Saturday, August 18, 2007

Summary of MMIS Conference : A Perspective from Dr. Vivek Gore

The MMIS Conference was held in sunny San Diego this year. San Diego is a beautiful city, and the conference location was right by the marina, with several ships and aircraft carriers within walking distance. I have to applaud the State of California for hosting the conference in San Diego instead of their capitol city of Sacramento.

The conference had some interesting sessions; Dr. Brailer had good ideas to present but I did not get a sense that there were any concrete next steps that had been identified. The PS-TG session was well attended, and there were a lot of good discussions during the break out sessions on the different topics. It was clear to me that the vendor community should focus on providing concrete examples and artifacts that can help to remove the vagueness that continues to plague the MMIS industry. A case in point was the discussion on security. We continue to talk about HIPAA and privacy and security yet there is no clear definition of these requirements from an MMIS implementation perspective.

The MITA Proof of Concept session didn’t have quite the impact that the presenters had hoped, because many people in the audience did not see anything that had not already been done. I realize that even this limited implementation required a lot of hard work from many people, but I feel that the MMIS audience won’t be satisfied until they something more comprehensive. People are also unsure about this whole model. I don’t believe that one can build an efficient system based solely on web services. Interoperability is good, and the SOA is a great concept, but an MMIS must first process claims correctly and efficiently.

Ever since CNSI set a tone for the evening events with the party in Big Sky, vendors have been trying to put on great shows for the conference evenings. This year, the Arabian Nights party by CNSI was a great hit, with belly dancers, swords, boa constrictors, and a cute four year girl being the stars of the show. The DJ struggled to put on good dance music, yet everyone had a good time. CNSI managed to put some eCAMS in all the attendees (I am talking about the drink), which was an innovative approach to branding. The zoo excursion by EDS and the dinner cruise with ACS were also enjoyable events, covering key San Diego attractions.

The booth displays were amazing because there were so many vendors. Only a few years ago, the booth area used to be really small with just the usual suspects. Now, if you have anything that is even remotely related to an MMIS, that’s a good enough reason to have a booth. I mean, just because I have some SOA product – and how is that related to MMIS? Also, if you sampled the booths, you would think that all that happens in an MMIS is fraud and abuse.

Personally, I enjoyed the conference. It is always good to meet people, learn about new ideas, demonstrate your products and have a good time. My personal triumph was winning a Socrates bobble head doll, as I somehow managed to balance that golf ball on the tee in just five minutes. The foxes given away by Fox Systems were quite a hit with my kids, as were the gadgets from S2Tech. Can’t wait to be in Nashville next year, hopefully with some more personal involvement in helping to advance the conference initiatives. I know that it will be a musical feast.

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Thursday, August 16, 2007

Day 2: Yet Another Day at MMIS Conference

The Day 2 started on a slow note after lots of eCAMS drink the previous night. Yes, there was eCAMS drink at the CNSI party. It was some kind of cocktail, blue in color and served on tap. I think an innovative brand recognition strategy.

Anyway, the biggest spotlights on Day 2 were two critical sessions. One was the session on new MMIS certification and the other on MITA Proof of Concept: Making MITA Reality. I guess the certification session was a disappointment. Reason: Two years after announcing the new certification kit: We are still awaiting it!!! It would not be ironic if some one joke that the CMS certification project slippage is much like the rest of the MMIS implementations in various states. I guess the previous certification checklist though old and archaic continues be the best bet for states currently in various phases of implementation. To continue the ding on the archaic infrastructure, it is amusing at best, that as states move to the next generation MMIS systems, the mode of communication and data exchange with CMS continues to be legacy mainframe tape cartridges.

The other session was on the MMIS Proof of Concept. The intention behind the whole exercise was fundamentally sound. However it left much to be desired since visually it did not relate with the audience and it was difficult to share the intricacies behind the implementation. I guess for some, the reaction was that this was done 5 years ago in the private sector. I believe that this is true. In the MMIS space we are not technology early adopters. However at the same time the amount of progress that we have made in MITA is very slow. There is a definitely a risk that without substance ( enforcement muscle) and initiatives ( vendors or CMS investing in building central repository) it could die a slow natural death and just end up as a good reference document. I participate in the PSTG and I think there is culpability on our side as well but the dynamics of the situation and the politics of vendor interplay make it highly cumbersome to make significant progress.
The evening culminated with the Zoo Visit. I choose not to go so can’t share the highlights but the attendees flocked the tour buses.

