Yep...One of Those Days

This picture pretty much captures the essesnce of the start of my week. I feel your pain little man.....ugh.

Free HL7 - MITA Orientation Today

Today is the day that CMS is sponsoring a brief orientation session for folks that are attending the HL7 Work Goup session in January. This session also appears to be a good, high-level introduction to HL7 for anyone interested in learning more about this DSMO. The orientation session is being held from 1:00 - 3:00 p.m. EST.

There is a WebEx component, which is a website that one logs onto and can then view a ppt presentaion and also make comments and also a teleconference number to participate in the audio portion of the orientation.

The WebEx site will be available for logon at 12:45 at this URL:
https://eval.webex.com/eval/j.php?ED=97461447&UID=1017175357

The telconference number is: 866-469-3239
When prompted, please enter the Meeting Number: 921 175 287 and then # sign.

The agenda includes an overview of HL7, information on how HL7 relates to MITA and State Mediciad, and some info about how best to participate if you are attending the January HL7 Work Group meeting in San Antonio next month.

Dear Abby M. Zealot

From MITA Zealot to Dear Abby, I would like to take this opportunity to share a reader’s comment with you since the response may be valuable in your life, love, and pursuit of MITA happiness. In response to my “get involved” post, “Sue” (name may have been changed to protect the innocent) writes:

[Dear Abby M. Zealot]
I agree, there needs to be more participation but with all of the subgroups involved, it is not easy to figure out how to get involved where and when. Any help you could offer is appreciated. Thanks.

Sue,

Thanks for your question! While I will never espouse full comprehension of all interactions, below is the world as I know it.

CMS – We all know who they are and the only way to join is to become a Fed. (grin!)

CMS MITA Team – The contracted team assisting CMS in MITA’s continuing evolution is also closed to the general public.

NMEH MITA SWG – This group reviews MITA artifacts allowing states to have input into modifying/improving new versions of the Business and Information Architecture. Open to all state staff members and their sponsored participants, this group is 800+ members and both public/private sector.

HL7 MITA Project – This group will convene in January to begin the process of modeling the MITA Business Processes using Unified Modeling Language (UML) and HL7 standards. Both public and private sector individuals are invited to participate. Membership in HL7 is required to have a vote on proposed standards.

Systems Technical Advisory Group (STAG) – This group is sanctioned as an advisory body to CMS and has been on many issues preceding the introduction of MITA. They continue to act as a conduit for CMS to disseminate MITA related information. CMS selects one representative from each region to participate, by invitation only.

Private Sector Technical Advisory Group (PS-TG) – Comprised of vendors in the same private industry role as the STAG, this group is recognized as an advisory body to CMS. Their MITA focus is in continued development of the Technical Architecture. The group is open to all vendors and rumor has it that some of the more tech-savvy state reps may have been invited to participate as well.

Business Architecture Review Board (BARB) – The newest addition to the family, this group is also by invitation only and is comprised of invited state staff who will participate in the governance process established to moderate MITA’s evolution.

With so much to choose from, you may find yourself asking, “Where should I start?” Here are my recommended steps for interested parties from both the public and private sectors:

Public (State and Federal Staff)

1. Join the NMEH Listserv! This is the broadest group and most of the relevant information flows through here at one point or another. Email Andrea.Danes@FOXsys.com for information on how to enroll.
2. Participate in the HL7 MITA Project. Even if you cannot get approved to travel in January, hook up with the project’s cochairs (Marykay.McDaniel@azahcccs.gov or wbranch@csc.com (Bill Branch)) to stay in the loop on their activities, many of which may be done remotely in between face-to-face trimester meetings.
3. Identify your state’s primary point of contact for STAG and insure that he/she is aware of your interest in MITA so information from the STAG can be forwarded to you.
4. Techno-geeks only: If you proudly wear your propeller hat in public, an email to the PS-TG to see if they would let you participate in their Technical Architecture discussions might be in order. Email dwalsh@ESRV.COM with your qualifications for more information.

Private (The “other side” comprised of vendors and fiscal agents)

1. If you are currently working on a state contract and the lead for that state likes you well enough, you could ask for sponsorship to join the NMEH Listserv. Email Andrea.Danes@FOXsys.com for information on how to enroll.
2. Just like step two for the public sector folks, participate in the HL7 MITA Project. Even if you cannot get approved to travel in January, hook up with the project’s cochairs (Marykay.McDaniel@azahcccs.gov or wbranch@csc.com (Bill Branch)) to stay in the loop on their activities, many of which may be done remotely in between face-to-face trimester meetings.
3. Since you are a vendor or fiscal agent, the propeller hat is optional for participation in the PS-TG. If you would like to learn more about the private sector participation in MITA’s evolution, send an email to the PS-TG for information about membership. Dues are a modest $50 per year so it will not break the corporate bank. Email dwalsh@ESRV.COM for more information.

The world as we know it is subject to change. But while we still know who’s on first, now is the time to swing for the fences!

