In order to have successful human services IT procurements, vendors and clients should take the time to establish a true partnership. Once there is a mutual understanding between vendors and their clients it is easier to reconcile any problems that may rise.

On May 1 to May 3, 2008, the American Bar Association (ABA) held the 3rd Annual State and Local Procurement Symposium regarding ground-breaking issues in state and local procurement throughout the United States. The speakers included attorneys, department leadership, and IT vendors who shared their perspective of human services IT procurements. While there was much discussion regarding the conflicts between state government and vendors, the speakers concluded that there are seven keys to having successful human services IT procurements.

These keys include:

• Communicating a clear vision with well defined goals for the project
• Creating quality RFPs in both content and process
• Establishing a solid contract
• Ensuring that the laws are applicable
• Understanding stakeholder involvement and management
• Establishing strong project governance
• Creating a true partnership between the state and the vendor

Though the speakers had different views and opinions of the procurement process, each concluded that the most important element in having successful human services IT procurements is true partnership between the state and the vendor. In addition, vendors must understand and work within the government environment. Many entities have workers who may have been working on the legacy systems for twenty years. Therefore, it is important to build relationships as the process of preparing and implementing the new systems begins. The same is true for the state. The state must understand the pressures of other entities on the vendors. The state cannot complete the projects without the vendors; therefore, it is essential that the vendors have their full support during the project.

If the state and vendors form a relationship, it is easier to deal with other areas that may be lacking. On the other hand, if a relationship is not established it will be difficult to resolve any issues that may rise.

Anyone who has ever applied for a federal job knows how challenging the process can be. The first step, determining how your education and skills align with federal jobs, is possibly the most important and most difficult part of the process. Once you figure out where to apply, you then face another slew of challenges to navigate, which can damper the enthusiasm of even the most die-hard, wanna-be public servant.

This week the Council for Excellence in Government, Young Government Leaders, Partnership for Public Service, and American University's Institute for the Study of Public Policy Implementation co-sponsored an event called FedPitch 2008 as part of Public Service Recognition Week. At this event, 16 finalists pitched ideas for attracting the Gen Y generation to public service. The winning idea: create a website that will help them determine which federal jobs fit their education and experience.

Clearly, this strategy will offer tremendous benefits to job seekers because it addresses a fundamental gap in the process. Other ideas made sense as well: using wikis to collect the institutional knowledge of retiring workers, holding virtual job fairs, and launching a marketing campaign to strengthen the government brand. What is compelling about this event is that it shines a very bright spotlight on just how far behind the private sector the government lags. These strategies are all great ideas that can be used as effective tools for addressing government's workforce challenges, but they seem to be Basic Recruiting and Retention 101 within industry. The fact that these ideas floated to the top as innovative for government underlines just how much work needs to be done.

The federal workforce numbers are not promising. The overall workforce declined 2% between 2003 and 2007. Hiring is picking up, but we're in an election year when many senior employees decide to retire (OPM expects retirements to be between 2% and 4%). There are shortages in the IT and acquisition occupations, which exacerbate the problem.

Human capital managers face a daunting challenge, and there is wisdom in starting with the basics. However, the lure of the public sector will require government to develop more aggressive and innovative strategies for capturing the talent and enthusiasm of the younger generation.

Like many of the claims cried on the various campaign trails recently, the Department of the Air Force seems to have jumped onto the same bandwagon. Currently the department is experiencing an aggressive and radical transformation in the areas of acquisition transformation and supply chain management. With initiatives like the Installation Acquisition Transformation (IAT) and additions like the AF Global Logistics Support Center (AFGLSC), there is no doubt that change is the main focus for the Air Force at this time.

In a new Analyst Recap, INPUT takes a deeper look at the 2008 Hill Air Force Base (AFB) Symposium focusing on how these changes effect specific installations like Hill AFB and the Department enterprise-wide.

