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May 12, 2011 By David Raths
Handler’s belief that the MMIS should be more flexible and modular fits with the strategy IT leaders at the federal Centers for Medicare & Medicaid Services (CMS) have been pushing states to adopt for years. CMS’ Medicaid Information Technology Architecture (MITA) approach seeks to formally define a core set of functions for each state system and make the design of those systems more modular based on a service-oriented architecture. “MITA is pushing states toward a more component-based system and away from mainframe architectures,” said Dan Sisco, director of professional consulting for MAXIMUS, a Reston, Va.-based firm that fosters government-citizen relations.
States are now moving toward plug-and-play and shifting from “big-bang” implementations, and new systems must be configurable. For instance, Sisco said, the rules for different benefit plans must be modified regularly by Medicaid agency staffers, without requiring programming staff to make changes.
But some CIOs and consultants say many states are struggling to adopt the MITA approach.
“MITA is a good concept, but there are things that hinder states’ ability to embrace it,” said Andrea Danes, senior principal for Chicago-based CSG Government Solutions.
“If you have a very old legacy system and haven’t done an upgrade in a long time, it is a huge leap,” she added. “Agency leaders are used to a cycle of working with vendor X, and they create specifications and put out an RFP based on what they know.”
Vendors are trying to upgrade their offerings for MITA, but Danes said she believes that the solutions they’re creating aren’t all that different. “They are incremental changes, but not the huge leap that the agencies need,” she said. “The systems are still not flexible enough.”
John Singleton, vice president of state and local solutions for CSC’s North American Public Sector group, said that MITA is the impetus behind much of the positive change in eliminating stove-piped systems at the state level. His company is working with North Carolina on a single enterprise application called NCTracks that will use Web services to serve five different health and human services programs with a single portal on the front end. The new system will offer enhanced reporting and analytics compared to the legacy system now in use. “The key thing is adaptability,” he said, “and the ability to respond to change.” With an older COBOL-based MMIS, staffers would write change requests, and it would take programmers weeks or months to make those changes. Now, with a rules engine and a graphical user interface, changes can be made much more rapidly, Singleton said.
You may use or reference this story with attribution and a link to
http://www.govtech.com/pcio/New-Approach-to-Medicaid-Management-Information-Systems.html
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I think that many people are misguided by the tag ‘Legacy’. While the software may be old the operating systems and database engines that run on mainframes are not old. As a matter of fact DB2 runs circles around any server based system in speed and reliability. I have been told, since the advent of server technology’ that mainframes are a thing of the past, that was 20 or so years ago. This notion that you have to get rid of mainframes is non-sense. The idea of 'cloud computing', which is little more than a new way to say outsourcing, being the solution to this problem is equally non-sense. I believe the way to go is to properly utilize mainframes and use them as extremely fast and reliable file servers. The server environment is not conducive to processing large databases and I think you all know this. I have been in the business for over 30 years and I can count one 1 hand the number of times I have seen a mainframe 'go down' other than scheduled maintenance. Can any of you say the same about the server world? In short, the mainframes are already there, they are already being paid for, you are not going to be able to 'get rid of them' any time soon, so utilize them and take advantage of what they do good and shift what they do bad (user interface) to the server world. It will not only save money in the long run but will provide faster and more reliable computing. I encourage any of you to explain to me how I am wrong, please I love a good argument and I love even more ideas better than my own.
About thiws comment '“MITA is pushing states toward a more component-based system and away from mainframe architectures,” said Dan Sisco' Mr. Sisco, are you trying to assert thet component based or modular systems and the mainframe are mutually exclusive? Really? Then I assert you don't understand the concept.
My apologies, Should always proof read before hitting the submit button. About this comment '“MITA is pushing states toward a more component-based system and away from mainframe architectures,” said Dan Sisco' Mr. Sisco, are you trying to assert that component based or modular systems and the mainframe are mutually exclusive? Really? Then I assert you don't understand the concept.
Well...maybe not mutually exclusive but I think modular systems are much more difficult to develop within a mainframe ecosystem. And all the ancillary/3rd party applications are fairly hard to integrate. To me, Java and .Net apps, web services, etc. are the way to go. Lot's of "Sisco/Cisco/Sisko's" commenting here. :')
I think the biggest problem is that systems like Oracle, Tera Data, SQL Server et al, cannot handle very large databases and they cost more to boot. My model is to use the mainframe (if you alredy have one) as a very fast file server with DB2 as the database engine. The only programming that need be done on the mainframe (in this model) are the batch updates and other maitenance. The Business rules and GUI applications would still be (and should be) in the server environment. it is a simple solution to many complex problems and I don't see why more IT people do not recognize this. The only reason I can see is that the people making the decisions do not have a real grasp of the problem and that the people they do listen to are either the vendor sales people or their own IT people who are just enamored with new rather than right. PS - The e-mail I am giving here is to a guy who has done extensive work on the geneoloy of the Cisco/Sisco family tree phsisco@gmail.com
From the ICD-10 deadline to the need for medical scribes, the hurdles facing EHR implementation are numerous. http://www.healthcaretownhall.com/?p=3858
Just think of mainframes as servers on steroids. All these guys who learned the business in the past 15-20 years think this is new stuff. The fundamentals are the same. Keep it simple. Today's architects love techno-speak, elegant solutions with the latest technology and moving parts. Unfortunately, the moving parts usually mean up and down. Touch one part of these complex architectures and you'll understand how much fun it is to watch the dominoes fall. You could learn something from us "legacy" guys.