Sincerely,
Abby M. Zealot

Business Architecture Update

MITA Governance has established a foothold and is under way. The MITA Business Architecture Review Board (BARB) has been formed and is scheduled to begin a review of the existing MITA business processes. It has been reported that CMS is working on a MITA repository that will provide public access to the revised and governance-reviewed business architecture artifacts in the not-too-distant future. Progress!

Calvin and UML

(click on pictures for a larger view)

Calvin was obviously having some trouble conveying his sandwich design concept to the sandwich developer. The result was less than desirable, especially for our young end user. Perhaps our friend Calvin should have tried communicating a more object oriented design request using UML. It may have looked something like this:

The major advantage to using UML is that it is a communications platform that bridges the communications barrier between people. UML allows developers, and even non-developers to understand design in a very simple, common, and straight-forward method.

Anybody want to take a stab at writing the xml for Calvin’s order?

Old MacDonald got FFP for HL7!

A public service reminder that State staff may be eligible for Federal assistance to attend the HL7 Work Group Sessions. Budgets in Implementation Advance Planning Documents (IAPDs) for new systems being built using MITA methodology can be written to include implementation-related activities that would include attendance at HL7.

For systems that are currently operational, job enhancement activities can be reimbursed by the Feds at 75%. HL7 training for ongoing maintenance and operations of your systems can be applied for through an APD update or claimed on quarterly CMS financial reports and justified on the basis that upcoming HIPAA-related claims attachments will likely be based on HL7 standards. In addition, many states are now developing EHRs and PHRs through Medicaid Transformation Grants. Some grant applications have line items for training and standards for the content of these electronic records will also likely come out of HL7.

See your friendly neighborhood CMS Regional Office Staff for details on this exciting offer.

Intimidation, MITA style

While sincerely flattered by the invitation to guest post, I must admit my reluctance to do so is directly related to the level of intimidation I feel in the presence of Mikey. I mean, how do you compete with the SOA to turkey dinner analogy? I am so intimidated by someone so knowledgeable about MITA that I just want to sit on the sidelines and maintain quiet observation so as not to reveal my inadequacy. And then it occurred to me…

Isn’t that why the blog, the NMEH MITA SWG call, and possibly the HL7 meetings are so quiet? It seems like there are those in the world that understand this all so well that the rest of us are left in the dust, trying not to choke, and definitely without breath to comment. But is that really the way it has to be? I vote, “No!”

See, MITA is a vision and goal established by CMS. But CMS is comprised of humans who know they are human and are trying their best to draw the rest of us humans into the conversation with them. Far from the edict descending from the mountain, CMS has invited each of us to bring our respective talents and experience to the table expecting the final product to be more comprehensive as a result.

So whether it is guest blogging, responding, or participating in the NMEH and HL7 workgroups, we should PARTICIPATE! With an endeavor that requires many perspectives and much collaboration, every single participant is valuable. And valued. While this “little” MITA project will likely take all of my career and part of the next generation’s, we are working on something that will change the world as we know it. And won’t that be fun to share around the family holiday table??

Thanks for the invite, Mikey! Hope I did not make you regret it!

CMS Announcement of HL7 Training

CMS has made an official announcement of the HL7 Workgroup pre-conference training session to be held next week.

Here is the announcement:

On December 11, 2007 from 1:00 pm – 3:00 pm, Eastern Standard Time (EST), you are invited to attend a CMS Webinar. The purpose of the Webinar is to explain Health Level 7 (HL7) and its relationship to MITA activities, and why you may want to attend the upcoming January, 2008 HL7 Working Group Meeting. The December 11th Webinar will:

Inform you of the objectives of the upcoming January 15 – 18, 2008 HL7 Working Group Meeting to be held in San Antonio, Texas that will be of interest to business/program staff, and State MITA representatives, as well as staff who are planning to, or are already building, MITA business/information models. More about the HL7 Working Group Meeting can be found at this site: http://www.hl7.org/index.cfm (early registration closes on December 14, 2007).

Invite you to attend orientation sessions in San Antonio for 1st time HL7 attendees, to be offered jointly by the National Medicaid EDI Health Workgroup (NMEH), and CMS, to orientate principally State folks about HL7 and the HL7 MITA sub-workgroup (SWG).

Introduce you to the collaborative activities of the HL7 MITA SWG, which is a subset of the general HL7 meeting, and their on-going activities, and demonstrate how your role in this activity can help.

Provide justifications, and explain allowable funding, for Medicaid State staff attendees.

The WEBINAR will provide you with high-level information about the HL7 meeting, how MITA fits within HL7, and reasons why you should think about attending the HL7 meeting in San Antonio, Texas in January 2008. We promise that the terms “UML” and "WSDL" will be excluded from the conversation!

Please join us on December 11, 2007 from 1:00 pm – 3:00 pm (EST). Webinar details will be sent to you the week of December 3rd.

HL7 Training Update

Update on CMS plans to hold a pre-HL7 Conference training session…

CMS announced this week that Tuesday, 12/11/07 is the planned date for this training. This call is being coordinated by CMS with the STAG, PSTG, and other interested individuals related to HL7 MITA development. Anyone interested or involved in MITA State Self-Assessments, or MITA-related HL7 development is invited to attend. The agenda will include multiple speakers providing information about the next MITA steps and the January HL7 meeting objectives. Specific dial-in information and the exact time of the training is expected to be available soon.

