Caring for the Masses

Massachusetts hopes to provide better service through its health and human services agencies by centralizing data and linking agencies.

by / May 1, 2002
Massachusetts cares about its citizens, although its health and human services agencies take better care of some citizens than others. The state's Executive Office of Health and Human Services (EOHHS) is comprised of 15 agencies, none of which is linked to the others.

Agencies often deal with the same clients and family members, leading to duplication of effort, fragmented care and missed opportunities. Some people receive abundant attention from multiple departments while others are neglected.

"Unfortunately, some agencies end up serving clients in ignorance of the efforts of others," said Henry Swiniarski, assistant secretary for the EOHHS.

To deploy resources more efficiently, Massachusetts is in the midst of MassCARES, an ambitious Web-based, e-government initiative aimed at unifying departmental information, removing inefficiency and improving service.

"There is so much financial pressure on state governments these days that the cost of duplicative functions will become intolerable," said Alan Day, president of Systems Engineering Inc. (SEI), the company building and implementing MassCARES.

Budget Crunch

EOHHS is the largest secretariat in Massachusetts, overseeing 26,000 employees and 20,000 community organizations. Its $9 billion budget comprises 44 percent of the state's total expenditure. But despite the size of the budget, EOHSS has been feeling the strain due to cutbacks. MassCARES is one of several strategies aimed at reducing costs while improving the quality of care.

"Though it's still [in its] early days, we expect MassCARES to result in millions of dollars in savings once fully implemented, as well as greatly improving the delivery of health and human services," said Swiniarski.

MassCARES began in early 2000 and won't be complete until 2005. It uses Microsoft Windows 2000 and SQL Server 2000, as well as XML, IBM MQ Series middleware and an Oracle database running on Unix. This technological combination creates a centralized backbone of client data that any agency can access via a browser, as well as many outward facing services that the public can utilize over the Internet to improve care availability. When completed, it will have cost about $23 million, according to Day.

The back-office infrastructure and piloted public components went into operation at the end of last year. Several components are currently under pilot in the towns of Springfield, Brockton, as well as a few rural communities. Based on feedback, the program will be refined and gradually expanded across the state.

Swiniarski predicts that most of MassCARES will be operating by June 2004. "But the public-facing tools will probably become available to the entire state by the middle of 2003," he said.

Systems integrator SEI included four levels of security in MassCARES. At the core, authorized case workers have access to personal and transactional data pertaining to their clients. Next up is an anonymous record layer where names and personal identifiers are removed. Above that, data can be sliced and diced in analytical applications for use in management and detecting broad trends. The final layer is purely for reporting purposes. ID and password access is granted to these various permission layers.

"One of the biggest barriers to a project like MassCARES is clarifying security and access policies between agencies," said SEI's Day. "While it entails technological change, it will mean far more organizational and cultural change by the time it is completed."

Eventually, MassCARES will be offered to caseworkers and citizens alike via a Web-based portal. The portal will provide access to all related systems and the services available under EOHSS. The four security features will be built into the portal.

.NET Gain

This project is already being touted as a fine early example of the Microsoft .NET strategy in action. Press releases on the Microsoft and SEI sites proclaim the success of .NET as the core of MassCARES' success. But talk of .NET application is perhaps a little premature.

"Microsoft technology forms an integral part of MassCARES," said Swiniarski. "But we have yet to complete a full assessment of .NET and alternative platforms."

In the meantime, the impetus behind .NET is reaching fever pitch. Many developers and systems integrators have formed partnerships with Microsoft under the .NET banner. "It is much easier to develop applications and Web services for e-government when all the tools and products -- database, development platform operating system, Web server -- come from the same vendor," said Mike Cardi, managing architect for Pinnacle Decision Systems, a Microsoft .NET partner. "I believe Microsoft has hit a home run with .NET."

In Massachusetts' case, Microsoft is already the dominant platform. As such, it has an early lead in the hearts and minds of e-government drivers like Swiniarski and IT managers. But that doesn't mean .NET will be the automatic choice. The roar from its critics is also growing, primarily from a competing platform that runs on Java known as J2EE that is backed by Sun Microsystems and IBM.

"This is the tiger changing its stripes," said Gartner Group analyst Mark Driver. "The migration to .NET will be a difficult one for IT departments, because developers will have to rewrite as much as 60 percent of the code for some existing Windows applications."

Microsoft counters such arguments with another Gartner study claiming it costs $65,000 to train someone to learn and use the J2EE standard. "Out of 25 million developers, only 2 million are trained in Java," said Barry Goffe, Group Manager of .NET Enterprise Solutions of Microsoft. "J2EE doesn't talk well to Web services running on other platforms, whereas .NET is the secret sauce that brings unity to 30 years of stovepipes, platforms and languages."

Both sides, of course, boast about cost, ease of use, ease of development and maturity advantages. No doubt the war will rage for some time before a victor emerges. And as usual, pragmatic results rather than public relations and marketing salvos will decide a winner at the end of the day.

"As MassCARES evolves, we will be watching closely how the .NET platform performs in the real world," said Swiniarski. "Once we have properly assessed it based on solid feedback of the application of .NET in government, that may steer us to utilize it as the e-Government backbone of MassCARES.
Drew Robb Contributing Writer