Modernizing Healthcare IT: Lessons From CMS, CDC, and NIH

By Scott Dix, federal civilian account manager,

Scott Dix

Telehealth services, health tracking devices, cloud-based electronic health records: these are just some of the healthcare services and technologies that have seen a surge in consideration and use because of the COVID-19 pandemic.  Since the start of the pandemic a year ago, telemedicine alone in the U.S. increased 20-fold, according to a RAND Corporation study.

Healthcare consumers are increasingly expecting simpler, faster, and easier ways to interact with providers and retrieve their healthcare information. Healthcare organizations must evolve their IT operations to meet these patient expectations, while operating more efficiently in a digital-first world. A common denominator across healthcare digital transformation initiatives – and a key driver of efficiency – is the cloud.

However, a 2020 survey looking into the impact of cloud adoption as a result of the pandemic found healthcare solidly in the middle of the pack in terms of adoption. While 19 percent of respondents implemented or plan to implement cloud because of COVID-19, a full 22% say they have no plans to implement.

What’s the challenge to further adoption? Technology is only one part of the answer. Deciding on the right cloud provider, negotiating a contract, and having in place the proper cloud management solutions to govern cloud use are key pieces of adoption, but people and process have a dramatic impact on every organization’s success in the cloud.

Fortunately, healthcare organizations can look to familiar partners to learn how to modernize their IT infrastructure through cloud adoption: the U.S. Centers for Medicaid and Medicare Services (CMS), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). In each case, these federal institutions focused on three areas to achieve successful cloud adoption: human-centered design, agile methodology, and training and upskilling.

The CMS modernized the Medicare Payment System by building a new cloud environment to process claims. They developed the “Blue Button” API that opened Medicare claims data to third-party developers, giving both beneficiaries and their providers a full view of the patient’s history. And they launched the Quality Payment Program that digitized documentation of value-based care quality metrics, which were previously submitted to CMS by fax and took months to return feedback and payment.

At the CDC, the Surveillance Data Platform created a one-stop location for state and local health departments to send data, where automation is used to route data to the appropriate CDC program. The National Syndromic Surveillance Program connects local, state, and national public health agencies to data from across the country, leading to earlier alerts for health events and quicker responses. And The Digital Bridge Project is piloting electronic case reporting, which reduces manual work processes and improves routine outbreak management.

Last year, the NIH made genomic data about the coronavirus publicly accessible to researchers in the cloud, allowing quick access at no cost. Its STRIDES Initiative allows NIH to explore the use of cloud environments to streamline NIH data use by partnering with commercial providers, providing cost-effective access to industry-leading partners to help advance biomedical research.

Human-centered design

Each of these advances starts with the foundational idea that adopting new technology must put the end user experience first.

“In almost everything that we do, human-centered design is a central component and we start with that,” Rajiv Uppal, CMS’ IT Office Director and Acting CIO, said at the AFCEA Bethesda Health IT day in January 2021, Federal News Network reports.

For example, CMS’ aforementioned Quality Payment Program has a human-centered design process that engages the clinician community for whom programs and services are created. Studies gather feedback from the community on an existing design, new concept, or interactive prototype. The QPP can also explore feature use to understand any pain points or gather clinicians’ perspective on a specific topic.

The CDC partnered with the Lab at the Office of Personnel Management (OPM) for a groundbreaking pilot that paired candid interviews with struggling veterans with data to bring a different perspective to develop transformative ideas on caring for those veterans.

“Human-centered design can be deployed in big ways to address sticky issues in public health,” Leah Chan, a team member and Public Health Advisor at the Injury Center, told The Commons. “But it also can be applied in small ways to make a meeting better or engage a partner in a new way. It’s making sure that we are putting people at the center of what we do.”

NIH CIO Andrea Norris told Federal Network that NIH supports about 300,000 researchers, meaning that much of its activity focuses on “investigator-researcher-initiated ideas and hypothesis for discovery.” The aforementioned advances in search and data directly tie to that mission.

Agile methodology

A key benefit of the cloud is agility – the ability to tackle projects in short sprints, leveraging easily available cloud resources and services and iterating and pivoting as necessary to respond to changes and new requirements. Getting to a human-centered design focus meant implementing an agile methodology, Uppal said. The key is having CMS teams taking on a product mindset, as opposed to a project mindset.

CMS reported that instituting an agile methodology resulted in its Hospital Quality Reporting system, which healthcare facilities use to report data to CMS, now using only 40 percent of its budget towards maintaining the existing system, rather than 100 percent of its budget. A full 60 percent of the budget now goes towards innovation for the system. The HQR team also reported a 55 percent decrease in help desk tickets from hospitals.

When the CDC’s Management Information Systems Office (MISO) — responsible for developing, maintaining, and managing a variety of enterprise business systems across the CDC — needed to make a rapid pivot, they relied on agile methodology to speed up the process while maintaining a collaborative approach.

To speed up its contract awarding process, the NIH’s IT Acquisition and Assessment Center adopted a self-scoring sheet and process that puts the bidder in the driver seat, while also taking a close look at the length of the documents required to bid, Lead Contracting Officer Keith Johnson said on a Government CIO panel last spring.

“That’s the biggest gripe with federal procurement — that it takes too long, particularly with IT goods and services. Because by the time you get to an award, the IT service you wanted is obsolete,” he said.

Training and upskilling

Digital transformation in the cloud isn’t possible without getting employees on board. That’s why CMS has put forth a concerted effort to train and upskill its workforce. Last year, during the pandemic, the agency’s Office of Information Technology held an “upskilling summit” to encourage employees to take courses in human-centered design, product management, cloud technology, and cybersecurity. And employees have been encouraged to try new approaches to find what works best for them. The result has been a 27 percent boost in CMS employee satisfaction.

Similarly, the CDC’s Future of Work initiative aims to help the agency enhance training and pipeline programs to recruit, train, and place a diverse and adaptable workforce. Last year, that initiative conducted workshops, comprehensive hands-on sessions, and a train-the-trainer session.

At NIH, the aforementioned STRIDES Initiative creates access to training for researchers, data owners, and others to help ensure optimal use of available tools and technologies.

Managing the sheer volume of health data, ensuring secure and easy sharing of health records, automating manual tasks, and delivering health app solutions that meet the needs of today’s consumers are powerful motivators that call for cloud adoption. Choosing the best cloud providers for your needs and implementing a strong governance model is one part of adoption. The experience of CMS, CDC, and NIH highlight that focusing on the end user, being agile, and advancing skills are just as critical. Learning from these experiences can ultimately accelerate every healthcare organization’s adoption of cloud and, as a result, transform the experience for patients and providers alike.

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