The requirements and initiatives of today are starting to shape the business practices and procedures for the Air Force of tomorrow. Officials are beginning to realize that a change in mentality towards organizational structure and strategic sourcing procedures is necessary to combat a shrinking workforce and tightening budget. By pursuing an enterprise-wide mindset, the Air Force is specializing the role of component organizations, like Hill AFB, and increasing the vision for satisfying the war fighter requirements. In this new mindset and structure, the vendor community is in a unique position to greatly affect these future policies through strong relationships with government. The key conclusions for industry are:

• Air Force is moving towards a more enterprise focused mindset specifically in the areas of acquisition and supply chain management
• Reform and centralization is a top priority, involving component organizations like Hill AFB
• Understanding Hill AFB's role and priorities can improve success in business opportunities
• Industry partnerships both regionally and Department wide are growing more vital

Air Force efficiency reform is only the beginning for the Department of Defense, and these initiatives and programs may impact the future of agency transformation for the entire Department of Defense. The main pain points for the Air Force, such as a shrinking workforce and budgetary tightening, are echoed through the Department of the Army and the Navy. Change is in the air at the Department of Defense; and industry must align with these changes to catch the wind.

With the Greening of state purchasing, it is likely that Green IT standards around data center consolidation, recycling of hardware, and virtualization will become more and more prevalent in the future.

This year's NASPO (National Association of State Procurement Officials) annual conference was held from April 6th to April 8th in the heart of New Orleans, LA. In attendance this year were procurement officials from 41 of 50 of the states. While numerous themes were presented at this years' conference, one in particular seemed to be highlighted repeatedly, and is anticipated to be more and more integral with state procurements in the future: Green Purchasing.

Even though it was mentioned in many of the conference's informative Regional Roundtable Discussions, attendees were able to learn a great deal about Green Purchasing in the hour-plus session "Green Purchasing and Recycling". Moderated by Diane Lancaster, Chief Procurement Officer, Oregon, with panelists Lee Johnson, Contract Manager, Oklahoma, Dmitriy Nikolayev, Procurement Manager, Massachusetts, Maureen McGuire, Procurement Manager, Ohio and Stephen Reksten, Assistant Director of the Division of Purchasing, Tennessee, this session touched on third party certifications and RFP specifications.

Ms. Lancaster and her panel discussed in great detail the benefits of Green Purchasing to the environment, as well as, that while her native Oregon has been "Green" for quite some time, other states are just starting to get their feet wet. On the other side of the U.S., Massachusetts has been "Green" for years as well, and their success in the field has led other states to take notice and follow in their foot steps. In Tennessee, for instance, vendors MUST be Green or Energy Star compliant to compete on the vast majority of their competitive bids. States like Oklahoma who are new to Green Purchasing have not yet had any detrimental executive orders or legislation passed to date on the subject, but anticipate that they will be coming down the pike in the very near future.

When Ms. Lancaster raised the question "What would help more Green Purchasing in the future?", the answers were, competitive pricing, credible information and a better selection on products and services. The panel tried to convey the importance of individual vendors having certification or compliance with some leaders in Eco-Labels, including: Energy Star, Green Seal, and Green-e. Ms. Lancaster and the panel went on to say that while being Green compliant is not a requirement on RFPs currently, it's certain that it will be in the years to come. The panel went on to say that while some vendors may be stubborn now by not accepting the "Green Revolution", they will only be hurting their business in the future by not doing so.

The first public meeting on the American Health Information Community (AHIC) Successor transition was held on March 10, 2008 in Washington, D.C. LMI Consulting, in collaboration with the Brookings Institute, assembled stakeholders for public comment to assist in determining the scope and purpose of an independent public-private entity, or AHIC 2.0 as it's frequently called.

AHIC 2.0 will need to preserve AHIC 1.0's progress but not become a cover version. As HHS Secretary Leavitt previously said, "...rather than being dependent on federal funding and political prioritization, the AHIC 2.0 will be a broad, public-private collaborative based in the private sector." But of all the things AHIC 2.0 wants to be, the new body alone is not going to be able to mobilize health IT. There are a lot of other things that need to align and coincide with the successor group: consumer awareness and confidence, financial assistance, provider involvement, etc.

