Beyond Efficiency

IT Takes On Health and Safety
August 2005

Good managers can use information technology to save money and make government more efficient, but government leaders need to look beyond those savings and invest to build government's capacity to provide better services. That was the recurring theme heard by the state and local officials who participated in Governing's annual Managing Technology Conference in Chicago in June.

The savings can be stunning. Michigan has cut its IT spending by $1 million a week over the past two years. Illinois is on track to spend $155 million less on IT in fiscal 2006 than it did in fiscal 2003. But while it's tempting to promise increasing savings in perpetuity, there is only so much fat in an organization that can be cut before striking muscle. Tight budget times have certainly provided government with a strong incentive for rethinking processes and implementing technological programs to help generate savings, but technology leaders from Illinois, California, Virginia and Michigan agreed that there comes a point when money must be reinvested--where further savings would hurt the agency and the enterprise.

Michigan's director of information technology (and chief information officer) Teri Takai assumed her post just as consultants delivered their estimate of the money the state could save if it used technology optimally. Her work to centralize state technology operations has saved money, but, she warns, at some point such changes limit government's effectiveness. Money is needed to update or replace old mainframes and do new projects.

"Cost savings in itself is not sustainable as a long-term goal," agreed Jay Carlson, deputy director of Illinois Central Management Services. "You can't just say 'no' to your customers." Takai and the other leaders concurred that program failure, whether through unreliable equipment or insecure technology, is one of their worst fears. "The one thing that keeps me up at night," said Takai, "is how aging infrastructure and aging or inadequate security was never written to live...with the security risks that we have today." BUILDING TRUST

Success as a leader is built on trust. For a CIO, that means delivering what is promised, when it's promised. CIOs are often both the liaison between executive and legislative decision makers--those who set a strategic direction for the enterprise and those who control the money--and the agencies and the end users who need to be happy with the final product.

Making the case and building strong support is not always easy, particularly in an area where leadership changes can come rapidly. Some employees become what Eugene Huang, Virginia's secretary of technology, described as "We Be's"--"We be here when you come, we be here when you leave." It is easier to build support from all levels-- executives as well as these "legacy" employees--by achieving some quick wins, creating momentum and taking on projects small enough to be manageable and successful along the way.

Another key to developing trust is an open and competitive procurement process. The process can be used to accomplish enterprise- wide goals, such as encouraging or requiring standardization to make eventual streamlining easier. It's important that the purchasing process conveys the same priorities as the executive leadership, says Sean Carlson, Michigan's director of procurement.

Accountability had been a problem in Michigan, with many contracts being sole-sourced to bypass the state's slow bidding process. "Nothing hijacks goodwill like a sole-sourced contract," noted Carlson. Now, Michigan has cut down on its no-bid contracts. To enhance speed, the state has pre-qualified vendors and implemented a faster system for approving technology project contracts.

Once savings are banked and trust built, then, said Illinois' Carlson, it's time to "be the champions and safeguarders of 'enough is enough.'" When CIOs demonstrate that a trustworthy purchasing process and a record of successes and promises delivered have actually helped save the state as much money as promised, then they can tell their leadership that they've gotten the fat out, now it's time to invest.

Virginia Governor Mark Warner underscored the importance of this strategy to the technology consolidation implemented in his state over the past four years. Building trust was crucial. An oversight board with strong legislative representation ensures that dialogue between the branches keeps key players informed. TACKLING HEALTH CARE

The biggest issue confronting state and local governments today, said Governor Warner, is how to bring "the power of IT to health care reform." Health care spending is responsible for much of the squeeze on state and local budgets, and Warner estimates that 5 to 8 percent could be saved through the better use of IT.

Taking on that topic, Janet Marchibroda, chief executive officer of the nonprofit group eHealth Initiative, gave an overview of what is happening across the country so far. While federal policy makers are deciding what role government should play in encouraging and standardizing electronic health records, state and local governments are building regional health information networks, she says. There are more than 100 regional initiatives so far, spurred by concerns about quality and safety as well as the role that inefficiency plays in increasing costs.

Rhode Island's regional health information network is more advanced than most, thanks to executive-level support. One element of the network is a master patient index, a central web that connects all information on a patient from various sources so that any health care provider can see a complete history. Dr. David Gifford, Rhode Island's health director, sees a clear role for state government in pushing forward the move to electronic health records. States are large purchasers of health care services, both for their own employees and for citizens covered by Medicaid. They're well positioned to facilitate public-private partnerships, and their leaders can guide discussion and bring key players to the table.

Tennessee Governor Phil Bredesen actively wields this convening authority to encourage the better application of technology to health care, said Will Pinkston, who is a special projects director in Bredesen's office. Dr. Mark Frisse, of the Vanderbilt University School of Medicine, emphasized the need for "a quantum leap in the quality of health networks. It's not a problem of technology, it's a problem of culture, it's a problem of incentives, it's a problem of time." SECURING THE COMMUNITY

While a bank robber crossing jurisdictional lines might not appear to have much in common with a patient seeing various doctors, the reality is that in both situations technology can help to overcome the boundaries that separate organizations.

Chicago has emerged as a leader in the field of integrated criminal justice information systems. Its CLEAR (Citizen Law Enforcement Analysis and Reporting) database brings together information from not only Chicago but also surrounding suburban jurisdictions, and it's in the process of going statewide.

Before CLEAR was set up, it could take weeks or months for officers to manually piece together details of crimes and evidence into the patterns that helped them to track down a criminal. With CLEAR, those kinds of connections can be made as quickly as the detective can think of the questions, said Lydia Murray, Mayor Richard M. Daley's assistant for performance management. In addition to queries, the database also automatically finds links and patterns that it provides to officers even before they've thought to ask.


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