Successful Public Health IT Project Collaboration

Noam H. Arzt, Ph.D.Most public health information technology projects rely on strong collaboration to be successful, especially across vendor-client boundaries. Here are some successful strategies:

• Clear vision. A concise and clear vision focused on public health outcomes is embraced and articulated by all participants in the project.
• Strong support and leadership from senior management. Without strong support from senior management, projects are rarely given the priority to enable success. This prioritization includes both agency and vendor commitment.
• Funding. Both external (Federal) and internal (state/local) funding need to be committed to enable success, though long-term sustainability is an ongoing issue.
• Flexibility in staffing. Many government agencies face challenges and constraints when trying to staff its programs. Various steps need to be taken to be as flexible as possible in considering solutions to these problems, including use of temporary positions, temporary/acting assignments, and use of external consultants without limiting them to staff augmentation.
• Strong project management. Leadership enables progress, but project management ensures that all the details are executed properly. Experienced project managers on both the client and vendor sides who work along with a diverse leadership team ensure that projects are executed properly. This might include frequent “stand-ups” among team members to highlight progress and hold each other accountable (part of their Agile process – see below). But by far the biggest role for project manager is managing expectations.
• Transparency. Through clear and thorough documentation, where all discussion and decisions are available for participants and managers to see and understand as appropriate, a successful project informs and assures everyone involved that there are no surprises or secrets.
• Leveraged expertise. Vendors often allow clients to draw on their national experts and consultants to bring their experience from other projects quickly to bear on their needs. This should be done with a minimum of ego, but careful and thoughtful consideration of where the experience of others could save time and money.
• Service-oriented Architecture (SOA). Systems should be engineered (or re-engineered) to use SOA, making it easier to consider and implement externally-developed modules where they made sense rather than feeling obligated to develop all aspects of the system in-house. In particular, SOA can enable the use of Open Source components.
• Agile methodology. Agencies and vendors are changing the way they deliver IT solutions from a more traditional waterfall approach – typified by extensive requirements and design documents and infrequent software releases – to an Agile approach which allowed the software to evolve in small, purposeful steps involving more day-to-day collaboration between technical and the Program staff. For many projects this represents a significant change from prior practices.
• Flexible contracting. The most successful projects are able to leverage a wide variety of contracting strategies within the constraints of Agency law and policy. This often includes leverage of Federal contract vehicles (g., GSA Direct Assistance, IDIQ/BPA contracts, CMS Medicaid/HITECH matching funds), use of third party intermediaries to facilitate contracting (often non-profit organizations), and use of multi-year contracts with options to renew. It is also important to make sure that contract structures fit the needs of the project: for instance, there is often pressure to have vendors enter into fixed-price, deliverables-based contracts when the requirements are unknown. Note that contracts that support Agile software development are particularly hard to fulfill as fixed-price, deliverables-based projects.
• Use of shared infrastructure. Many agencies are making investments in shared technical components such as a Master Patient Index (MPI), shared services to support interoperability, and a unified approach to registering and managing provider participation in the CMS EHR Incentive Programs. This leverage not only increases the coherence with which the provider community experiences interactions with the Agency, but also reduces redundancy thereby reducing cost. The mantra of “create once, use many times” is key to success in this area.
• Focus, focus, focus. The result of many of these drivers is the ability and freedom to focus on the goals of the effort with fewer distractions, technical and policy.