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Maryland and West Virginia HIE Procurements Hit the Street

In Maryland, the health information exchange (HIE) effort is being spearheaded by the Chesapeake Regional Information System for Our Patients (CRISP) in conjunction with the Maryland Health Care Commission (MHCC). Last month, MHCC applied for $9.3 million in Office of the National Coordinator for Health Information Technology (ONC) grant funding for HIE implementation activities. Project details are as follows:

  • Current Status: CRISP released an RFP on November 16, 2009 for an HIE Core Infrastructure. A letter of intent to bid is due by November 25, 2009. Proposals are due by December 16, 2009.
  • Scope of Work: Requirements include provider/network participant identity management, document registry, document repository, integration and adapter framework, authentication, authorization, network monitoring and consent management. CRISP released separate bids for the ePrescribing and Master Patient Index (MPI) components.
  • Funding/Contract Value: Total project funding is estimated to be $33.3 million. GovWin estimates the value of the HIE core infastructure portion to be approximately $2 million to $4 million based on similar projects with a likeness in size and scope.
  • For more information please see GovWin Opportunity #36694.

The West Virginia Health Information Network (WVHIN) is leading the West Virginia statewide HIE initiative. Project details are as follows:

  • Current Status: WVHIN released an RFP on November 23, 2009. A mandatory pre-bidder's conference will be held on December 16, 2009. A letter of intent to bid is due by December 23, 2009. Proposals are due by January 15, 2010.
  • Scope of Work: Requirements include project management, systems analysis, architecture, design, development, implementation, systems integration and operations support.
  • Funding/Contract Value: GovWin estimates the value of this project to be approximately $2 million to $5 million based on similar projects with a likeness in size and scope.
  • For additional information please see GovWin Opportunity #50159.

GovWin's Take:

States that were developing health information technology (HIT) roadmaps and strategic plans prior to HITECH are well positioned to begin procuring for technical assistance and shifting into an implementation phase. These are the first two HIE procurements to hit the street since the grant applications were due and there are many more to come. These procurements provide an opportunity for vendors to start partnering with states and demonstrating the value of their solutions. The more experience at the state and local level with implementing effective HIE systems the greater opportunity for business.

Texas Child Support Prepares for Change

The Texas Office of the Attorney General, Child Support Division (CSD), is planning on releasing a Request for Proposals (RFP) for the design, development, and implementation of the next generation of the Texas Child Support Enforcement System (TXCSES 2.0) next month. The project should keep CSD from experiencing the same problems that their fellow Supplemental Nutrition Assistance Program is dealing with- families waiting months for applications to be processed, loss of experienced state staff, technology problems, and low morale. CSD will be looking towards system flexibility and adaptability to meet the increasing customer service demands that are overloading benefit systems across the country. The new system will manage growing and changing caseloads, improve automation of processes, and retain a changing workforce. CSD hopes to enhance the child support system over time, allowing for better management of project costs over a multi-year timeline. Incremental changes will not only improve the technological aspect of the system, but should ease the burdens of the case workers behind the technology.

The TXCSES 2.0 roadmap is broken down into three phases, with the first completed by the last quarter of FY 2012. The Contractor will be responsible for the design, development, testing, and implementation of projects surrounding incremental case initiation and locate renewal. The second phase focuses on establishment and enforcement, automating the exchange of information between courts, genetic testing vendors, and process vendors. Phase two is estimated to be completed by FY 2015. The third phase, estimated to be complete by FY 2017, centers on financial renewal.

The current child support system was developed twenty years ago, with the newest enhancement being TXCSES 1.0 developed in 1996. In 2007 CSD entered a contract for consulting services to conduct a Business Process Redesign study, creating the multi-year roadmap that supports CSD's vision to renew TXCSES 1.0 using newer technologies. GovWin is tracking the release of the RFP under Opportunity ID #47374.

Michigan Consolidation and Streamlining: DMB and DIT to Merge

In a recent press release, Michigan Governor Jennifer Granholm announced that the Department of Management and Budget (DMB) will merge with the Department of Information Technology (DIT), thus eliminating five state agencies and approximately 200 boards and commissions. Kenneth Theis, the current Director of DIT will oversee the consolidated departments while current DMB Director Lisa Webb Sharpe will step down from her position to accept a position at Lansing Community College as Senior Vice President of Finance and Administration.