A few reflections from the forum:

• There needs to be a robust discussion about the vision of AHIC 2.0 and a roadmap with consensus on approach. Vendors need to see where priorities are aligned.



• Health IT workgroup and organization harmonization efforts are necessary. No need to keep starting from scratch and duplicating like-minded endeavors.



• The government will have a role in AHIC 2.0, but it's yet to be determined what kind. It was asked "where do the state and local governments fit in?" There's value to having state level representation in AHIC 2.0 - it will allow participants to recognize and understand the states diverse policies and varied health IT engagement.

From now until the end of May they are hoping to establish the governance structure, develop a financial model, and build a management staff. The organization is to become a fully operational body by December 2008. This timeframe will ensure their hard work is not jeopardized during the change in Administration. Leavitt has previously commented, "By establishing AHIC 2.0 this year, we can avoid the inevitable pause that would happen during a transition between any two Administrations. This will help us protect, perpetuate, and accelerate the progress we've made."

At the meeting, LMI-Brookings requested volunteers for the four planning groups for Governance, Membership, Sustainability, and Transition which are being formed to deliver key requirements for operationalizing the new entity. Enrollment remains open through tomorrow, Friday March 14th.

On March 1, 2008 through March 5, 2008, the National Association of Counties (NACO) held its 2008 Legislative Conference. NACO, as the only representative of county governments in the country and as acting liaison with other levels of government, intends for their annual legislative conferences to bring together counties from across the country in efforts to share best practices, voice opinions and educate each other on major legislative issues affecting their constituencies. Several legislative areas and educational sessions addressed by NACO's legislative committees revolved around technology-related issues, which are major concerns to county governments.

On the first day of the conference NACO held a Technology Submit. Panelists included County CIOs and a variety of county and industry leaders. The discussions centered on the notion that technology does not exist if it was not for the vision and strategies of local governments. Local governments must then address the right questions in controversial areas where technology plays a major role. A point was made to the fact that smaller localities typically have the most number of questions because these do not have the funding support or the interest from higher officials as opposed to bigger localities. However, they must understand that a change of paradigm MUST occur in order to improve the service of public service.

The panel began with the topic of Enterprise Document Management. The fact of the matter is that abundance of paper trail for services remains a typical problem in governments. This is the cornerstone and one of the many aspects of content management. Many expressed questions that localities must asked to address the management of electronic documents. These include: What is the biggest asset in the county? What are the business challenges in departments? What are the benefits of content management solutions that work for the current applications? and when approaching board of supervisors/administrators, what are the justifications used for the investment.

Los Angeles County CIO, Jon Fullinwider, is an advocate of content management solutions. His county is currently in the process of implementing an enterprise content management solution. Mr. Fullinwider shared that during this process he learned that it is very difficult for government officials to articulate a document management strategy to higher department heads. In order to keep higher officials engaged and ready to make a commitment, higher officials need reasons or justifications as to why the technology should be implemented and they must understand the value proposition for making the type of investments. Therefore, localities are urged to ask higher officials for a fundamental change but they "must show them success with metrics". In addition, localities need to project business objectives accurately to vendors in order to have a successful partnership.

Other discussions that gained great momentum included demands in elections technology, broadband and enhanced government service delivery through technology. The panel recognized that in the future elections technology will be the least eco-friendly. This is due to states going back to optical scanning paper ballots and the roll out of the voter verifiable paper audit trail. However, the main problem in the environment of electronic systems surrounds the verification of voter accountability.

A major highlight referring to broadband deployment was that if congress passed legislation that enable every state to implement programs modeled after ConnectKentucky, a direct economic stimulus would be more than $134 billion per year for the nation. ConnectKentucky has been highly praised for its success in broadband deployment and closing the digital divide in many of their rural areas. Many states are considering the possibility of replicating this model.