I will try to post the training agenda when it is made available from CMS.

Back to Nature

I am off to to distant shrines renowned in sundry lands.

Perhaps our friend MITA Zeaolot will be moved by the blog spirits to post in my brief absence :-)

See you next week, and if you haven't voted yet in the November poll, please do.

Because I Can, That's Why...

Top 10 reasons why service-oriented architecture is like a Thanksgiving meal:

Like a Thanksgiving meal, it takes a lot of work to put together an SOA ... and no one wants to clean up the associated mess that comes with it.

Reuse, the next round of Web services you build are the IT equivalent of next week's turkey sandwiches and soups. You should be getting a lot of meals out of this feast.

Like a big turkey meal, too much SOA can put you to sleep.

An SOA project can bring together a lot of people you rarely see. In fact, you probably aren't even sure you want to see some of them.

SOA can give rise to lots of interesting combinations, kind of like turducken (a chicken stuffed inside a duck stuffed inside a turkey).

Everyone offers up advice on how to cook up an SOA, but they always leave you with the distinct feeling that they aren't so sure these tips actually work.

You can undertake lots of small projects while you've got your SOA bird in the oven.

It takes a solid network and good communication to move all the food around a Thanksgiving table so that everyone gets to pick exactly what they want.

In many ways, it's a service-oriented meal dependent on a loosely-coupled infrastructure.

Screw up your SOA and you'll never hear the end of it.

HL7 Conference Update

Just in from the MITA rumor mill (and yes, that is the fabled "Cone of Silence")...CMS may be planning a pre HL7 Conference training session.

Some MITA type folks who will be attending HL7 for the very first time have expressed concern that they may need to spend valuable time at the conference getting up to speed on the basics of HL7 and the RIM when this time could be spent with the HL7 MITA Workgroup.

In response to this concern, CMS is looking into providing a training session for CMS and State staff, in a webinar format, that will briefly cover HL7's relevance to MITA and lay the groundwork for what will be covered in the HL7 MITA Workgroup sessions in San Antonio in January. If it happens, it sounds like the webinar will will be held sometime in mid December. Stay tuned for updates on this important pre-conference event.

Getting Ready for Turkey Day...MITA Style

My SOA approach to Thursday's Feast....

(Click on picture for larger view)

NMEH Information

The MITA Matters blog inbox has received several inquiries regarding the NMEH; mainly, what is the NMEH and how do I get involved? NMEH (pronounced Neh-mee) is an abbreviation for the National Medicaid Electronic Data Interchange Healthcare Workgroup. NMEH members are primarily State staff. In some cases, NMEH members can be vendors directly representing State staff. This group exists to “provide a united Medicaid voice when working with the health insurance industry". Lately, the NMEH has been a critical member of the MITA team by reviewing business processes, participating in the MITA track at the MMIS conference, and providing other vital support to the MITA initiative.

If you are working in a State on MITA and are wondering how to actively participate in the further development of the initiative, joining the NMEH MITA workgroup is a good idea. To be placed on the NMEH listserv (to receive periodic emails about NMEH activities and info), simply send an email to this address: NMEH@edifecs.com. You will receive a reply to your email with instructions on how proceed from there. If you have questions about NMEH’s role in MITA and would like to find out more, you may contact Andrea Danes, one of the NMEH MITA sub workgroup co-chairs, at Andrea.Danes@FOXsys.com .

Editor’s note: The book, “The Mouse and the Motorcycle” has no direct link or affiliation to the NMEH whatsoever. Well, okay, it does in my small and twisted brain. You see, when I was but a wee lad, I had a favorite aunt named Emily. All of the cousins called her “Em” for short but I, being one of the youngest of the cousin rat pack, could not master the simple “Em” and instead called her “Nem” and by extension, occasionally “Nemmy”. One of my aunt’s favorite things to do whenever I would visit her was to read me the Beverly Cleary book “The Mouse and the Motorcycle”. So it is one of those weird and unexplainable things in life that whenever I hear or say the word acronym “NMEH”, I immediately think about a little mouse named Ralph and his shiny motorcycle. (Yes, I have tried therapy and no, it did not work…)

Nuts and Bolts and ROI

I was asked recently to comment about the return on investment for service oriented architectures. Because SOA is the approach, not the solution, cost justifying it in the context of a quarterly budget is tough – and perhaps even counter-effective. I realize that this is not the best answer to folks who are trying to sell an investment in MITA to a CIO, but it is, unfortunately, the nature of the beast that ROI in today's IT market makes a direct correlation between the investment in the nuts and bolts of the system and performance measures of that system. In that light, an MMIS that is built using an SOA approach may provide a faster and more accurrate claims processing engine but this performance improvement in moving claims through the mill misses the mark in terms of the real value of MITA - maturing all of the business processes assciated with the Medicaid Enterprise and improving the quality of care being given to Medicaid beneficiaries. ROI in this context will ultimately be measured in the lower program costs that result from improved benficiary care. Because program dollars and IT dollars usually come out of different pots, it is difficult at best to correlate cost savings across the two budgets. Lower application maintenance costs are the closest thing I can come up with as a tangible IT ROI for an SOA build related to MITA. I am interested in hearing from anyone who has faced the challenge of selling MITA in terms of ROI to a State CIO.

