Public Sector Turmoil and High Impact Solutions

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Public Sector TurmoilandHigh Impact Solutions

• Lee Denny
• Director, Information and Technology Services

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Objectives

• Context and IT Context.
• Challenges in Implementation.
• Personal Case Studies Key Enablers.
• Leadership.
• Resources.
• Critical Success Factors.
• Key Ministry Activities.
• Discussion.

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Health Are We Winning or Losing Today?

• Are We Meeting Public Expectations?
• Service Levels.
• High Value / Low Cost.
• Whose Issue BC, Canada, World?
• Where Can Information Technology Contribute?
• Speed-Time-Distance Equation.
• Efficiency / Effectiveness.
• Do We Have Realistic Goals for Technology?
• Incremental Improvement.
• Paradigm Shifts.

4
IT Context Our Best Shot.

• Standards.
• Administrative Efficiencies, Particularly as They
  Relate to Information Movement and Records
  Retention.
• Planning Information Demographically Driven
  Process and Flow Modeling.
• System-wide Solutions.

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Shared Solutions The Challenges.

• Shared Vision Common Objectives.
• Trust.
• Sponsorship.
• Cost of Collaboration.
• Funding Money in the Middle.
• Standards and Legislation.
• Drift Focusing Enough Talent on the Objective
  for Long Enough.

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The Fundamentals

• Leadership.
• Resources.

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Personal Case Studies

• US Federal Government NII NPR.
• State of Maryland EBT.
• State of Maryland Technology Investment Fund.

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US Federal Government 80s/90s

• Collapse of USSR.
• Desert Shield/Storm.
• 104th Congress (Newt Company).
• Budget Impasse.
• Furloughs.
• Y2K.

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US Federal Government

• National Information Infrastructure.
• National Performance Review.

(Information Infrastructure Task Force)
(National Partnership to Reinvent Government)
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NII and NPR

• Legislatively Enabled.
• High Profile Political Support.
• Multi-jurisdictional Encouragement.
• Public-Private Encouragement.
• Build It and They Will Come Vision.
• Real Money, as in Billions.
• Recognition and Reinforcement.

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Technology Results

• Focused the Internet on Commerce.
• Fostered eGovernment Initiatives.
• Online Purchasing.
• Universal Electronic Mail.
• Web Forms and Information.
• Funded the Building of the Commercial Internets
  Infrastructure.

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NPR Strategic Results (5 Years)

• Procurement Reform A.
• Customer Service B.
• Downsizing B.
• Performance Improvement C-.
• Service Integration Incomplete.
• Approximately 170 Billion Saved.

Graded by Brookings Institution 1998
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State of Maryland

• Population is About the Size of BC.
• Economy is About Double.
• Concentrated in Two Main Centres.
• Suburban DC - High Tech, Transient.
• Baltimore - Medical Research, Traditional Power
  Base, High Poverty Inner City.
• Established CIO Function and ITB in 1993.
• State-wide Strategy and Standards.
• Governors Information Highway Initiatives.
• No Operational Responsibilities.
• Established Technology Investment Fund in 1995.

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Electronic Benefits Transfer

• Issue Welfare Theft and Abuse.
• Technology Solution ATM Card for Recipients.
• Barriers
• Nobody Else Has Done.
• Federal Law Doesnt Allow.
• No Money to Do Have to Set Up ATM Network.
• Recipients Cant Get Bank Accounts Because of No
  Job, Bad Credit, etc.

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EBT Implementation

• Allocated Funding.
• Governor Got Executive Office Approval for a
  Pilot Program Built the Feds In.
• Changed the Maryland Banking Law Banks Have to
  Give Recipients Bank Accounts, Let Use ATMs.
• Didnt Have to Establish Any Infrastructure or
  New Standards.
• Took Less Than a Year First Use in US.

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Technology Investment Fund

• Issue How Do We Fund Multi-jurisdictional
  Initiatives.
• Solution Create a Self Renewing Funding Pool.
• Barriers
• Legislative Bodies Dont Like Standing Funds
  Usually Abused.
• Pork Barrel Perception.
• Pork Barrel Reality.
• Source of Funds, Source of Renewal.

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Fund Implementation

• Governor Personally Sponsored Legislation.
• Set Up as a Revolving Fund so Self Renewing.
• Other Sources of Continual Revenue.
• Put Under Separate Oversight Committee (Public
  Private Members).
• Small Number of Recipients - Real Money.
• Now at Around 100 million.

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Common Critical Success Factors

• Manageable Number of Initiatives.
• Committed, Visible (Political) Leadership.
• Identifiable Public Interest.
• Outcome Driven, No Studies.
• Achievable, Quantifiable Objectives.
• Passionate Knowledge Workers.
• Significant Funding Pool.

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So What About Private-Public Partnerships?

• Are There Any?
• Mostly Vendor-Buyer Relationships With a Few
  Considerations Attached.
• Difficult to Determine Equivalent Value.
• Difficult for the Public Partner to Participate
  in Promotion.
• Value is Almost Always Overstated by Both Parties
  Leading to Disappointment.

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Just When You Have It Figured Out!

• Globalization of IT Skills.

This Man May Put Us All Out of Business!
Hi, My Name is Phil.
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Key Ministry Initiatives

• HealthNet/BC/ Pharmanet Extensions.
• HNData - Data Warehousing.
• Standards.
• Claims Standard.
• Lab Test Standards.
• Registries.
• Client.
• Provider.
• Facility.
• Collaborations.

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Pharmanet

• Emergency Room Access is in Deployment.
• 45 of Profiles Rated High/Very High Use.
• 20 of All Profiles Affected Treatment Decisions.
• 27 Emergency Departments.
• Doctors Access is in Pilot.
• 200 Volunteers So Far.
• 100 Sites Randomly Selected.
• 26 Doctors Implemented.

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HNData

• Will Provide a Sophisticated Data Warehousing
  Capability for Health Stakeholders.
• Final Negotiations Underway.
• Project Will Commence Immediately.
• Initial User Deliverables in the October
  Timeframe.

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Standards-Hot Ones

• Electronic Claims Standard.
• Lab Test Standards.
• CIHI Agreed to Evaluate Becoming National
  Standards Body for Health Information (HL7).

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Electronic Claims Standards

• Transportation, Format, and Content of Messages
  Traveling Among Organizations.
• Accepted By
• Payers Processors.
• Software Support Organizations.
• Based on Existing International Standards.
• Potential for National Acceptance.
• CIHI.
• Private and Public Insurers.

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Lab Test Standards

• HealthNet/BC Standard April, 1999.
• BCHISC Standard September, 1999.
• MSC Approval November, 1999.
• WHIC Acceptance January, 2000.
• Implementations Underway Under Evaluation
• CDC/PHIS.
• PathNet.
• Health Authority Working Group.

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Registries

• Client, Provider, and Facility.
• Implemented Client Deploying Wider.
• Co-developing Provider as a WHIC Project Design
  Stage.
• Facility is in Feasibility Study Stage.

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Collaborations WHIC.

• October Start-up.
• Identified 15 Opportunities 8 Key.
• Leverage Each Others Previous Activity.
• Collaborate on New Activity.
• Federal Funding Opportunity.

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WHIC Lead Provinces.

• British Columbia.
• Provider / Facilities Registries.
• Health Claims Standard.
• Lab Test Order/ Reporting.
• Alberta.
• SPHINX-Population Health Analysis.
• Consumer Access.
• Continuing Care.
• Telehealth.
• Saskatchewan.
• Reciprocal Billing.

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Discussion

• healthnet.hnet.bc.ca