A Framework for Interoperability: Human Services 2.0

Human service leaders have always dreamed of systems in which services are planned, coordinated, delivered, monitored and evaluated in an integrated and efficient manner, maximizing positive outcomes for children, families and communities. Until recently technological limitations have prevented this bold vision from becoming a reality. Today the emergence of “interoperable technology” provides a real opportunity for new systems and approaches that connect across traditional boundaries and silos in exciting ways. The opportunities and the challenges of this new inter-connectivity are significant and represent the cutting edge for the development of new service models and approaches.

Efficient coordination of resources and services is particularly important given current government spending levels on human services and the high number of citizens seeking help. Today, 20 to 30 percent of any given state’s population receives some form of human services, which consumes up to 40 percent of a state’s budget. The federal government’s budget for human services in 2009 is projected to be $737 billion—of which $62.7 billion is directed towards non-health related spending.1 Approximately $14 billion of the total budget ($9 billion human services and $5 billion health) is directed toward the cost of technologies to track, manage and analyze service trends. Most recently, as part of the American Recovery and Reinvestment Act the Health Information Technology for Economic and Clinical Health (HITECH) authorized approximately $36 billion for incentive payments to Medicare and Medicaid providers associated with the adoption and use of health information technology. This increased flow of dollars (in addition to billions of additional dollars from other federal initiatives for health interoperability) will accelerate the opportunity for Human Services to leverage the additional resources and efforts towards connecting systems.

While the federal government funds more than 50 percent of the cost of human services delivery, according to Government Accountability Office reports, state and local governments cover the rest in a patchwork of services, often sub-contracting through local non-profits and private providers. This widespread outsourcing adds yet another service silo to the mix. Innovations and developments from the business sector offer promise for breaking down narrow operational silos in order to transform service and product delivery. Instead of simply selling a discrete product or service, for example, many businesses now strive to sell “solutions” to address customer needs, integrating multiple products and services – sometimes in collaboration with direct competitors. Supply chain management from manufacturing is another example of innovation that has improved operational coordination. Industry has spent huge sums to optimize and coordinate disparate processes—starting from raw ingredients through manufacturing, shipping and sales to break down barriers, improve quality and speed to implementation.

A growing number of businesses have found that such an integrated approach improves their performance and profits by increasing customer satisfaction and augmenting their client base. Moreover, businesses that have been unable to adapt to this new model find themselves at a distinct disadvantage. Similarly, recognizing that multiple agencies often serve the same children and families, human service systems have begun to implement thoughtful innovations to coordinate systems, eliminate duplication of services, and most importantly improve outcomes for clients—in spite of categorical funding streams, strict legal requirements and varied accountability measures. This process is referred to as interoperability, a term that implies the ability of two or more systems or components to exchange and use information. As in the business world, dedicated leaders in the human services arena have found that such interoperability offers solutions, but to reach full potential, it must be implemented in the context of comprehensive and accessible strategies creating new structures, policies and practices.

Technology’s Role in Achieving Interoperability

While attempts to integrate human services delivery models are not new, marked changes in the human services landscape and beyond have created a brave new world for innovative agency leaders. first, human services, such as health care, have continued to evolve from a reactive, crisis-driven approach to a more proactive, preventive model driven by client needs and outcomes. Additionally, revolutionary technology changes enable a level of interoperability unimagined even a few years ago. Unfortunately, in government, as in business, many organizations make the mistake of adopting new technologies as a preconceived solution without taking time to develop a larger business plan. In such cases, the technology often drives the organization’s mission instead of being used to facilitate a well-designed plan. As Jim Collins explains in his book Good to Great: “Why Some Companies Make the Leap… and Others Don’t” (HarperCollins Press), “Thoughtless reliance on technology is a liability, not an asset. Good to Great companies use technology as a momentum accelerator, not a momentum creator. None of the good to great companies began their transformations with pioneering technologies; they all became pioneers in the application of technology once they grasped how it fit.” While billions of dollars have been spent building technologies to improve human services, much of the technology spending to date has been used to report transactional data for funding and accountability requirements instead of helping to build more holistic and effective models of care. As a result, many human services agencies are data-rich but knowledge-poor, lacking the most fundamental information needed to improve the lives of their ultimate consumers: children, adults and families at-risk. For technology to play a meaningful role in eliminating silos, agencies must first align their policies, practices and structures with their institutional mission. In addition, agencies must pay attention to their technology “yield”—the ways in which the resulting service coordination and data directly improve performance and outcomes.

Holistic, Consumer-centric, Family Focused, Technology-enabled Human Services Systems

While interoperability in human services delivery has not yet been fully accomplished, several states and counties are actively working on strategies to achieve a more holistic, consumer-centric approach. Unlike the historical human services approach that carefully delineates where, when and how each agency provides which services, the consumer-centric model relies on a combination of agencies, services and staff to meet client needs. For example, today some progressive systems have established a “no wrong door” method that allows clients to access the full range of services and supports they need regardless of the agency they approach first. Instead of having to visit multiple offices to apply for food stamps, Medicaid, disability benefits and other services, consumers apply for multiple benefits at a single office or, in a few areas, use a community-based kiosk to assess their eligibility for various services. Additionally, clients requesting housing subsidies or energy assistance learn about other benefits and services for which they may be eligible. Because the goal of all human services programs is to increase individual, family and community stability, providing a more comprehensive array of supports increases agencies’ collective chances of reaching this fundamental goal. Several states and county systems have risen to the challenge and successfully achieved a degree of interoperability that is improving outcomes for their citizens, families and communities. See our case studies for more information.