Frosty Friday

First frost this morning at Mikey’s humble home. Take some time away from your busy work schedules to enjoy the fleeting remnants of Fall. Watch the geese fly, take a deep breath of the crisp November air, drink some cider, bake a pie, or go for a walk this evening and enjoy the Autumn sky. We all work so hard that we tend to forget sometimes that life has a way of passing us by. So take some time today or this weekend for yourself, for your family, you have earned it!

New Meeting Strategy

I tried this in a meeting yesterday afternoon. I think I pulled it off but the meeting notes I took are pretty much worthless...

HL7 Meeting in January

The next step toward using MITA artifacts to do actual systems development work is to transcribe the MS Word versions of Business Processes into a modeling language that can then be passed along to developers for implementation. The concept of taking the text descriptions of the business processes found in the MITA Business Process Model and turning them into Universal Modeling Language (UML) was proven to be plausible through development of the Enroll Provider Demo that was presented at the 2007 MMIS conference. The demo proved that users of disparate technical platforms could submit a standardized input to invoke business services that support a MITA Business Process and receive a standardized output, again, independent of the technical platform.

Why am I telling you this? Well, primarily because it makes me look smart! But I also bring it up here because most of the modeling of the MITA Business Processes remains to be done and the HL7 standards that will support these models are still under development. In order to evolve the BPM, a MITA focus group has been formed within HL7 to leverage their tools and methodology to create the Business Processes in Unified Modeling Language (UML) as the next step in evolving the MITA Framework into the foundation for detailed design specifications (okay, I stole that line, sue me). The next opportunity for this group to get together cheek-to-cheek (hey, what happens in San Antonio stays in San Antonio) is coming up in January.

During the HL7 conference in January in San Antonio, TX, the HL7 MITA focus group will meet to develop the work plan, set the direction for the work, and solicit state input and volunteers. NOW is the time for state voices to be heard as the UML development work begins. Just as state input is valuable in reviewing and revising the Business Processes, it is even more valuable in development of the UML versions. Further refinement of the Business Processes will take place during the course of this development work. Additionally, the data standards for use in each Business Process will also begin to be drafted (okay, so I stole that too!)

This is a great, nigh, GRAND opportunity for anyone involved in MITA to develop a new skill! UML modelers right now are a scarce resource, trust me, I’ve looked! This may be the perfect opportunity for someone to step outside the world of their miserable little cubicle, spread their wings, and fly with reckless abandon toward the brave new world of business process modeling. Just think of the longer hours, the separation from family, the late evenings of high anxiety and frustration, the 80 hour work… weeks…okay, maybe don’t think of those things, but seriously, it IS a golden opportunity to become part of an elite class of “crossover analysts” who dwell in the netherworld between the Land of Requirements Development and the Land of Systems Design, never really fitting in with either class, not having a clan of your own with which to identify, always being on the outside looking in, always the Bride’s Maid and never the…Bride….okay forget all of that too. This is going according to plan here.

Look, just check out the link here and decide for yourself, but don’t ever say you weren’t given an opportunity to play an active role in the development of MITA because here is your chance! http://www.hl7.org/events/sanantonio012008/

MITA Matters November Poll

The November Poll is up.

Scroll to the bottom of the blog.

Go ahead, take a shot!

October Poll Results

In the inagural MITA Matters poll, Mikey posed the question, "How familiar are you with the MITA State Self Assessment (SS-A) Process?". Fourty five people voiced their opinions, the results are presented here. I was pleased and a little surprised by the results.

For those of you who are kodachromically-challenged here is the breakdown:

37% Had a high level of understanding

28% Had an adequate level of understanding

31% Said they needed more training

2% Had no knowledge

All graphs are sold on an "AS IS" basis unless stated otherwise. All prices plus sales tax and shop supplies where applicable. Graph may not represent actual poll results. Results and special offers are subject to change. Some graph information and graph pricing may be unintentionally missing or inaccurate, and MITA Matters, Inc. will endeavor to correct such discrepancies in a commercially reasonable manner upon Customer notification of such errors or omissions, but graphing errors and listing errors are considered invalid and may or may not be honored at the sole discretion of MITA Matters, Inc. and its participating bloggers. Graphing calculator should not be used for exact poll results. Daily changes in inventory may result in the unavailability of certain graphs listed on-line. A commercially reasonable effort will be made to keep the inventory database current on a multi-week basis. Actual Mileage may vary.

MITA Compliant?

Is there truly such a thing as “MITA Compliant” solutions or components? Can an existing architecture be “MITA-sized” with the addition of drop in “MITA-compliant components? Can a vendor today deliver a “MITA-Compliant” MMIS?