Finally Mr. Fullinwider addressed several recommendations aimed at improving service delivery in local governments. Some of these include: strive for good management practices, establish standards; implement an IT plan (it was noted that 1/3 of organizations do not have a strategic plan); use a single vendor for enterprise type solutions - it tends to be very difficult when communicating with multiple vendors; localities need to understand that just because equipment runs fine it doesn't mean it will not need upgrades. In his opinion, governments over-utilize consultants. Consultants do serve as a reassurance to government actions, however, governments need to lessen those services and be confident and lead.

Other legislative areas addressed at the conference that are causing much distress and affect county operations relate to changes in case management regulations, jail and prison re-entry, transportation and immigration laws.

INPUT's take

INPUT shares the recommendations outlined by the panelists and is well aware of the necessity to convey these statements to local and state governments. Successful public-private partnerships exists when governments accurately communicate their business objectives and when vendors understand that government officials are not as interested in technology as they are in solutions to problems – the justifications to invest on a technology solution.

The Health Information Management and Systems Society (HIMSS) hosted their 2008 annual conference in Orlando, Florida on February 24-28, 2008. HIMSS08 attendees included a wide range of stakeholders from the health care industry such as, state CIOs, IT vendors, and hospital representatives, all of which were in pursuit of the latest technology demonstrations, public policy forums, roundtable discussions and education sessions. A major theme at the conference was in regards to the role of state, Regional Health Information Organization (RHIO) and private industry in health IT efforts.

Discussions surrounding state, local and community level e-health initiatives took center stage as these entities have taken primary leadership roles in pushing forward health IT efforts. Some of the presentations referenced a recent National Governors Association (NGA) and The Commonwealth Fund survey of the state e-health landscape which indicated that the top priorities over the next two years are electronic HIE adoption and electronic HIE Policy Development. Other priorities listed include telehealth and e-prescribing. Current state e-health activities are focused on developing and implementing electronic registries for disease, immunization, newborn screening and surveillance. A major platform for state health IT projects has been Medicaid; in particular through the federally funded Medicaid Transformation Grants. More than half of the states that responded to the survey reported implementation of a web-based Medicaid Management Information System (MMIS) along with other decision support tools.

RHIOs and Health Information Exchanges (HIE) have endured despite criticism over their lack of financial sustainability and inefficient business models. Several conference activities focused on RHIO development, planning, modeling, stakeholder engagement and effective strategic planning. Stakeholder engagement was noted as a crucial public-private collaboration that should employ a bottom-up approach. Vendors have proven to be valuable stakeholders in the health IT process because of the expertise they bring to the table and the capacity to develop, design and implement health IT systems.

While health IT initiatives are primarily occurring at the state and local level there was an underlying theory which surfaced in several of the session that a private sector entity could eventually be at the helm of health IT efforts. Large private companies with substantial human capital, financial capital and IT expertise could have the necessary resources to generate widespread consumer and provider interest. This could lead to the bandwagon effect whereby a private entity could change the current direction of health IT. A few examples of "household name" companies that have established a favorable reputation with the general public and are dipping into the health IT market are Google and Microsoft.

INPUT's Take:

The financial support trickling in from the federal government has been essential to jumpstart many of the current health IT initiatives and has provided platforms for pilot testing prior to statewide expansion. Several states have been preparing their MMIS systems for health IT enhancements will continue to seek vendor assistance and support. State and RHIO activities continue to gain momentum and continued vendor involvement in public-private collaborations demonstrate a vested interest in these networks and their projects.

Public Technology Institute's (PTI) first Health Care IT Summit was held in late January in Atlanta, Georgia. Participants from the government, IT vendor, and health care communities were in attendance to discuss the role of IT in improving health care delivery. The Summit also featured case studies of state and local health information exchange activities. Attendees were interested in success stories – they wanted to hear what has worked for others and how it could work for them.