This consolidation is a result of Gov. Granholm's pledge to reduce the number of state departments from twenty to eight in order to streamline government processes and realize cost savings. This effort comes in conjunction with Gov. Granholm's request to Lt. Gov. John Cherry, Jr. in the 2009 State of the State address to lead an initiative to provide higher quality state government services at a lower cost to taxpayers than are currently available. Given how technology enables both government employees and citizens to do better business, and technology's increasing role in streamlining government, the plan to house the two departments under one roof is very logical.

What this means for vendors: One of the primary goals of the consolidation is streamlining government. Procurement is a prime example of this. Procurement and information technology will now be in the same department so vendors can anticipate a more efficient procurement process. Procurement officials and project managers will likely have a closer working relationship; there will be an increased level of interaction and communication on a variety of initiatives. Vendors should be prepared to work with the newly structured government – a single entity in which all players are on the same page and have access to the same information, rather than separate agencies passing information back and forth and following different procedures and protocols.

As always, given the government's budget cuts and revenue problems, vendors should continue their efforts to offer the most comprehensive solution at the lowest price, but now attention must also be focused on adjusting to the new consolidated structure. Many states already house information technology departments with management and budget-type agencies, and it is possible that other states will follow in Michigan's footsteps and make similar transitions in order to achieve the same efficiencies. It is in vendors' best interests to study Michigan's actions and develop new strategies for addressing this shift.

Will Health IT Reduce Costs and Improve Healthcare Quality?

With nearly $20 billion slated toward Health IT as part of the American Recovery and Reinvestment Act of 2009 (ARRA), it is widely presumed that information technology will lower healthcare costs in the U.S. and improve health outcomes among Americans. However, a startling new report from Cambridge Hospital/Harvard Medical School and Partners Healthcare System in Boston contends that there is little evidence to date to substantiate these claims.

"Hospital Computing and the Costs and Quality of Care: A National Study" was published November 20th in the on-line version of the American Journal of Medicine and is based on data from 2003-2007 provided by HIMSS Analytics, Centers for Medicare and Medicaid Services, and the Dartmouth Health Atlas. Researchers analyzed whether more computerization in hospitals had lowered costs or increased administrative efficiency in the five years examined. Analysis suggested that computerization produced no costs savings or efficiency gains. In fact, it may increase administrative costs in the near term.

The report also examines care quality as it relates to Health IT implementation and found only slight quality improvements, but they were dispersed and not consistent among the 4,000 hospitals examined. The report asserts, to date, computerization has not significantly improved care quality.

The report authors offer several theories as to why information technology is not delivering anticipated cost savings:

  • Computerization expenses may offset savings, at least in the short term
  • Health IT may need to be in the advanced stages of implementation to realize cost savings
  • Hospitals may not be implementing optimal products to increase efficiency

While the industry is struggling with the findings of the Harvard report, Congress is in the throes of enacting legislation that would provide funding to healthcare practices for implementation of information technologies. Legislation has been introduced in the Senate that would authorize the Small Business Administration to grant loans to healthcare providers for purchasing Health IT, including electronic health records systems to meet meaningful use criteria in ARRA.

The House recently passed similar legislation as part of a larger bill (H.R. 3854). Both bills have been referred to the Senate Committee on Small Business and Entrepreneurship.

GovWin's Take

Harvard's study of cost savings and quality issues as related to Health IT implementation in hospitals raises legitimate concerns regarding expected gains in these areas as a result of having adopted information technology solutions. However, monetary and quality returns on investment take time. Health IT implementation in practitioner settings typically result in short term efficiency losses and cost gains. Cost returns on the investment traditionally are realized in a two to five year timeframe. Although the Harvard study attempted to look at lagged effects of computerization, the analyzed timeframe may have been too condensed to show correlation.

In addition, Health IT implementation in hospital settings is still very fragmented at best. GovWin believes that true cost savings and improved outcomes for U.S. population health will begin to materialize in the second stages of the Health IT evolution path. The secondary stage of Health IT evolution involves further widespread computerization of the practitioner enterprise, as well as interoperability and health information exchange among providers, hospitals, pharmacies, insurers, and government entities. The sharing of health data across these organizations allows for better treatments, diagnosis, collaboration, and preventative care.

Finally, the Harvard study used only Medicare cost data as a basis for its analysis. By definition, the cost data examined is related primarily to the U.S. senior population. Because Americans are living longer, Medicare data may falsely skew the resulting analysis. The older population tends to seek medical care more frequently, and as people age they tend to develop more medical problems. A study of cost and quality data related to an evenly distributed spread of age groups or of younger patients may have yielded different results and conclusions.