Well....no.

If one Googles the term “MITA compliant”, the search engine returns over 100 listings of web entries that contain this term; a fascinating number, really, considering there is currently no such thing (Although if you Google “Sasquatch” you get almost two million hits so I guess we aren’t doing all THAT bad…yet).

Most of the sites that reference “MITA Compliance” are related to vendors that appear to have little or no understanding of MITA or MITA concepts; these vendors pepper their sites and their site’s meta-data with the terms “MITA” and “compliance” in the hope that search engines will direct people seeking information on MITA to their site. One particular gem that I happened upon stated that “MITA compliant MMIS systems will enable real-time HIPAA processing” and that this new and amazing capability, “will give healthcare providers to [sic] significantly increase the productivity of systems and staff.” Now this might be amusing except…there are actually real people working for real State governments in the area of Medicaid information systems who have been charged with determining the impact of MITA on their State Medicaid business and these good folks have to navigate the gauntlet of false claims and misinterpretations being offered by many of these self-proclaimed experts (present company excluded of course).

This raises an interesting question – will there be such a thing as a MITA-compliant solution at some point in the future? To answer this question, it helps to take a closer look at what MITA is and what MITA is not.

Simply put, MITA will provide standards around which technical and information solutions will be built and/or provided to advance the maturity of State Medicaid business processes. More specifically, MITA will stipulate standard formats for business process inputs and outputs and for the shared data that are used in the performance of these processes – MITA is a framework, not a solution.

In its simplest of form, a “framework” is a structure supporting or containing something or an organizing structure for the essential knowledge and skills in a program area. Some common industry definitions for the word “framework” include, “an extensible structure for describing a set of concepts, methods, technologies, and cultural changes necessary for a complete product design” and, “a systematic format and technical structure that supports metadata concepts, contents, and controlled vocabularies.”

MITA is today, a set of defined business processes that will provide significant help to States as they complete the business process re-engineering phase of systems development with the goal of maturing these processes toward the long term aspirations of utilizing clinical data to improve the quality of beneficiary care and the enabling the interoperability that will support the quality goals.

MITA today contains the basic elements needed to introduce States to the tenets of service-oriented architecture (SOA) and lays the foundations for the technical functions that need to be implemented to allow this architecture to support the maturing business processes.

MITA today explains the need for a standardized information architecture and reliance on data standards to support maturing business processes.

MITA today is not complete and does not contain the components needed for anyone to offer a “MITA compliant” solution. Noticeably missing are the definitions of the formats for the standard WSDL inputs, outputs, and data standards for various levels of business process maturity along with common conceptual and logical data models. Both of these areas are currently being addressed by CMS and various workgroups but are at best works-in-progress.

Until the MITA framework is more complete, claims of MITA compliant solutions should be viewed through the prism of caveat emptor. If someone approaches you claiming the ability to deliver a MITA compliant solution, I would simply ask, based on what?

Pianos and MITA

A little Monday morning humor...

A grade school teacher was asking his pupils what their parents did for a living. "Tim, you be first. What does your mother do all day?" Tim stood up and proudly said, "She's a doctor." "That's wonderful" said the teacher.

How about you, Amy?" Amy shyly stood up, scuffed her feet and said, "My father is a mailman." "Thank you, Amy" said the teacher.

"What does your parent do, Billy?" Billy proudly stood up and announced, "My daddy plays piano in a whorehouse."

The teacher was aghast and that evening went to Billy's house and rang the bell. Billy's father answered the door. The teacher explained what his son had said and demanded the Billy’s father provide an explanation.

Billy's dad said, "I'm actually a UML Modeler specializing in producing diagrams from which XML packets are derived to support the WSDL for MITA…Now how do propose I explain THAT to a seven-year-old?"

October Poll

We are up to 43 votes now on the October Poll - SS-A knowledge. I was surprised and rather pleased to see that so many MITA Matters visitors have a relatively high level of familiarity with the SS-A process!

If you haven't voted yet, please do, only one week left to go. The poll is at the bottom of the page.

If you have a suggestion for the November poll, please leave it in the comments box, your participation is much appreciated.

Mikey is going on a short sabatical, back next Monday. Have a great weekend!

To Be or not To Be

The MITA State Self Assessment (SS-A) is a process that a State uses to review its strategic goals and objectives, measure its current business processes and capabilities against MITA business capabilities, and ultimately develop target capabilities to transform its Medicaid enterprise to be consistent with MITA principles.
The SS-A has four main purposes:

1. Map the State’s business processes to the Medicaid business processes as they are described in the Framework document

2. Define the State’s current level of business capability maturity (the “as-is” status)

3. Identify the target levels of business maturity that the State hopes to achieve in the future (the “to-be” status)

4. Serve as input to the Transition Plan

A dilemma facing many States as they embark on completing the MITA SS-A is just how far into the future to go when identifying their “to be” capabilities. It is tempting to aim high and identify levels 4 and 5 maturity for all business processes to demonstrate that the State is going to have a “super system” that complies with the all of the principles of interoperability and health care data exchange…but is this vision realistic or even helpful in designing a new system or preparing the procurement documentation that will drive the transition?