In just one of the case studies, the Executive Director of the Delaware Health Care Commission, Paula Roy, gave an overview on the state's public-private partnership that is known as the Delaware Health Information Network (DHIN). The DHIN is an infrastructure to support clinical information exchange across the state. In wake of the high-profile reports of "defunct" data exchange utilities, Delaware's "First State" innovations are proving to be successful. Roy pointed out that the commission spent 5-7 years just trying to figure out what the DHIN was going to do. As for lessons learned, she said consensus takes time, don't assume that there will be a common value among your stakeholders, and "distractions" must be managed. Some stakeholders were apprehensive when it came to technology. She said their non-technical stakeholders wondered "why it had to be so difficult?" and "why can't we just find a vendor to build the system?". In contrast, their technical stakeholders wanted to plan every last detail such as which data formats they would utilize. However, she said that having all users agree to one standard data format has been a tremendous value. She also pointed out that the state's CIO involvement was critical and that their CIO has the ability to make all state IT applications support the DHIN.

Delaware has proven successful so far by making strategic decisions based on what they really wanted out of their utility and getting the key stakeholders to sit around a table and rally around that vision. But they also learned that they needed to nail down that vision and bring in implementation vendors and a project management vendor to offer neutrality and experience amongst groups that may not have either.

INPUTs Take:

It has become apparent that the states and localities are becoming true health IT innovators. Health IT projects are being developed for local optimization but participants are looking to collaborate with other communities to share insight and expertise in order to create regional efforts. But in Delaware's case, due to their size, starting "small" or "local" actually meant starting statewide. Overall, events like these are becoming increasingly important to build collaborative dialogue and enhance relationships between health professionals, governments, and IT vendors.

On February 6, 2008, the Federal Communications Commission held a summit on Next Generation 911 (NG-911). The summit was aimed at exploring NG-911 technologies and the steps that need to be taken by Public Safety Answering Points (PSAP) to implement this technology. NG-911 is a 911 system that uses an IP-based network which allows for the sharing of voice, video, and data across the network. With more than half of commercial cell phones equipped with camera and video capabilities, it only seems necessary that those technologies be used to their full capacity during emergency situations. The goal of NG-911 is to allow a person to transmit voice, video, or data from an emergency to the PSAP. Pictures and video of suspects, crime scenes, license plates, and disaster areas can be valuable to first responders during an emergency.

The summit began by discussing PSAPs and their use of technology. Panelists included Directors and Commanders of emergency communication centers as well as a variety of agencies and industry leaders. The discussion centered on PSAP planning efforts and the actions that need to take place to ensure that disaster recovery is effective. Many expressed the need to "professionalize" the PSAP industry. PSAPs are struggling to retain dispatchers for long periods of time. It is crucial for PSAPs to provide the resources necessary to make dispatching a career. Many panelists confirmed that the turnover rate among PSAP dispatchers is so high because of the level of stress and lack of competitive pay and benefits. In order to begin planning, you need to have dedicated and skilled dispatchers to sit at the discussion table. These dispatchers will have the knowledge and understanding of how to properly address the "what if's" of emergency response. They can help formulate proper contingency plans.

The panel also discussed the need for a set of national standards that guide PSAP directors and dispatchers in dealing with disaster scenarios. Who will take over calls if a PSAP is compromised? What is the best way to communicate with the deaf and hard of hearing? What roles will people play in recovery? What technologies need to be implemented to ensure that calls get directed to the right PSAP? These are all the questions that will need to be answered through national standards.

The second panel gave insight into what NG-911 is and the progress it has made over the past few years. Many noted that it is imperative that PSAPs implement IP networks as soon as possible. It may not be as necessary to implement an entire NG-911 system as it is to implement a digital IP network. This has been expressed as one of the possible standards.

The panel also discussed the status of 911 systems in rural areas. There are still a good number of cities and counties who don't have wireless 911 or even standard landline 911. A move to wireless 911 should be a federal mandate if the nation wants to eventually move to a NG-911 standard. A few panelists noted that we are far behind where we thought we would be in this realm. Many would have thought that phase II wireless 911 would be nearly nation-wide. A lack of funding, standards, and proper national attention to this issue can be attributed to the lack of wireless 911 coverage.