Human Services 2.0—InterOptimability — An Evolving Theory of Change

During the first Stewards of Change Conference in 2005, SOC introduced its Theory of Change model as a means of organizing innovation within child welfare and human services. The intent of the model was to provide a structure for rethinking the field’s overall business model. It defined change as either revolutionary or evolutionary in nature. It also identified three core domains of change for categorization: policy, structure and practice.

Over the past four years, Stewards of Change has continued to refine the Theory of Change model with additional research, consulting engagements and case study development. SOC has studied the impact of emerging technology trends and interoperability on the creation of new operational models within child welfare, human services and, more recently, health and education. From this work, it has become clear that interoperability can serve as a stimulus and enabler of the systematic change that has been desired for so long.

Decisions about expensive new technology systems are a serious matter with significant implications for management at all levels and functions. Every year an estimated $14 billion is spent on HHS systems in state and local governments. Unlike private industry, which has a more rapid redeployment cycle, government decisions about major information system changes are usually made only once every 10 years or so. Today’s leaders must more fully understand interoperable trends to effectively guide their organizations through these decisions.

Since the first conference, Stewards of Change has studied emerging technology trends and the impact of interoperability on the creation of new business models within child welfare and human services systems. Based on an extensive environmental scan, it became clear that interoperability is a significant innovation that has the potential to change the fundamental structure and function of human services. Despite the massive implications of this innovation, few resources have been dedicated to provide up-to-date information about the status of past or current interoperable initiatives. There is no national clearinghouse that documents best practices, researches key operational considerations, publishes best/worst practices or provides technical guidance about planning for interoperability.

In response to this gap, SOC has refined and expanded our Theory of Change to describe a process for achieving interoperability which we named: Human Services 2.0: InterOptimability. “Human Services 2.0” describes the long-term vision or future state of what a connected and coordinated human services system could or should look like. “InterOptimability” describes the processes for assessing, planning and implementing interoperability initiatives. Taken holistically this model can be thought of as the conceptual architecture guiding the development and implementation of interoperability.

The Human Services 2.0 Framework: Approach

The Human Services 2.0 framework is intended to foster integrated business and IT transformation across the human services enterprise to improve the administration and outcomes of human services programs across the country. It proposes national guidelines for technologies and processes to enable improved program administration for the human services enterprise. It includes a conceptual framework, an architecture framework, organizational assessment templates and procedures and proposed planning guidelines for enabling human services enterprises to meet common objectives within the framework while supporting unique local needs.

• The Framework is a consolidation of principles, business and technical models, and guidelines that form a template states and counties can use to develop their own enterprise architectures.
• The Framework includes a conceptual architecture that incorporates all 10 drivers, assessments and the Vision Landscape. This provides an overlay and interprets the human and organizational components to match with the technology infrastructure supporting interoperability. 
• The Framework’s processes provide guidance for human services enterprises in adopting the framework through shared leadership, partnering and re-use solutions.
• The Framework provides planning guidelines to help each organization to define its strategic goals and objectives within the context of the vision, and also to tailor enterprise architectures that are consistent with federal, state and county expectations of program integrity, privacy and confidentiality standards and financial support.

Human Services 2.0 is intended to help jurisdictions with their own “central information nervous system” to support the entire human services enterprise according to general standards. A universal data dictionary and standard definitions of business services and common data elements will help transcend the constraints of today’s platform-dependent systems. Using “best of breed” systems for special purposes requires that these individual systems be compatible with the Human Services 2.0 framework’s data and architecture standards. This consistency will help them communicate directly with each other and the resulting processed data will be meaningful when merged into operational data stores. The Human Services 2.0 framework emphasizes the following key features:

• A customer-centric, family-focused view not constrained by organizational barriers
• Interoperability between state human services organizations within and across states, counties and nonprofit agencies involved in human services
• Interoperability between federal and state organizations
• Common data and technology standards that facilitate interoperability 
• Web-based access and integration
• Use of commercial off-the-shelf software where applicable
• Integration of public health data, education and others

How the Human Services Framework Will Create Change

The framework will have tremendous impact on the way jurisdictions design and build, change or modify their systems. Different jurisdictions have differing needs and are likely to begin their participation at different points. To implement it, states and counties will choose the elements of the framework that best meet their strategic and tactical IT goals and objectives. The framework can accommodate an implementation path best suited to the individual situation. States and counties may collaborate on joint projects to develop and implement shareable, re-usable IT components and business processes and services. State participation will help shape the world of human services IT in the years immediately ahead. In addition, the vendor community will use the framework to shape its product offerings to enable services to be leveraged and re-used across states.

To ensure that the framework continues to evolve and meet the changing needs of the Health and Human Services field, Stewards of Change will create an on-line collaborative community and forum where stakeholders can participate in the refinement and ongoing development of the framework and models. Additionally, Stewards of Change will coordinate activities among interested state partners to continue developing standards and perhaps a charter to align interests and actions moving forward. The journey is just beginning. We expect the models and approaches will continue to evolve and grow with the participation and help of human services stakeholders and partners.

1 The U.S. Department of Health and Human Services Budget Brief, 2009. The $62.7 Billion HHS expenditures include the Administration for Children and Families, Substance Abuse and Mental Health Administration, Health Resources and Services, Administration on Aging, Indian Health Services, Food & Drug Administration, and Public Health Social Services Emergency Fund of the total $737 Billion.