Planning for an Incremental Approach to Modernization: The World of Health and Human Services IT Transformation Is Changing

By Hencoski, Paul | Policy & Practice, August 2016 | Go to article overview

Planning for an Incremental Approach to Modernization: The World of Health and Human Services IT Transformation Is Changing


Hencoski, Paul, Policy & Practice


In virtually every industry, there is demand for faster and more nimble approaches to information technology (IT) transformation. Take the auto industry where, according to a 2013 Harvard Business Review article, the typical automotive design cycle had shortened to just 24-36 months; five years earlier this same cycle took 60 months. (1)

The impetus for change in the automobile industry seems fairly obvious; car makers had to keep up with customer demands for better, more efficient, and more technologically advanced cars so they sped up innovation cycles. Taxpayers and recipients of public services, including health and social service programs, have the same expectations. Yet government, and particularly the health and social service agencies and the vendor community that serves them, sometimes may make it appear that we are still acting like it is 1999. However, the tired attempts to rip-and-replace siloed systems with yet another monolithic transfer system are coming to an end.

A variety of forces is demanding this change. First, the speed and level of technical innovation are simply mind blowing. Second, the pace of regulatory change has never been faster. The Health Information Technology for Economic and Clinical Health Act, the Patient Protection and Affordable Care Act of 2010, the enhanced federal financial participation (FFP) for Medicaid modernization, the time-limited Office of Management Budget A-87 cost allocation waiver, and the newly adopted Comprehensive Child Welfare Information System rule, among other regulatory and funding changes, are both encouraging--and mandating--that we do things differently.

Despite some great successes in the industry, there have been simply too many costly failures and modernization efforts that do little more than re-platform antiquated legacy technology (and the associated business processes that go with them). Often these projects take too long, cost too much, and make only moderate improvements in the efficiency or effectiveness of case practice if they reach production at all.

There are signs, though, that the industry is quite rightfully moving toward a more nimble approach to IT transformation. When viewing the business and IT environment through the lens of the capabilities needed to support a new business model, technology becomes the solution enabler, not the solution itself. The initiatives taking such a view typically leverage a more incremental approach to planning and an agile development approach to deliver results quicker, help mitigate risk, and allow strategy adaptation, if needed, mid-stream.

As is often the case with large-scale change, the temptation could be for the pendulum to swing too far the other way. Indeed, an "agile" approach that does not include a clear roadmap for reaching the desired end state, or that fails to account for realities such as the length of a public procurement cycle, is likely destined to fail.

However, with a rather straightforward four-step planning process that can be accomplished as quickly as 60 days, an agency seeking to adopt a more incremental and agile approach to modernization and systems development can do so with a clear vision for how to get to the finish line.

Step 1: Develop a Vision and Set of Guiding Principles

Before embarking on a transformation journey, it is important that the executive sponsor(s) of the effort establish a clear vision for where they want to go. Just as you would not start a road trip from New York to San Francisco without a clear idea of where you are headed, you should not start a transformation program without a definitive destination in mind. The risk is that without a clearly defined destination, you could end up driving around the country for years wasting gas money and wear and tear on your car, only to realize you never actually accomplished anything. You may have seen some great sights and had some fun experiences along the way, but the effort would not have been productive and, given the typical status of state budgets today, limited resources would have been wasted. …

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