Last but not the least; I had two other interesting observations at the booths. One was the Golf Ball Patience Game and the Accenture Booth approach to maintain 24 hours presence. The Accenture booth had representation by the hotel bar tenders ready to serve you smoothies and explain you the business value services that the organization provided. I took a snap shot of the loyal hotel employees doing booth duty for Accenture.
The Golf ball game was an interesting choice by this new company in the MMIS space called Socrates. I think an ideal choice of game since you needed to be patient with it. It sometime took people 10 minutes and yet not be successful. I say an ideal game since once again it reflects the state of MMIS projects where every one needs patience to get things done.
Stay tuned for Day 3 Coverage.
PS There were certain personal incidents that I needed to share. These can be found at my personal blog site
And here is the rest of it.
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Tuesday, August 14, 2007

Day1: Eventful Day at the MMIS Conference

As the first day wrapped up it is time to look at things that caught attention from everyone. To start with none of the attendees got their registration backpacks. The story behind that is interesting to say the least. The bags were being imported (what happened to made in USA) and they could not clear the freight dock stuff since there were certain things in the package that were not documented. I guess they need to compensate us or send us bags by mail as and when they are released.

The sessions were interesting. The key note by Dr. Brailer continued to emphasize on Medicaid reforms by bringing in industry trends of pay for performance, outcome driven health care but once again failed to give any concrete next steps. I think it is high time people shared their ideas with something that is actionable within the context and constraints of our industry. Yes we need to breakaway from our industry constraints (political far sightedness, no innovative financial models to support changes) but a matter of another post and discuss thread.

EDS spoke on the Health Records space. Well they started with their commitment to that space by setting up a unit internally but ended up pitching their MMIS system.
CNSI started showing their R&D investment with their future release of eCAMS and asking for feedback from the industry (state and vendors). A unique approach to collaboration.!!!

I spoke in my session for Breakthrough in Medicaid Communications. The attendance was average given the multitude of sessions. I assumed we did OK but not exceptional and for sure could have done better. There were some interesting questions around measuring effectiveness of outbound communications.

Anyway the stand out event of the day was the Arabian Nights evening. The dancer with snakes tied around their waists was the WOW moment. Yes, some of us were busy getting tattooed (Indian henna in beautiful and intriguing patterns) and there was one gentleman who had his company name written on his forearm. Now that is call dedication. Any challengers!!! Yes CNSI once again will stand out with this evening reception. They are definitely committed and dedicated to be the different and being the best in whatever they do.

. More updates from other attendees at the conference later.. Read more!

Sunday, August 12, 2007

Successful MMIS Implementations (Part 1 of 3)

Permit me to rise upon a soap box and talk a bit about how the challenges MMIS projects face in implementing these complex systems. This is the first of a three part blog entry. In this article I want to present the background of the MMIS industry. In the second article, I will list the challenges we all face. In the third article, I will pretend I'm king for a day and fix all of the problems!

Bear with me if you are on the "buying-side" of an MMIS procurement because it may sound like a vendor (i.e., the "selling" side) whining and complaining. The whining is unintentional but a few notes may leak in......

MMIS projects are large, complex, lengthy, expensive, and often political in nature. These characteristics and others make successful implementations difficult. With the advent of new technology and new initiatives like MITA, the level of difficulty is bound to increase. Many recent MMIS implementations have had challenges that necessitate a review of potential root causes.

MMIS procurement guidelines are largely dictated by individual state’s procurement law, even through the Federal government finances as much as 90% of acquisition costs. In addition, while state Medicaid programs vary widely, and states’ MMIS requirements vary considerably, majority of the states use the same approach for procuring MMIS Design, Development, and Implementation (DD&I) projects. MMIS projects are large projects on virtually every measure. Consider the following measures for MMIS DD&I projects:

  • State staffing ranges from 10 to 110 people;
  • Funding typically ranges from $30M to $100M (state and vendor combined);
  • Implementation timelines vary from 24 months to 36 months; and
  • Man-hour effort approaches one half of a million hours

Consider also that Medicaid regulation, policies, and business rules are extremely complicated and vary from state-to-state. These projects are also highly politicized. The dollar value and risks involve typically place MMIS projects within the top five of every state’s IT portfolio. The risks are high for all stakeholders: state; providers; recipients; vendors; and CMS.

State agencies are procuring Medicaid systems under fixed price contracts. The fixed price environment is having deleterious effects on the quality and value of MMIS projects for taxpayers, patients, and government officials. Recent project failures and distresses should give rise to serious analysis of what is causing these problems. And, in many troubled projects contract disagreements over money are major contributors to eroding relationships and present a barrier to project success.

(potential whine alert...)

In each of these examples, states use a fixed price contract to manage the relationship and performance of projects. Using fixed price contracts to manage such a large project with an incredibly high level of complexity and a large number of stakeholders creates an environment with an inequitable distribution of risk and reward.

That last bit might sound like whining but stay tuned...I'm not saying to do away with fixed price contracts....

Continued in Part 2...

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My Pick of Sessions at the MMIS conference : Evening Receptions

The MMIS conference will be filled with sessions about changing health delivery models, improving efficiencies and so on. I guess I do my pick up of the must attend sessions. My conclusion : Evening Receptions :).