Probably not.

Keep in mind that the results of the SS-A are going to be used to drive the State’s Transition Plan. The main component in the transition plan is the gap analysis. In developing the gap analysis, the State will compare their “as-is” maturity capabilities to their target “to-be” capabilities and then identify the scope of work and the level of technical support that will be required to make the transition. The scope of work and technical architecture will in turn drive the cost estimate for the project. All of this then comes together to help prepare an Implementation APD to request Federal dollars and as input to the RFP process.

So how far into the future should a State project the “to-be” levels of business maturity when conducting an SS-A? In my humble opinion, not beyond what is reasonably achievable over the next 2-5 years based on technology enablers and budget constraints. For many State’s, this means moving only to level 2 or level 3 maturity level for the business processes that will be affected by the transition or enhancement. Keeping the “to-be” targets realistic will not only promotes better planning, it will also result in better proposals from vendors in response the RFP.

It IS important for State’s to have a long term strategic plan that describes where the State would like to be in terms of business maturity 10 years from now; but this vision does not belong in the SS-A. This vision belongs in the concept of operations document or even as a separate section of the transition plan. Having this well-defined concept of the future of the Medicaid enterprise will help to ensure that any shorter-term enhancements or replacements will be in line with where the State wants to be down the road. But for the SS-A, stick to what is achievable within the span of the next procurement.

Skill Sets

A tourist walked into a pet shop and was looking at the animals on display. While he was there, another customer walked in and said to the shopkeeper, "I'll have a C monkey please." The shopkeeper nodded, went over to a cage at the side of the shop and took out a monkey. He fitted a collar and leash, handed it to the customer, saying, "That'll be $5,000."

The customer paid and walked out with his monkey. Startled, the tourist went over to the shopkeeper and said, "That was a very expensive monkey. Most of them are only a few hundred bucks. Why did it cost so much?" The shopkeeper answered, "Ah, that monkey can program in C - very fast, tight code, no bugs, well worth the money."

The tourist looked at a monkey in another cage. "Hey, that one's even more expensive! $10,000! What does it do?" "Oh, that one's a C++ monkey; it can manage object-oriented programming, Visual C++, even some Java. All the really useful stuff," said the shopkeeper.

The tourist looked around for a little longer and saw a third monkey in a cage of its own. The price tag around its neck read $50,000. The tourist gasped to the shopkeeper, "That one costs more than all the others put together! What on earth does it do?" The shopkeeper replied, "Well, I haven't actually seen it do anything, but it says it's a project manager".

Comments

Yogi Berra once said, “You can observe a lot by just watching”. While it’s hard to argue with Yogi’s reasoning (in fact, it just about impossible to argue with most of Yogi’s reasoning) the fact remains that blogs are designed to be interactive. If Mr. Berra were hosting this site I would expect him to say something like, “90% of the visitors to the MITA Matters blog don’t leave any comments and the other half don’t say much either”.

This blog is now averaging 150 visitors each day. The comments box is a great way to communicate a thought, or strike up a dialogue with folks who are working through many of the same issues related to MITA, MMIS procurements, or the Medicaid systems environment in general. It’s really not hard (heck, I learned how) – just click on the “comments” tag below any of the posts and the comments window will appear. You will have the opportunity to leave an anonymous comment, or use a catchy moniker like “MITA Man” or “MITA Maiden” or “MITA Skeptic” or “Joe MITA” or MITA Maniac” or, “Please take me off your d@#m mailing list”. Simply type a few words in the comments text window and hit the “Submit Your Comment” button and voila! You have just posted a thought that will be pondered by hundreds of your peers. You don’t need a username or password and the posting can by totally anonymous if you choose.

To view comments, you may have to scroll up in the comment box as the text box appears first, and is at the bottom of the window.

The point is that observing is fine, but participating will make this blog much more valuable. So go ahead…(queue Schwarzenegger voice) Do it Now…Leave a comment Now…I’ll be Back!

Sheres of Influence and MTGs

It is important to remember that MITA is much more than “an MMIS on steroids” as has been eloquently stated by a well-known MITA Champion at CMS. MITA attempts to boldly go beyond the boundaries of the traditional claims processing and reporting system that we have all known and loved for 3 decades and into a realm where Medicaid information systems can be platforms upon which clinical data is shared and quality measures are monitored. MITA speaks in terms of the "Medicaid Enterprise".

In MITA Framework 2.0, The Medicaid Enterprise is defined in the MITA context as three spheres of influence. The first sphere is basically anything that has traditionally been covered under Federal matching funds – the “core” of the system - the part that would be ingesting the aforementioned steroids if they were legal and/or the league commissioner chose to look the other way.

The second “sphere” basically includes the interfaces into and out of the core system. Nothing really new here, unless we are talking about building bridges to agencies such as mental health, public health, education, corrections, etc… in an effort to expand the Medicaid Enterprise.

