http://www.niem.gov/ http://it.ojp.gov/default.aspx

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Relevance to HHS

Medicare fraud prevention and detection, child support enforcement

Health Care Eligibility Benefit Inquiry and Response (Medicare), Immunization data and patient charts (Indian Health Service)

“Child Support Order”, “Prescription Drug Monitoring Information Exchange”, “Psychiatric Assessment”

Department of Justice, Department of Homeland Security, state, local, tribal governments

Health IT Standards Committee, “Planning and Accountability” Domain

Improve sharing of critical information

Develop standardized automated information exchanges with their partners

Save time and resources by reusing existing information exchange specifications

Engage new information exchange partners in the future

Contribute to shaping nationwide standards for information sharing

NIEM Value Proposition

Evolution of NIEM

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• Evolve metadata specification standards– To embrace the Semantic Web languages

• That provide a Uniform Data Model • Across all Gov info domains

– Enabling easier Dataset Assimilation• Realizing cross domain correlation via ‘bridge’ ontologies or

‘connector’ metadata• Uniform processing and persistence of any info domain

• Leverage the Standard Web API– Add REST to existing RPC service implementations

• Uniform interface for metadata and dataset access (via HTTP)• Uniform query points (via SPARQL endpoints)

Semantics (Ontology, Metamodel)

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• Domain specific standards evolve independently– Each authoritative domain stewards their published metadata standards and

corresponding instance datasets on the Web– Metadata and instance datasets are cumulative, where one publisher reuses

and extends other published metadata and datasets• The Federated Data Portfolio implements a shared storage service

– Aggregating independently published datasets from agency.gov/open sites – Assimilating their instance data via bridge or connector metadata for cross

domain correlation• Open Gov Directive

– Participation with and by external dataset consumers– Collaboration for domain and cross domain correlation standards

• NIEM Governance and Momentum– Leverages existing NIEM constructs but lowers coordination cost

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NIEM & Standards for the Health Domain

Context (Information Model) Standards

Information Interchange

Terminology

Security & Privacy

Functionality and Process

Identifier Standards for Individuals and Organizations34

ACA: Community Living Assistance Service & Support (CLASS) View

Enrollment

SSAAuthoritative data source

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THIRD PARTYEmployer/Broker

HHSAuthoritative data source

CUSTOMERS

EducationAuthoritative data source

TREASURYIRS & FMS

Authoritative data source

NIEM: Help define IEPD’s information content & structure

ACA: Health Insurance Exchange View

Enrollment

SSAAuthoritative data source

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THIRD PARTY

TREASURYIRS & FMS

Authoritative data source

HHSAuthoritative data source

CUSTOMERS

DHSAuthoritative data source

Improve service architecture

• Documented current architecture• Catalog current services• Standardize, consolidate, automate,

move to the cloud• Improve service performance

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Electronic Health Records

• Encourage adoption and use of electronic health records by care providers, and of personal health records by individuals.

• Complete, accurate, and searchable health information, available at point of diagnosis and care, allowing for more informed decision-making

• Facilitate better communication between clinicians and patients

• Make delivery of care more efficient and convenient

• Earlier diagnosis and characterization of disease, with the potential to improve outcomes and reduce costs

• Nationwide health information exchange capability to provide the best opportunity for each patient to receive optimal care – if data cannot be accessed and exchanged, it isn’t useful

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The Electronic Health Records challenge

Source: CDC NCHS Health E-Stat - Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm#fig1

Percentage of office-based physicians with electronic medical records/EHR 2001-2009 and preliminary 2010

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Public Health (Food/Product Safety)

• Data comes from many sources (surveillance, research, cohort, non-human, payer/provider, etc.) and huge variation in scope, definition, methodology, etc.

• High degree of data manipulation, documentation and quality assurance involved in order to prepare data for analysis

• High-degree of duplication and lack of coordination

Better collaboration

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Public Health (Food/Product Safety)

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Apply Open Government to Domains

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• Foster transparency within:– Continue to publish data by embedding the identification,

prioritization, and publishing of datasets and tools in existing HHS’s processes

• Encourage collaboration & participation with other agencies, industry, and the public

• Semantic Web• Flagship initiatives:

– CMS Dashboard– FDA Basics & FDA TRACK (performance management system)

• Community Health Data Initiative

Improve IT Governance for Domains

• Implement 25 Point IT reform– Improve efficiency and effectiveness of IT management in

government• Enterprise Performance Life Cycle (EPLC)

– Continue to standardize effective processes, to improve project execution and performance

– Flexibility required to accommodate legacy as well as new technologies and solutions

• Risk Management– Adopt formal risk-based decision making processes– Designate executive risk management role (potentially

multiple individuals)

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Program Goals & Objectives

HHS IT Portfolio

C&A Maintenance

Select / Reselect EvaluateControl

Security Testing, C&ASecurity Planning

EA

Security

CPIC

EPLC

Stage Gates

Preliminary MaintenanceAcquisition DevelopmentACQ

Planning Requirements Analysis Design TestDevelopment Implementation Operations &

Maintenance DispositionConceptInitiation

Follow the EPLC within Domains

The EPLC includes Other Critical Partner / Stakeholder Functions

1 3 42Preliminary

Design ReviewSelection Review

Baseline Review

Operational Design Review

OperationsSolution Development RetirementSolution Architecture Development

INTE

GR

ATI

ON

PROGRAM GOALS & OBJECTIVESHHS IT PORTFOLIO

44Can be delegatedIT Governance Organization Led

Common Themes• Encourage compliant and interoperable

services and tools• Be proactive with voluntary standards and

initiatives• Seek innovative ideas• Get the public and industry involved:

– Collaborate– Participate– Provide Feedback

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QUESTIONS ?

John TeeterDeputy Chief Information OfficerU.S. Department of Health and Human Services