The Fierce Urgency of NOW

In my 36-year career with the federal government, I have never seen a better time to reach our goals of achieving interoperability across the Health and Human Services Divide. From across the broad spectrum of stakeholders, organizations, key decision-makers and thought-leaders are all signing on.

Like many of us, I have collected and treasured favorite quotations over the years. The one below which underscores urgency is from Dr. Martin Luther King, Jr. when he spoke at Manhattan’s Riverside Church in April 1967 to end the war in Vietnam.

“We are now faced with the fact, my friends, that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there is such a thing as being too late. Procrastination is still the thief of time. Life often leaves us standing bare, naked, and dejected with a lost opportunity. The tide in the affairs of men does not remain at flood — it ebbs. We may cry out desperately for time to pause in her passage, but time is adamant to every plea and rushes on. Over the bleached bones and jumbled residues of numerous civilizations are written the pathetic words, Too late.”

Daniel Stein’s and Mary Curtis’ blogs on this site, “Interoperability At the Tipping Point,” and “New Funding Opportunities for Interoperability,” both underscore the Fierce Urgency of Now in terms of the need for states to take advantage of the generous, but time-limited, federal matching funds and revised cost allocation policies to build new health and human services IT systems or enhance existing ones.

Vivek Kundra, until recently the US CIO, wrote in his “25 Point Implementation Plan to Reform Federal Information Technology Management” that “…a pervasive issue in government programs is that individual stakeholders focus primarily on performance metrics within their functions and not on the holistic outcomes of the program…We need to replace these “stove-piped” efforts which too often push in inconsistent directions with an approach that brings together the stakeholders and integrates their efforts.”

Have you seen the latest NASCIO white paper, “A Golden Opportunity for Medicaid IT Transformation: State CIOs and the MITA Framework”, the title of which says it all – A Golden Opportunity?”

NASCIO’s Executive Director, Doug Robinson, writes, “There are substantial fiscal incentives for states to meet the seven standards and conditions for enhanced federal funding, but the benefit of state adherence to the principles of MITA will also be advantageous to citizens, federal government, and the vendor community.  Budgets are tight and Medicaid expansion is going to be a major concern for the states. State CIOs recognize there needs to be an enterprise approach that focuses on re-use and adaptability of emerging technologies to find potential savings.”  

One of those seven standards and conditions Doug mentions is the REQUIREMENT that in order for state Medicaid programs to receive the enhanced 90% IT match, they must “allow interoperability with health information exchanges, public health agencies, human services programs, and community organizations providing outreach and enrollment assistance services” (underscore added) per the enabling regulation.  Note that’s a “must” – and not a “it would nice to do if you felt like it.”

And it’s not just CMS that is talking about enterprise systems able to leap tall buildings at a single bound.  

ACF’s Administrator, George Sheldon, recently announced a series of 45-minute webinars starting at 1PM EDT every other Thursday on May 31, June 14, June 28, July 12, and July 26 to discuss the National Human Services Interoperability Architecture (NHSIA).  Developed with the help of Stewards of Change, Johns Hopkins University’s Applied Physics Lab, and a broad cross-section of state and local human services providers, NHSIA provides a critically important reference architecture for human services interoperability and horizontal systems integration. Check out ACF’s “Your Essential Interoperability Tool Kit, An ACF/HHS Resource Guide.”

The American Public Human Services Association (APHSA), representing every State and Territorial Department of Health and Human Services CEO in the country, in addition to state and local human services leaders of every stripe, has been hard at work on their “Pathways” and “National Workgroup on Integration” initiatives, both of which emphasize holistic, cross-boundary data interoperability and systems integration.  Also see the APHSA site for more information and their latest guidance documents on the subject of governance  and IT .

But time is running out.   Human services leaders cannot afford to wait until January 2014 to begin planning for horizontal integration.  These systems take years to plan, develop and test, regardless of what you may have heard.  And both the enhanced federal match for the Medicaid eligibility systems, and the A-87 Exception that allows human service programs to benefit from IT components ranging from client portals and automated account creation to master client indices and enterprise service busses at no additional cost except for their unique needs, all turn into pumpkins by the end of CY 2015 if the items are not only contracted for but fully tested and implemented.

“Politics ain’t beanbag,” as American humorist and Chicago journalist Finley Peter Dunne wrote years ago.   Regardless of whether you or your state think Health Reform is the greatest thing since sliced bread or Stage One of Sodom and Gomorrah, it doesn’t matter.  If you’re not at the table now or at least by the end of this summer, as a serious player, it will be too late.  You, your state and its taxpayers will have missed this once-in-a-lifetime opportunity to save millions of dollars in program and administrative costs, thousands of hours of staff time, and countless opportunities to better serve America’s most vulnerable citizens. Tomorrow is, indeed, today.

Agree?  Disagree? I’d love to hear your thoughts.

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  • Sherri Heller
    Reply

    Who wouldn't be inspired by Dr. King and Finley Peter Dunne, in the same breath?

    Here's Lincoln's 1862 message to Congress, urging action on difficult, controversial proposals such as compensated emancipation:

    The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew. We must disentrall ourselves, and then we shall save our country.

    Yes, we've spent years wrestling with the very real challenges of categorical appropriations and confidentiality concerns. But I would add another reason to Rick's list of why the time is right now: The public has, in fact, accepted and adapted to the challenges of inter-operability, thanks to new technology that is responsive to those challenges. We give our credit card numbers to Amazon. We use our bank cards at ATMs that belong to 'foreign' banks. We know how to set our privacy settings on Facebook.

    In the stormy present of budget challenges and statutory deadlines and political stridency, we must disenthrall ourselves from the reasons we've used for years to say it's too hard, we can't do it.

    Sherri Z. Heller

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