The third sphere is defined in Framework 2.0 as “the sphere of influence that touches, or is touched by, MITA”. This is where we break ground in the realm of Health Information Technology (HIT) and Health information Exchange (HIE). To this end, it useful to consider the Medicaid Transformation Grants (MTG) that were let by CMS over the last year.

As described on the CMS MTG web site: Section 6081 of the Deficit Reduction Act (DRA) authorizes new grant funds to States for the adoption of innovative methods to improve effectiveness and efficiency in providing medical assistance under Medicaid. Through the use of the Transformation Grants, States can work with CMS to create programs that are more aligned with today's Medicaid populations and health care environment.

Of the 46 MTGs that were awarded, 25 of them - over half - are related to HIT. While this “Third Sphere” is characterized by the exchange of information or influence without involvement of any Federal matching funds for the Medicaid agency, it is important to examine these projects through the prism of the MITA Maturity Model. There are still some MITA skeptics who believe that maturity levels 4 and 5 in the MITA framework are pipe dreams; these transformation grants, and the pioneers behind these grants are proof positive that HIT and HIE integration with MITA is truly on the horizon.

More information on these grant projects can be obtained by contacting the Medicaid systems folks in each of the named States. More information on the Medicaid Transformation Grant awards can be found here: http://www.cms.hhs.gov/MedicaidTransGrants/02_2007awards.asp#TopOfPage

Choices

OMG Conference Announcement

The Object Management Group (OMG) is referenced in MITA Framework 2.0 as a source of technical standards including Security. For anyone that could bear the pain of a week in Orlando in January, this conference will probably have ramifications for MITA. Go ahead...take one for the team :-)

What:OMG's Maximizing BPM Investments with SOA Workshop

When:January 14-17, 2008

Where:The DoubleTree Castle Hotel, Orlando, FL

Info: http://www.omg.org/bpm-soa-ws-pr/

The Object Management Group* (OMG*) is an international, open membership, not-for-profit computer industry standards consortium. OMG Task Forces develop enterprise integration standards for a wide range of technologies and an even wider range of industries. OMG's modeling standards, including the Unified Modeling Language* (UML®) and Model Driven Architecture® (MDA®), enable powerful visual design, execution and maintenance of software and other processes, including IT Systems Modeling and Business Process Management. OMG's middleware standards and profiles are based on the Common Object Request Broker Architecture (CORBA®) and support a wide variety of industries.

Enough Said

T.G.I.F.

Well the weekend is finally upon us :-)

I hope everyone had a happy and productive work week, I know I did.

I am thinking of stitching together an essay on MMIS procurements and the effect that MITA is having and will have over the next decade in the MMIS marketplace. The days of the legacy, one-vendor solutions are slipping by the wayside and new systems are likely to include multiple solutions and multiple vendors.

If you have some thoughts you would like to share on this topic, please leave them in the comments box or email me at mitablog@comcast.net.

Thanks, have a great weekend!

Poll Envy

Some thrilling news – one more vote and the October MITA Matters Poll will be up to a whopping 10 votes…Oh Boy!

For those of you who have cast your ballot, a hearty thanks!

For those that visit and do not vote, what are you waiting for? Its free, its painless, its anonymous, and it would just fill me with warm fuzzies to see more of my MITA mates participating. Scroll to the bottom of the page to cast your ballot or view the results.

For those of you still grappling with the Mikey ID issue, the photo here is Mikey at 4 mos.

2008 Conference Site Announced...

The MMIS Conference Website has next year's conference location posted!

It's the Gaylord Opryland Resort in Nashville, TN

http://www.mmisconference.org/2008/index.htm

Click here for a photo tour of the resort.

Columbus Day Assignment

In this picture, we see Christopher Columbus making an appeal to Queen Isabella for her support of his plan to open a trading route with Asia through a West Indies passage. To accomplish this feat, Columbus would need to chart a new path, through unknown and untested waters. Columbus was a visionary.

At the end of the last century, the Medicaid systems realm was the beneficiary of a gathering of visionaries within the Private Sector Technical Group (PS-TG). When I saw this picture, I thought of Arthur McKay and Susan Fox putting the finishing touches on a document that would lay the foundation for MITA. The document is titled


Steps Needed to Improve State Medicaid Information Systems (MMIS):
The Private Sector View of Challenges and Opportunities for the 21st Century
The severity of the demands pressuring the present day MMIS prompted the PS-TG to publish this paper as a way of contributing to the change process. Within this document, the PS-TG addressed the following issues:

1) Impact of expansion of managed care; introduction of Welfare Reform; expansion of waivers and carve-outs

2) Changes in the healthcare delivery system with expansion of and experimentation with new arrangements, e.g., PHOs, MCOs, IPAs, MSOs

3) Political pressures to privatize, thin the ranks of state employees, carve out services

4) Technological explosions in communications, electronic media, information highway, hardware

5) Reduction in the ranks of traditional MMIS contractors; increase in numbers of new specialty service vendors

6) Increase in experimentation leading to project failures, delays, overruns, and disputes

7) Break up of the traditional MMIS into component parts

If you haven’t read this document, I urge you to do so - Make it your Columbus Day homework assignment.

http://www.pstg.org/21centmmis.htm#Section%209:%20Next%20Steps

Mikey 411

The mitablog inbox has been inundated with inquiries regarding the sincerity of our host’s claim to be the real “Mikey”. As the MITA Blog Master, I felt it my duty to put an end to this budding controversy post haste.

