Health and Human Services departments across the states and the federal government are making a seachange from legacy silo systems to interoperability, William D. O'Leary writes in Public CIO. O'Leary, the former secretary of HHS for Massachusetts, is Microsoft's director of health and human services, US Public Sector.
Social policies and legal pressures are forcing government to increase its coordination among previously disconnected systems. In turn, a more consumer-centered approach is evolving and enabling greater efficiencies, measurement, quality of care, access and safety. With respect to technology, this shifting terrain requires that CIOs maintain existing systems, develop new ones, and introduce commercial off-the-shelf (COTS) applications and Web services to add and extend existing functionality.
He notes that in the past IT tended to be a hindrance towards interoperability.
In the 1980s, the federal government supported an automation model based on the transfer of legacy systems. The goal was that a statewide child welfare information system developed for one state could be transferred to another. The code would be given to the new jurisdiction.
Unfortunately problems have been abundant. Transfer systems were designed for particular states. Business processes vary dramatically across jurisdictions, however, limiting the systems' reuse. States were forced to retool these transfer systems to meet local needs. It could take five years to install a system that was built 10 years earlier. The result was an obsolete architecture that required continuous modifications -- agency heads became increasingly dependent on the few staff who understood how these systems worked, and could modify them and change the business rules over the long-life cycle.
Many states are moving towards enterprise frameworks to handle to chore but that process is proving to large and slow for some pressing needs, so states are adopting a multifaceted approach.
Time is of the essence -- states must offset the high cost of maintaining mainframe systems, but are impatient with the time it takes to implement an enterprise system. In these cases, a combination of approaches will occur. States will replace a legacy system in one agency, and utilize COTS applications to add functionality and take advantage of legacy investments in other agencies. Iowa, for instance, is seeking a framework approach to replace its child-care system that will interoperate with a modern and user-friendly front end to its state automated child welfare information system.
Bottom line? A rapidly changing environment for CIOs, who must develop enterprise architectures, adopt XML-based web services, and manage a transition from legacy systems.
When CIOs utilize the Internet's power, workers can collaborate across agencies, share information and hold virtual meetings. By adopting Web services and a common language (XML), CIOs can provide their agencies with access to data stored in disconnected mainframe legacy systems.
Agencies no longer have to wait to replace large systems to modernize functionality. Service-oriented architecture has spawned COTS offerings in numerous areas -- disease management, call centers, decision support, document management -- that can enrich existing Medicaid, child welfare, public health or human service systems. Advancements in security allow access to data to be defined by role. In sum, the public sector can coordinate how it serves common clients across multiple systems through increased interoperability, merging some functions while keeping organizations largely intact.
CIOs must keep archaic systems operating while planning for, budgeting and implementing new systems and applications. IT workers who have skills maintaining old systems may not be qualified with more modern approaches. As the legacy systems age, so do workers -- when they retire, the CIO is left with few resources that understand the old technology, including the history of modifications and rule changes. CIOs may have to provide incentives to keep these staff employed or to bring them back as contract employees.