Designing website applications is not innovative, but necessary, federal health IT officials say.
It’s true that the government needs to be innovative, but before agencies can adopt the newest and shiniest technologies, it needs to master the execution of simple, everyday capabilities that citizens need.
The Veterans Affairs Department and its U.S. Digital Service team released a new and improved Va.gov in November, a consolidation between Vets.gov and Va.gov with a design more in tune to veterans’ purposes for visiting the site.
The department had been working toward these online capabilities and attention to human-centered design for years. But according to Charles Worthington, VA chief technology officer, there’s a difference between innovation and execution, and both are needed to solve some of the country’s biggest challenges.
Innovation Vs. Execution
“In government, often times . . . the concept of innovation gets conflated with execution, and I think we really need both in government, and do both,” Worthington said at the Dec. 5 FedHealthIT100 event in Washington, D.C.
For Worthington, innovation means inventing something that did not exist before, like fundamental research in medical sciences that yields new discoveries. “Building a web application and hosting it in the cloud is not innovation,” he added.
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“That is solved, and the fact that the government does not routinely build web applications correctly is not because we lack innovation. It’s because we lack ability to execute using standard industry best practices.”
And at times, it’s in the process of execution that the inspiration for innovation is found, and according to Dr. Neil Evans, chief officer for Connected Care at the Veterans Health Administration, this happens often in the clinical arena.
In a panel with Worthington, Evans explained that when trying to execute and solve a real problem in government, there’s a certain discipline required that leads to new ways of solving that problem.
In healthcare, for example, one of those problems is access. There’s the relationship between patients and providers and the health systems that patients are entrusting for their care. There’s also the information, skills and procedures that the health systems have and can provide to patients.
“We’re trying to solve the problem of access,” Evans said, “that is an execution problem. How do we configure our clinics, how do we build digital properties that connect patients to providers?”
And trying to solve that problem leads to new and innovative ideas, like the VA’s Tele-Intensive Care Unit system. Based in Minneapolis, the Tele-ICU connects veterans in rural areas with high-quality healthcare, intensivist doctors and nurses with a video screens located in each ICU room. A green button alerts doctors when they’re needed, and they use teleconferencing technology to virtually interact with patients.
This is one of the ways the VA is solving its challenge of providing good, quality clinical care to vets around the country. “It’s pretty innovative when you say, ‘Ok now we’re going to deliver that care from all the way across the country,’” Evans said.
The confusion between innovation and execution is prevalent at the Centers for Medicare and Medicaid Services, too.
“I hear a lot from people at CMS . . . they want to do cool [artificial intelligence] stuff, and I come back to this space where I’m like, ‘You guys can’t even build a 10-page static website for less than $10 million,’” said Shannon Sartin, executive director for USDS at Health and Human Services Department.
In the same panel, Sartin explained that when it comes to innovation in government, the intention can sometimes be misplaced.
“We, in a lot of ways, need to be focusing on the execution of our core mission and making sure that the critical services that we need to offer to people are executed really well, that we’re not struggling with building basic websites to communicate information,” she said.
Improving digital services should start with the basic frameworks used to engage with citizens, before trying to implement the “latest and greatest technology.”
To do so, CMS is taking on a new outcome-based perspective with industry: loosen up the way it writes regulation, focus on the actual outcome that is intended, and focus less on explicitly describing the process.
And for Evans, part of aligning mission with innovation means truly understanding what customers need. Evans spends a day every week in clinics to truly understand customer experience and pain points.
“Sometimes, one of the challenges in government is that those of us who are making decisions, who are driving acquisitions, may not have a full of understanding of what the reality is for frontline employees and for customers,” Evans said.
There’s “tremendous value” in getting to that frontline for the government and the contracting community, to align innovation and mission.
How to Execute to Innovate
To ease execution and innovation challenges, Worthington said agencies need to reduce the cost and difficulty of change.
“Anytime you can make it easier to change something, I think that is going to speed up the process,” he said. This involves empowering parts of the organization to be the decision makers for their area of expertise, democratizing decision-making as a whole and using smaller contracts that require less lengthy request for proposals.
This extends into the contracting and vendor community, too. Worthington said he’s noticed the vendor community views itself as “helpless background characters in this story of public service.”
Meaning, in the trenches of a project, if government is asking a vendor to do something that the vendor knows isn’t a best practice, will take too long or is worthless documentation, the vendor should speak up and pull back from a “it’s in the contract, we have to do it” mentality.
Rather, agencies need the contracting community to tell it if a tool is too outdated and shouldn’t be used, if a framework being used is broken or if a cryptography standard is six versions behind. “Don’t make us do the wrong thing. We need the vendor community to show leadership,” Worthington said.
Government needs that push back.
Sartin agreed and expressed that anyone delivering a service to the federal government and knows something shouldn’t be done but stays quiet because of the price on a contract is “just as complicit as any federal employee who doesn’t know enough to say no.”
“This is an ecosystem that we all have to be a part of,” Sartin said, and when it comes to innovation, vendors are the subject matter experts the federal government hires because it doesn’t have those skills internally.
Date: December 19, 2018