Allow me to share the following on behalf of our vertically challenged host:

Little known factoid - early versions of Life cereal contained inordinately high concentrations of benzoates, sulphites, nitrates, and sulfates - nearly 1000x the RDA levels that appear on the side of the box today. For most all consumers, the elevated levels of preservatives had no noticeable affect. For Mikey, because he ate so many bowls of delicious (and nutritious) Life cereal during the tapings of the Life cereal commercials, his physical growth was stunted and his physical looks were preserved indefinitely. In fact, the picture that you see above was actually taken shortly before the first posting of this site as Mikey was enjoying yet another helping of the ambrosial pabulum that is Life cereal.

The good news is that, although Mikey’s cute little frame ceased to expand at a normal rate, Mikey’s mind continued to grow until it reached the awe-inspiring, mensa-like level of thinking that we see today and from which we all benefit through the near genius creation of this bogging site. So yes, he really is THAT kid from the Life cereal commercials.

Critical Mass?

Well the dust has settled from the 2007 MMIS conference, and I think Mikey has finally digested the last of the fish burritos he scarfed down on Old Town. At the conference, we heard that many states are either actively engaged in or contemplating the performance of a MITA State Self Assessment. We also heard that CMS is on their way to formalizing both a MITA governance process and some kind of MITA repository. At the conference this year, there seemed to be less of an air of skepticism surrounding the reality of MITA and more of a resigned acceptance that MITA is the path that MMIS systems development will follow going forward. “Critical Mass” is defined as “the minimum amount of fuel needed in the core of a nuclear reactor in order to start a self-sustaining chain reaction.” Has MITA reached the critical mass necessary to sustain itself?

A quick assessment of the MITA Framework 2.0 document suggests that, although the level of enthusiasm may have reached critical mass, there remains much work to be done before there is sufficient substance to support the coalition of the willing in turning MITA theory into reality.

The Business Architecture is close to being complete but is missing important elements of the Business Capability Maturity Matrix, including conformance criteria, that are essential to both conducting an SS-A and developing requirements based on the To-Be description of a new system.

The Technical Architecture is more than just a skeleton but far behind the BA in terms of completeness. The Technical Functions/Areas need to be reviewed and refined and the technical capabilities that describe these technical functions are missing for many of the maturity levels in the Technical Maturity Matrix. Along with completing the descriptions, there need to be measurable qualities developed for each level of technical maturity. In addition, the specifics of the Application Architecture need to be supported with details and requirements.

The Business Process Model requires a companion data model. The MITA Information Architecture has neither a conceptual data model nor logical data model upon which data architects in the states can build a physical data model.

Some of this work is dependent upon the completion of the BA; some of the work can be begin right away. Who will perform this work? How will it be directed and coordinated? How do we ensure that everyone with a stake in the process has a voice?

There is no doubt (in Mikey’s mind) that MITA has a solid foundation, has reached critical mass, and has a good chance of becoming the model for future Medicaid systems implementation. So, what are the priorities going forward into the next year of the MITA journey? Does anyone visiting this site have an opinion?

Mikey is lonely…

Big Time!

Big Ups to the NMEH List Serve folks for giving Mikey some props! 346 hits to the MITA Matters blog in one day!

A Blog Is Born...

The English play write and purveyor of prophetic proverbs, John Heywood, once postulated that “a hard beginning maketh a good ending”. I fully anticipate that this blog will have a hard beginning and so thanks to Mr. Heywood, I'm as happy as a rat with a golden tooth!

After attending the MMIS conference in San Diego in August, it occurred to me that someone should establish a forum that would allow for a free exchange of ideas about MITA and/or the Medicaid information systems environment in general. Yes, there are workgroups, and advisory groups, and the suits at CMS and consortiums of States – all of whom meet at various intervals to discuss specific aspects of MITA and all of whom make a significant contribution – but these environments often suffer from “group think-itis” (yes, that is a valid meeting diagnosis and no, there is not an ICD9 code for it!). Oftentimes the comments and observations in these forums are constrained through the pressure of attribution alone.

In other words, this blog will, if used, provide a space for people with an interest in MITA to post anonymous comments – both good and bad – as well as a place for folks who wish to be recognised to commiserate, exchange ideas and generally just connect.

The MITA Matters blog team (okay, its just me for now) will try very hard (okay, not really THAT hard) to provide thought-provoking posts that will help to facilitate the "conversation". If there is a topic that you would like to see raised for discussion, please include it in a comment to this post - click the "comment" button at the end of this post and a comment window will magically appear. This comment window also allows you to read what others have said - it provides the interactivity portion of the blog.

Suggestions for topics and also suggestions for links to add to the CMS MITA stuff can also be submitted via email at mitablog@comcast.net.

We'll give it a month or so and see how it goes....

-Mikey

On the way.....