INPUT agrees with many of the statements made by the panelist and understands that there needs to be more attention put towards 911. It is important for the public sector to work closely with the private sector to improve 911 coverage. INPUT sees wireless 911 and NG-911 as an ever growing industry. As agencies and PSAPs move towards this level of service, there will be greater demand for IP networks, telephony, and system software that is capable of handling voice, video, and data. It is important for vendors to be on the look out for jurisdictions that are working on pre-basic 911 systems. These jurisdictions are most likely going to be implementing wireless and NG-911 systems in the near future as federal and state legislatures are beginning to demand IP-based 911 systems.

During the Governing Live! 2008 Outlook in the States Conference, I attended a roundtable topic that I have been monitoring pretty closely over the past year, Immigration. Immigration, no matter what side of the fence a U.S. citizen may lie on in regards to this debate, affects every single citizen in a plethora of ways. Whether it be issues on how immigration is affecting our educational system, employment, health care or law enforcement, the ripple effects are being felt at the in all 50 state capitols. Immigrant population is significant and will continue to grow (12% of the overall population; 1 in 5 children in US today live in immigrant families, many of whom are U.S. citizens). Being a third generation Irish immigrant, the topic is of great interest to me.

In 2007, no fewer than 1562 pieces of legislation related to immigrants and immigration had been introduced among the 50 state legislatures. Of these bills, 244 became law in 46 states (only Alaska, Wisconsin, New Hampshire and New Jersey did not enact immigration related legislation). 11 bills have been vetoed by governors. The main topics in state immigration related legislation focused on employment (244 bills introduced) and ID/Drivers License (259 bills introduced).This comes as a result of continued inability of the federal government to enact immigration reform. To give one an idea of the magnitude of what 1562 pieces of legislation being introduced in 2007 means, one must only look back 10 years ago. In 1997, 202 pieces of legislation related to immigrants and immigration had been introduced, with 50 being enacted and 9 vetoed. From 1997-2007, that is a percent increase of 673%. Originally, immigration was only an issue for the "7 big immigration states": California, Texas, Florida, New York, Illinois, New Jersey and Arizona.

Oklahoma Representative Randy Terrill (R-Moore) joined the roundtable and discussed about Oklahoma House Bill 1804, which created the Oklahoma Taxpayer and Citizen Protection Act of 2007 and relates to illegal immigration. It restricts access to driver's license, ID cards and other licenses. It terminates several forms of public assistance and places tighter restrictions on higher education, benefits and provides for exceptions with respect to emergency care, disaster assistance and certain immunizations. The law also makes it a felony to harbor, transport, conceal or shelter unauthorized immigrants and provides for fines. In other words, this is the "granddaddy" of state immigration bills. HB 1804 also has the support of two national immigration reform advocacy groups, and has been called the single most significant step that any state has taken in this area and one of the nation's toughest anti-illegal immigration laws. 12 states have followed and have introduced similar bills to HB1804.

INPUT's take:

• Immigration reform is a topic hot on the minds of the governors as they are delivering their 2008 State of the State addresses. This is an issue that hits home to many U.S. Citizens. As budgets tighten across the US, Governors realize something needs to be done with immigration. States feel the affect of immigration first hand because they are the ones responsible for paying in the areas of health care, education, corrections and public welfare. Look for state governments to continue to be aggressive with immigration legislation in 2008.
• States and localities, with the assistance of sophisticated federal and non-federal systems, are expected to introduce technology initiatives focusing on law enforcement information sharing and employer-conducted background checks, enhanced driver licensing and visitor tracking systems. Technology is needed to help curb the problem of immigration. Legislators can introduce bills to their faces turn blue, but it's the technology that will help the law enforcement fight the problems they confront with immigration day in and day out.