U.S. Department of Health and Human Services 2007 E-Gov Annual Report

Section 1 – Implementation of Electronic Government Initiatives Section

A. Describe how the initiative is transforming agency operations

• The Hospital Compare tool (via www.hospitalcompare.hhs.gov  is “A quality tool for adults, including people with Medicare”.  Hospitals can vary in the quality of care they provide.  This website was created to help consumers see how well the hospitals in their area care for their patients and to compare the quality of care hospitals provide.  The Centers for Medicare & Medicaid Services (CMS) launched Hospital Compare March 31, 2005, with seventeen processes of care quality measures in three clinical conditions: heart attack, heart failure and pneumonia; and, surgical infection prevention. As of June 2007, CMS increased the number of quality measures, reporting 22 process measures and two outcome measures.  CMS will add Patient Satisfaction measures in early 2008 to provide even more detail to help make available the information consumers need for health care decision making. 
• The Hospital Compare tool allows consumers to see the recommended care that an adult should receive if being treated for a heart attack, heart failure, or pneumonia or having surgery. The performance rates for this website reflect care provided to all adults, not just people with Medicare. Psychiatric, children's, rehabilitation and long-term care hospitals currently are not reported on this website, although many have agreed in principle to provide data using standard quality measures. This is due to the fact that the conditions currently measured -- care of adults with a heart attack, heart failure, or pneumonia -- are less commonly treated in these settings.

The quality of care information comes from hospitals that submit their data voluntarily from their patient records. The information is converted to rates that measure how well the hospitals care for their patients. In addition to reporting quality measures, Hospital Compare includes tools consumers can use to start a conversation with their physician or hospital about what the information means and how they can best get the care they need.

In September 2003, the “National Voluntary Hospital Reporting Initiative”, the predecessor of Hospital Compare, had only 415 hospitals that voluntarily reported information for one or more quality measures.  In less than four years, the number of hospitals that voluntarily report quality measure data in September 2007 Hospital Compare tool increased to 4,416. 

Hospital Compare is one of six compare tools that CMS provides to consumers to locate and compare quality of care information through its beneficiary-centered website www.medicare.gov.  The other tools are Dialysis Facility Compare, Home Health Compare, Nursing Home Compare, Medicare Options Compare (Medicare Managed Care Plans) and the Medicare Prescription Drug Plan Finder.  In March 2008, the Hospital Compare tool will provide patient experience (Hospital-CAPHS) data.  CMS staff are also meeting to develop meaningful methods to providing the cost and volume information for the commonly performed procedures.

The Hospital Compare Website enables CMS to transform agency operations by implementing the principles of a value-based system in the Medicare program. Hospital Compare empowers consumer choice and gives consumers a better insight into the quality of care provided by their local hospitals. The Hospital Compare initiative supports CMS’ commitment to the four cornerstones of value-driven healthcare: ensuring transparent quality and price information, interoperable health information technology and incentives for high-quality, efficient health care delivery. These quality compare tools position CMS to achieve the HHS Health Transparency and e-Government priorities by providing easy electronic access to helpful comparative information on health care quality.  CMS is also working with the Agency for Healthcare Research and Quality to develop a patient experience tool for home health agencies which will also be provided online.

B. Explain how your agency maintains an ongoing dialogue with interested parties to find innovative ways to use information technology for the initiative; AND

C. Identify external partners (e.g., Federal, State or local agencies, industry) who collaborate with your agency on the initiative;

• CMS works with its partners in the Hospital Quality Alliance (HQA), a public-private collaboration established to promote reporting on hospital quality of care and to increase the number of measures and the types of conditions and treatments on which the hospitals will report over time. The HQA consists of organizations that represent consumers, hospitals, doctors, employers, accrediting organizations, and Federal agencies.  The HQA effort is intended to make it easier for the consumer to make informed healthcare decisions, and to support efforts to improve quality in U.S. hospitals. The major vehicle for achieving this goal is the Hospital Compare website. The HQA provides CMS with suggestions to improve the ease of use and displays in the tool.  They also encourage hospitals to report on and improve their quality of care.  HQA members include:
• AARP
• AFL/CIO
• Agency for Healthcare Research and Quality
• American Hospital Association
• American Medical Association
• American Nurses Association 
• Association of American Medical Colleges
• Blue Cross and Blue Shield Association
• Centers for Medicare & Medicaid Services
• Consumer-Purchaser Disclosure Project
• Federation of American Hospitals
• General Electric
• National Association of Children’s Hospitals and Related Organizations
• National Business Coalition on Health
• National Quality Forum
• U.S. Chamber of Commerce

