In Can IT Help Government Be Less Bureaucratic? I waxed optimistic about a government IT program that could significantly reduce the burden on constituents applying for government social services programs and opined that the same approach could be used for other interactions between people, businesses and the government. I spun this vision by extrapolating the consequences of a simple, short-term assignment for the Secretary of HHS, to recommend enrollment standards. The vision, should it arise, will not be derived from a narrow view of the task and may not be possible in the four months that remain. As I discussed in my blog it is important that this important opportunities not get the short shrift due to tight Congressional deadlines.
The committees will certainly create an inventory of places where common enrollment has been achieved and the specifications that were used. They can survey standards that are available. For example they will certainly examine the ASC X12 834 Benefit Enrollment and Maintenance standard. Although it is identified under HIPAA they will find is little used and narrowly defined for healthcare coverage. They should also examine the National Information Exchange Model (NIEM), which has been effective at creating interoperability in a green-field area (law enforcement and anti-terrorist information sharing). They should examine the NIEM experience in terms of the time frame and level of economic support that was necessary to achieve functional interoperability and whether the potential availability of existing standards accelerates or impairs the NEIM process.
Business Architectural Considerations
The ultimate standards approach depends on the business architecture and interact with governance. Will information that is shared among agencies within a state, across states and between states and the federal government be mediated by consumers using personal repositories, by a spider-web of reciprocal agreements among these agencies or by a uniform governance agreement comparable to the Data Use and Reciprocal Support Agreement (DURSA) created in support of the U.S. Nationwide Health Information Network artifacts. The spider web is exponentially impossible. It took about three years to conceptualize and complete the DURSA and that effort was arguably much easier than creating a similar agreement among 50 states, some territories and a few large city-states that operate their own social service programs.
The committees should consider standards that support a constituent-mediated approach comparable to the popular conception of the personal health record (PHR). Will each government agency have only two connections to consider:
- sending data to the constituent or the constituent’s representative
- receiving data from the constituent/representative.
The direct involvement of the constituent significantly eases governance and authentication in healthcare. The argument that it provides similar simplification for government data is less clear, but I believe the underlying principle is the same. Complex policy issues arise when a keeper of data (health data or other data) sends it to another agency on behalf of the constituent. The requirement to ascertain that the two agencies have identified the same actual person is difficult and they must exercise their obligations to be good steward of the data provided them by the constituent. On the other hand, when the data is managed by the constituent, that person identified himself to both the source and recipient using on-line authentication methods that already exist.
In this model the data repository software that constituents would probably be vendors and agencies that offer on-line storage mediated through the Web, just as TurboTax does now.
It is natural to ask whether the constituents in most need of government services are capable of serving as an intermediary through a Web. Many people, probably a majority are or will be particularly if the required personal technology is limited to a smart phone. Those that aren’t may rely on advocate organizations to assist them. Being an advocate for such constituents requires more than technology; the people who are functioning as advocates will be able to operate the technology.
As always, the standards – however challenging – will be the easy part of realizing a new vision for facilitating interactions with the government. Although the law creates a narrow charter for these committees and a tight deadline, it is important that they at least consider the broader context so that the standards they choose enable the support of the Internet culture that is upon us.
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