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!