Policy and Practice August 2016

Disruptive Technology

ISM2016 delves deep into what emerging technologies are actually having a major, even disruptive, impact on

implementation of HHS IT systems and service delivery. The mission-critical nature of HHS requires rigorous vetting and

planning to ensure that a disruptive technology does not interrupt or interfere with service delivery. New technologies

often come with hard-to-verify claims of increased programmer productivity and lower costs. While these are admirable

goals, it is incumbent upon HHS IT management to ensure that prior to adopting a new technology that all of its impacts

are thoroughly assessed, understood, and communicated to all actors and stakeholders. Where better to begin your

assessment of the suitability of an emerging technology than to hear from your counterparts in other states already

working to implement new technologies, and private-sector representatives that are vested in the successful integration of

these technologies into the HHS IT enterprise.

Open Source Software (OSS) has many advocates in several technical communities, especially with academics, but has

not made major inroads into the HHS IT space. Barriers to OSS adoptions include lack of in-house or vendor expertise,

concerns that OSS is not as secure as proprietary software, and hard-to-quantify costs related to “free” OSS. Despite these

concerns, several HHS agencies are cautiously moving to adopt OSS. ISM2016 addresses the concerns, challenges, and

costs associated with OSS with presentations from three states about their experiences and outcomes using OSS.

One disruptive technology that is getting a lot of attention in the private sector is the Internet of Things (IOT). From

household appliances to autonomous automobiles, there is tremendous interest and considerable investment in IOT. Is

IOT applicable to HHS service delivery? IOT is beginning to show up in the health care space with solutions such as remote

health monitoring, which can help patients and providers more effectively manage chronic diseases (diabetes or congestive

heart failure). Tracking devices in the form of wearable technologies can be used to monitor Alzheimer’s patients or enable

aging in place. Providers are starting to send patients home with remote health monitoring devices (blood pressure cuffs,

weight scales, heart rate monitors) for early detection of problems before they become critical and result in expensive

hospital readmissions. All of these innovations are driving better health outcomes at lower cost. Can IOT for HHS be far

behind?

HHS has been active in adopting mobile technologies for a mobile workforce and client population. Our clients are much

more likely to have access to a smartphone than a laptop. HHS mobile workers routinely use standard smartphone

features like GPS as an integral part of their work day. Given the penetration of mobile technology in HHS is it now possible

to pinpoint when, where, and how to acquire, implement, and maintain mobile apps?

Often a legacy HHS IT replacement takes multiple years and millions of dollars before the

HHS agency receives any value in return on its investment. The popularity of Agile software

development methodologies and modular development seeks to alter that paradigm.

Automated software migration from expensive, outdated, proprietary mainframe source code to a modern code base like

Java is another promising approach to quickly realizing value by eliminating licensing fees and creating a stable platform

for application modernization going forward. Automated code generators have been around for some time. While early

initiatives produced code that was inefficient and hard to maintain, recent entries into the market appear to be delivering

on their promises of generating clean code with minimum human intervention. Several state HHS agencies are moving

ahead with “black box” platform migrations with encouraging outcomes. Is getting off the mainframe first and then

modernizing your legacy app the right approach for your agency? It depends!

Cloud is another disruptive technology that HHS agencies have been slow to adopt when compared to the private sector.

But there are signs that the times are changing as several HHS agencies appear ready to move some portions of their

IT enterprise to the Cloud. There is now a considerable body of knowledge on Cloud implementations from both the

government and private-sector communities. In the near term, however, it is unlikely that any HHS agency is ready to

move their entire enterprise to the Cloud. State HHS IT management, working with their program counterparts, need to

establish criteria and expectations for what part of the enterprise is best suited for the Cloud and what should remain on

the premises.