I hope organizations and sponsors take this in the right spirit and enjoy the read.
Anyway I am disappointed since I will be missing the Sunday Nite Special from Unisys. There Company Logo could easily have been misread as 'Just Imagine it is Done'.

Well on Monday my organization CNSI sponsors the evening. It continues to come out with some theme every year at the conference and this year it chose after a series of choices : Arabian Nights. I guess given the current global political situation, I just smile at this choice.

Tuesday Evening is the Day of the Goliath of the Industry: EDS. And yes they chose to send us to do some team building at the San Diego famous zoo. I guess it is time we learned to collaborate and team build with other species.

And on Wednesday evening the other industry stalwart
ACS wants to say enough on this earth lets take the USS ship to a distant land where no man has gone before.

I know all organizations will put a great show, entertain the attendees and establish good networks and there is always positive to come out of all of this. After all we are all social animals and it is good to break some vendor barriers and enjoy the evenings. I hope I am not excluded from these evenings after these comments and see you there :) Read more!

Tuesday, August 7, 2007

Satire on the MMIS RFP's

This was a post I wrote a while back but felt it is pertinent to revisit this on the eve of this years MMIS conference. Hope you enjoy reading this....
I have to admit that the brains behind this is Mike Morgan but I have attempted to tailor his article such that this reads as if a State (referred to as me) is enlisting requirements of an MMIS project in a RFP. The content of the MMIS RFP reads something like this ..

Please design and build me a MMIS system. I am not quite sure what I need, so let’s get started. My system should be aligned with all the MITA business processes even though I am not sure of what they are?. Just make sure the designs are such that the MITA processes can be easily adopted as they mature in their details. When you bring the blueprints to me, I’ll make the final decision about what I want. Also, bring me the cost breakdowns for each configuration so I can arbitrarily pick one at a later time.

The requirements go on..

As you design, also keep in mind that I want to keep yearly maintenance costs as low as possible. This should mean the incorporation of automated workflow like single click magic buttons and autonomic computing using industry intelligence standards (If you choose not to use industry artificial intelligence standards and products, be prepared to explain you decision). Please take care that modern design practices and the latest techniques are used in development of the system, as I want it to be a showplace for the most up-to-date ideas and methods. To assure that you are building the correct system for our entire state, you will need to contact each of our sister agencies and their managers and team leads. My sister agency X has very strong feelings about how the system should be designed, since the agency uses the system once every year for some strange reasons. Make sure you weigh all these options carefully and make recommendations. However, I retain the right to overrule any recommendation you make. Please don’t bother me with small details right now. Your job is to develop the overall plans for the system and get the big picture.
Also, do not worry at this time about time and the resources to build the system itself. Your first priority is to develop detailed plans and specifications. Once I approve these plans, however, I would expect the system to be up and running within 18 months.

And to top it all...
You must be thrilled to be working on such an interesting project! To be able to use the latest techniques and technologies and to be given such freedom in your designs is something that can’t happen very often and its great for your company's future market.

Does that sound familiar to your State MMIS RFP and requirements or a similar state IT project....

Note: Any references are purely coincidental and any resemblance purely unintentional.
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Live from San Diego: 2007 MMIS Conference

I will attempt to enthuse the blogging phenomenon in the MMIS space this year. I will be attending the 2007 MMIS Conference from August 13-August 17th at San Diego and I intend to use the blogging tool to share information updates from the MMIS conference. Will it be useful for the reader community. Well I don't know about that. I will try my best to make it a good read, invoke some thought in the minds of the reader, intrigue the reader with my perspectives. It has been now a regular annual event for me and my company CNSI to attend. We are all excited at CNSI since we continue to make a difference in the industry with our solution offerings and this year we are planning to give a preview of our new user interface.

Personally, I continue to make my 2 cents of contribution by doing sessions that challenge the status quo. It is always nice to see that the ideas raised last year by us are being accepted across the vendor community. Last year, CNSI led the way with our pragmatic roadmap to RHIO integration. The 'Inside-Out approach' trend is now being expanded in two separate vendor tracks. It goes to show that we can make a difference.

This year, I am co-presenting with Pitney Bowes on Monday August 13 at 3:30 PM. Even though we are running our session in parallel with MITA and a RHIO track, I hope we have audience that can listen to our message. We hope to make people pause and reevaluate their approach to Communications. As we usher and embrace the new social interaction models, we need to shed our archaic model of communication in the Medicaid industry.
Also, I will like to welcome other contributors to this blog, since this poor soul cannot be there all the time at all the events. As we are in era of information overflow, the MMIS organizers are doing their contribution by conducting 30 odd sessions with diverse topics in three days. Good Lord! I just wished I was back in the good old days :) Read more!