GovWin believes that Health IT will produce cost savings and improved health outcomes in the future. However, the timeframe for their realization extends five to ten years in the future and is dependent on widespread Health IT adoption, interoperability, and health information exchange.

Additional Resources:

Health IT Transformation: FY2009-FY2014 Federal Market Forecast

Health IT Transformation: FY2009-FY2014 State and Local Market Forecast

Hospital Computing and the Costs and Quality of Care: A National Study

Half of NASCIO's Top 10 Management/Solution Priorities are being driven by the Recovery Act

NASCIO recently released results to their latest survey of State CIOs asking to identify Top 10 IT priorities for 2010. For the past 5 years Consolidation, Shared Services, Information Security, Health IT and IT Governance have consistently made the top 10 list as strategic priorities of State CIOsIn 2009, 3 of the IT priorities were new to State CIOs including Budget and Cost Control, Green IT and Transparency. This year, it is no surprise that Broadband & Connectivity and American Recovery and Reinvestment Act made the list. Half of the list contains priorities being driven in some way shape or form by the Recovery Act.

Table 1


-- Not ranked as top 10 IT priority
* New IT priority
Source: GovWin and NASCIO

Furthermore, NASCIO provides a list of top 10 priority technologies outlining to what extent each of these technologies, applications and tools are expected to be the next big trend.

Table 2


-- Not ranked as top 10 IT technology
* New IT technology
Source: GovWin and NASCIO

The NASCIO chart (above) in comparison to strategic technologies identified by IT research firm, Gartner (below), shows a pretty vast difference in their ranking of priorities. While Gartner has had Cloud Computing on their list the past two years, this is the first year that State CIO's have identified this as priority technology. Storage, computing, data center and server Virtualization continues to rank #1 among technology solutions with State CIO's. Two other common priorities that appeared on both rankings include Business Intelligence (BI) and analytics applications/Advanced Analytics as well as Social Media and Networking (Web 2.0 services, wikis, blogs, collaboration technologies, and social networking)/ Social Computing.

Table 3


-- Not ranked as top 10 IT technology
* New IT technology
Source: GovWin and Gartner

The IT strategies, management processes and solutions identified by both NASCIO and Gartner are certainly shared by most states as are continuing IT challenges and IT drivers. The current economic downturn continues to be a major concern to state CIOs as State CIOs will look for creative options to "do more with less" and use ARRA funds to help inject an additional flow of money to help further their top priorities. As vendors align their IT solutions with government priorities, it is important to note the number of opportunities available to vendors by being creative and offering expertise. Therefore, teaming with businesses that already have strong relationships with states is highly recommended to better identify state's IT needs but to also optimize from brand recognition..

Minnesota issues RFI for License and Registration System (MNLARS)

On Monday, November 16th, the State of Minnesota Department of Public Safety released a Request for Information for the replacement of the state's legacy Driver's License and Registration System (MNLARS). The system will include Driver's License, Driver Compliance, Vehicle Title and Registration, Dealer Licensing, Inventory, and Finance Processes. The state has estimated that this project could cost around $30 million. The state recently awarded a contract to Mathtech for the business requirements portion of the project, which was valued at $811,000.

The cost of this project assumes the implementation of Real ID measures, which is close to being dead. The U.S. Senate recently approved a $43 billion budget for the U.S. Department of Homeland Security for fiscal year 2010. The budget had substantial increases in certain DHS spending areas, but it slashed Real ID funding by 40%, from $100 million to $60 million. This news is hard for many states to swallow as they face increasing financial constraints within their state budgets. This cut in funding will make it increasingly difficult for states to implement and keep compliant with Real ID regulations.

Making Health Information Exchange Strides in Ohio

In Ohio, officials are engaged in strategic planning activities for a statewide health information exchange (HIE), which includes developing network specifications that will leverage existing infrastructure.

The Department of Insurance in partnership with the selected non-profit entity, the Ohio Health Insurance Partnership (OHIP), is working to lead state health information technology (IT) efforts. OHIP applied for the Office of the National Coordinator for Health Information Technology (ONC) HIE grant funding on October 16, 2009. HIE project details are as follows:

Current Status: The Partnership is in the process of developing a strategic/operational plan for approval from ONC. A Request for Information (RFI) is being developed to share information with vendors and solicit feedback.

Purpose: Constructing an integrated, technology-enabled healthcare infrastructure is a critical step in improving the health of residents and driving economic growth across the state.

