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May 12, 2011 By David Raths
Despite a long procurement process, Washington state’s recent experience with MMIS replacement shows the potential for steady progress, according to Rich Campbell, director of systems and monitoring, and Medicaid CIO in the Department of Social and Health Services. Its legacy system, built in the late 1970s, had connectivity issues and its database was hierarchical. “We had tacked things on, but that had just caused our environment to be more complicated,” he said. “Initially we considered rebidding for maintenance of the same system, but we realized about the same time MITA was in its infancy, that we needed something more flexible, something we could change rapidly.”
Washington’s RFP in 2004 came at the same time that vendors were just starting to move to new architectures. “When we were looking, it was sort of a case of lipstick on a pig,” Campbell said. “It was the same back end with some really nice Web pages on the front end.”
Campbell likes that the system is modular. “We asked them to give us the best of breed, so the call-center module is from Siebel and the interface with our state accounting system is from Oracle Financials. But if later we decide we want something else, we can pull that piece out.”
Campbell’s team is preparing the system for the CMS certification process this year.
According to Gartner Research Director Rick Howard, procuring a new MMIS gives CIOs the opportunity to change the perspective of the health and human services enterprise from a collection of discrete programs to a portfolio of interrelated services.
As Medicaid CIO in Oregon, Howard led an effort to rethink how a new MMIS might provide a core set of services to multiple program areas, and he said other CIOs are envisioning a new architecture from both an IT and a business point of view.
For instance, in the financial back end, MMIS handles the processing of payments, he said. That can lend itself to Medicaid, pharmacy benefits management and the Supplemental Nutrition Assistance Program. States could use one enterprise rules engine for all three, he said.
In the midst of all the health-reform activities, the biggest challenge for CIOs is gaining access to the Medicaid program executives who are being pulled in different directions to work on projects. “That creates a real access bottleneck,” he said. “There is much more interaction between CIOs and directors of these agencies as they work on IT decisions related to supporting health reform.” Howard added that such close cooperation hasn’t always been the case. “Now the CIO is a trusted adviser and broker of IT services, some of which his or her organization will be providing, many of which it will not.”
But beyond the federal reforms, there are drivers that make IT-enabled health care inevitable, as consumers, payers and providers seek greater transparency into costs, outcomes and quality data. “Those changes,” Howard added, “are already under way.” ¨
David Raths is a regular contributor to Public CIO. He also is senior contributing editor of Healthcare Informatics magazine.
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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.