P&P August 2016

I n virtually every industry, there is demand for faster and more nimble approaches to information technology (IT) transformation. Take the auto industry where, according to a 2013 Harvard Business Review article, the typical automotive design cycle had shortened to just 24–36 months; five years earlier this same cycle took 60 months. 1 The impetus for change in the automobile industry seems fairly obvious; car makers had to keep up with customer demands for better, more efficient, and more technologically advanced cars so they sped up innova- tion cycles. Taxpayers and recipients of public services, including health and social service programs, have the same expectations. Yet government, and particularly the health and social service agencies and the vendor community that serves them, sometimes may make it appear that we are still acting like it is 1999. However, the tired attempts to rip-and-replace siloed systems with yet another mono- lithic transfer system are coming to an end. A variety of forces is demanding this change. First, the speed and level of technical innovation are simply mind blowing. Second, the pace of regulatory change has never been faster. The Health Information Technology for Economic and Clinical Health Act, the Patient Protection and Affordable Care Act of 2010, the enhanced federal financial participation (FFP) for Medicaidmodernization, the time-limited Office of Management Budget A-87 cost allocation waiver, and the newly adopted Comprehensive ChildWelfare Information System rule, among other regulatory and funding changes, are both encouraging—andmandating—that we do things differently. Despite some great successes in the industry, there have been simply too many costly failures and modernization efforts that do little more than re-platform antiquated legacy technology (and the associated business processes that go with them). Often these projects take too long, cost too much, and make only moderate improvements in the efficiency or effectiveness of case practice if they reach production at all. There are signs, though, that the industry is quite rightfully moving toward a more nimble approach to IT transformation. When viewing the business and IT environment through the lens of the capabilities needed to support a new business model, technology becomes the solution enabler, not the solution itself. The initiatives taking such a view typically leverage a more incremental approach to planning and an agile development approach to deliver results quicker, help mitigate risk, and allow strategy adaptation, if needed, mid-stream. As is often the case with large-scale change, the temptation could be for the pendulum to swing too far the other way. Indeed, an “agile” approach that does not include a clear roadmap for reaching the desired end state, or that fails to account for realities such as the length of a public procurement cycle, is likely destined to fail. However, with a rather straightforward four-step planning process that can be accomplished as quickly as 60 days, an agency The world of health and human services IT Transformation is changing.

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August 2016 Policy&Practice 27