Scope of Work: The Ohio HIE will be a fully integrated, HIT-enabled network that is flexible and able to accommodate increasing volume and service demands over time. The data management structure will follow a federated model. In addition, the exchange will provide security measures, including access upon patient authorization, roll-based requester privileges and automatic data access tracking.

Funding/Contract Value: The state's 2010-11 biennial budget allocates $8 million in non-GRF funds to the Department of Insurance to support efforts in health IT. GovWin estimates the value of the HIE project to be approximately $4 million to $8 million based on similar projects with a likeness in size and scope.

The Partnership is in the beginning of the HIE planning process; therefore vendors have an opportunity to build relationships early on. Notable is the emphasis on network security measures which will likely be a central focus of the future solution. For additional details on the HIE project please see GovWin Opportunity #59145. Please go here for Ohio health IT information.

Public safety technologies of today and their potential impact on the DC sniper case

The conclusion of the DC sniper case played out yesterday, as John Allen Muhammad was executed for his shooting rampage in and around the Washington, DC area. Muhammad, along with Lee Boyd Malvo killed 10 people and wounded 3 others over the span of three weeks in October 2002. Muhammad was sentenced to death in September 2003 and was given a lethal injection yesterday. As we look back on the events that unfolded over the three weeks in 2002, it is hard not to think of the implications new and advanced public safety technologies would have had on the situation.

For example, closed circuit television or surveillance cameras could have played an integral part in identifying and capturing the sniper. While the technology was present back in 2002, advances in optical imagery, zooming functions, and wireless capabilities could have aided in police efforts to collect and store evidence.

Another technology that could have played a key role would be that of license plate recognition systems. It could be argued that the license plate of the blue sedan Muhammad was driving may have been quickly identifiable had the DC metro area been equipped with such technology. Utilizing license plate recognition technology in conjunction with traffic cameras and additional surveillance systems could have allowed police to track the movements of Muhammad.

Gunshot detection systems would have been another great feature to have during the shootings. If officers could have utilized this acoustic technology, chances are they could have been alerted to the scene faster. Currently, gunshot detection systems are positioned more for urban areas, but since the shootings happened in suburban areas, this technology will need to expand its coverage. This technology coupled with surveillance cameras could have given officials additional evidence of the area in which the gun was fired.

One final piece of technology that could have assisted public safety officers would be that of automatic fingerprint identification systems (AFIS). These systems, if tied into a regional or national database could reduce the time spent processing fingerprints. It was the fingerprints gathered around the area that lead to the identification of Muhammad.

While hindsight is always 20/20, it is encouraging to see the advances in public safety technology since the DC sniper shootings. It is also encouraging to see more local agencies pursuing these types of technologies as seen in the economic stimulus requests for public safety funds. The only problem is that events like the DC sniper case can happen without knowing and can highlight the lack of resources an agency has. Lucky, public safety technologies are quick to react and can provide effective solutions to combat these events.

Recession Pounds State Unemployment Insurance (UI) Systems

While some states agencies prod forward on their own to plan and deploy Unemployment Insurance (UI) Information Technology (IT) modernization projects, other states are embracing neighboring state agency leaders to leverage the power and synergy of a consortium. Regardless of the approach, the common goal is to modernize legacy mainframe systems, in spite of diminished funds. Demands on legacy systems are necessitating greater need for states to streamline processes, integrate benefit and tax systems and ensure unemployment checks are dispersed timely, given many citizens continue to wrestle with unemployment.

The U. S. Department of Labor (DOL) awarded funds earlier this year for State Unemployment Insurance and Employment Service Operations, targeted for eligible workers through Federal and State cooperation. Recently DOL awarded funds for an Unemployment Insurance (UI) Technology Infrastructure Grant program. Though dollars provided are not of the magnitude to fund complete modernization projects, some states are using federal dollars to plan projects, and will seek additional funds from U.S. Department of Labor as they move forward with projects. Varying amounts were allocated to states and some are using funds to add technologies to enhance call centers that have been slammed with calls, or create more web interface with existing back end systems. Two regions are working together to use funds for studies to evaluate the best method to move away from legacy mainframe systems, written mostly in Cobol programming language, to newer platforms that are better for both the tax side and the benefit side of UI systems in the states.

States that have already upgraded UI systems successfully are indicating it is feasible for considerable operation cost savings to be realized given such statistics as of up to 88% claims now being filed via Internet without staff intervention. Achieving similar results is a significant driver in states planning modernization efforts to follow suit. The modernization projects are a vast undertaking and a sizable effort and typically software development is not a core competency of workforce agencies, though state IT organizations are striving to achieve some measures internally, these comprehensive projects cannot be tackled with internal staff alone.

The first region consisting of Tennessee, South Carolina, North Carolina and Georgia are collectively giving consideration to a regional "cloud" based system in a Service as a Software (SaaS) environment. The premise is that such a model will likely yield a reduction in operations and support cost. In a climate of diminishing budgets, the ability for states to gain twenty to fifty million dollars from legislatures to fund replacement systems is a seemingly insurmountable challenge. Grant funds allocated: Tennessee $6,892,526; South Carolina $6,845,618; North Carolina $5,625,765; and Georgia $8,850,630.

Another regional effort underway includes Idaho serving as the lead state working with Arizona, North Dakota and Wyoming. This consortium anticipates plans for one of two possible directions. One, having a new system developed and having one state serve as a host state and process the other consortium members UI taxes and benefits. The second option is to have the new system developed and each state will then have their own migration plan for their existing systems to the new platform. The effort will likely take years to fully implement; however, plans are moving forward to look at a high level design of moving to modernize needed changes to yield more efficiency and lower operating costs. Grant Funds allocated: Idaho $6,093,305; Arizona $6,778,673; North Dakota$6,473,523; and Wyoming $4,682,103.

States look to the National Association of State Workforce Agencies (NASWA) as a voice to advocate on their behalf and advise congress of state needs. Additionally, states have enacted new legislation during current legislative sessions to plan for receipt of the UI Modernization incentive payments. Integrators and vendors need to be aware that state labor agencies have experienced a high rate of failed systems in years past and leaders will need strong assurance that testing systems will be a critical component of plans, to ensure systems are successful once deployed.

To review these opportunities please see GovWin Opportunities:

Slashed Budgets force Changes in Corrections Policy and the Corrections Market

Over the past few decades "lock em up and throw away the key" was the standard mentality that pervaded corrections policymaking. Today, in the wake of the economic downturn, legislators nationwide are scrambling to find that key. Policies such as mandatory minimums, three strikes laws and reducing the availability of early parole caused prison populations to swell, and this policy seemed to work out for everyone (expect those who were incarcerated). Voters were content that their representatives were "tough on crime"; politicians were able to bring jobs to rural areas by building bigger prisons and vendors benefited from the increased revenue the prison contracts bought. This era came to an end when the recession forced politicians to rethink their fiscal priorities, and the level of corrections spending was deemed unsustainable.

I blogged on this topic in relation to California this summer, and decided to revisit it after reading about the increasing number of states and localities seeking out methods to decrease the cost of corrections. It depends upon whose numbers you trust, but a year of incarceration costs anywhere from $25,000 to $45,000 per individual. Many (but not all) legislators and governors have taken the stance that some of the offenders who are locked up in their states do not pose enough of a threat to society to justify spending that much money. They very well may be correct, but making that determination is not the purpose of this blog.

Regardless of what your opinion on this issue may be, it is evident that the landscape of corrections policy making is shifting towards alternative forms of sentencing, and these changes will affect the vendors who do business in the corrections marketplace.

The following are some new measures that states and localities are considering:

  • Establishing separate courts for non-violent offenders
  • Increasing sentences of probation instead of jail time
  • Allowing early parole of certain inmates who meet behavioral requirements
  • Avoidance of jail time for minor parole violations
  • Ending mandatory minimums for drug possession

When I speak with the decision makers within correctional organizations the refrain that I hear is no purchase will be made unless the product provides tangible risk avoidance and/or cost savings. Vendors would be wise to provide answers to the questions corrections officials are considering, and to do so before RFIs and RFPs hit the street. Questions such as: will installing a new surveillance system decrease the number of officers needed to maintain order in the county jail? With more individuals being placed on parole, the caseloads of parole of officers will increase; can case management software streamline their workload and allow them to effectively supervise more individuals? Would tablet PC's untie probation and parole officers them their desks and allow them to visit more individuals in a single day? Does GPS monitoring of paroles decrease the likelihood that they will violate the conditions of their release? These are just a handful of questions that corrections officials are considering at this time.

Providing answers to these types of questions will by no means guarantee a sole source contract, but it will allow vendors to showcase their skills and establish a working relationship with the agency or department. This topic will definitely continue to be the subject of debate in the coming year.

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