Since its inception in December 2002, the HQA has worked to increase hospitals’ voluntary participation in public reporting and expand the set of reported quality measures to provide information to the public on hospital quality.  The highest executive member of each organization (the HQA Principals) meet in-person on a quarterly basis to discuss hospital data collection, data submission to the Quality Improvement Organization (QIO) Clinical Data Warehouse, and public reporting on Hospital Compare of both current and future hospital (including outpatient department) measures.  These meetings are open to the public.  CMS also participates in the weekly HQA conference call.  Website content and design are frequently discussed and reviewed to collaborate on areas for improvement. 

D. Identify improved performance (e.g., outcome measures) by tracking performance measures supporting agency objectives and strategic goals;

• The Hospital Quality Initiative (HQI), like other CMS quality initiatives, consists of many facets. Its goals are to improve the care provided by the nation’s hospitals and to provide quality information to consumers and others to use for informed decision-making. CMS has several activities in progress to provide hospital quality information to consumers and others, and improve the care provided by the nation’s hospitals. These activities build upon previous CMS and QIO efforts on behalf of Medicare beneficiaries and other adults to promote the best medical practices associated with certain clinical conditions.

During the 12 month period July 2006 through June 2007, there were 22 quality measures reported on Hospital Compare. All but two of these measures had overall improvement rates of 1 to 13% at the National level.

CMS is supporting this priority by developing quality alliances to obtain and disseminate consistent quality measures of health care, allowing consumers to make better informed choices.  With these alliances in place, CMS will provide easy-to-access information about health care quality, patient experience, and pricing to consumers.  CMS will include comparative information on providers and other key stakeholders including hospitals, ambulatory care centers, cancer and kidney care centers, pharmacies and nursing homes.  CMS is on track to establish demonstrations and pilots which include performance-based payments.  The public reporting aspect of various pay-for-performance initiatives will also generate data that can be used to support transparency.

Annually, CMS considers the initiative to be successful as it continues to expand the quality information available to people with Medicare to make informed decisions about their healthcare choices.  In terms of a measurable outcome, Hospital Compare continues to be refreshed and/or enhanced without interruption or significant lapse in availability to the public.  Additionally, current and future website navigation, design, enhancements, and additional measures are consumer tested and usability tested to implement improvements based on user-feedback to offer accurate, timely, and relevant quality information in an easy-to-understand consistent web format that supports multiple agency and departmental initiatives for improving public access to quality information for informed decision-making.

E. Quantify the cost savings and cost avoidance achieved through implementing the initiative (e.g., by reducing or eliminating other investments in information technology);

• This initiative provides a consolidated, easy to access place for a variety of audiences to seek and find important Government information through a relatively inexpensive channel and provides for cost avoidance in other investments.  Without this investment in Hospital Compare, which provides a one-stop shop for hospital quality information for consumers, Medicare beneficiaries, and external stakeholders, alternatives would have to be developed to provide this information to the public through other channels in order to meet mandated reporting requirements.  1-800 MEDICARE would need to develop print-based packages that are customized to beneficiaries on demographic information and physically mail booklets at the request of beneficiaries and other audiences and be able to update this information frequently with new measures and accurate data.  Also, IT investment dollars would need to be directed to incorporate this set of data into a different technology that is not accessible to the public so that 1-800 MEDICARE can find and answer questions electronically for beneficiaries who call seeking information on hospital quality in order to make informed decisions about their health and quality of care.  This would be exceedingly more expensive and less efficient in meeting the goals of multiple quality and e-gov initiatives.

F. Explain how this initiative ensures the availability of Government information and services for those without access to the Internet and for those with disabilities;

• For those who do not have access to the Internet, CMS provides access to the same level of information through 1-800 MEDICARE. The 1-800-MEDICARE call center provides an alternate channel for communication and information dissemination for beneficiaries 24 hours a day, seven days a week. 

Additionally, Hospital Compare, as a component of the www.medicare.gov website, complies fully with Section 508 requirements.  CMS strives to continue to improve its resources for persons with disabilities and annually reviews the website for opportunities for improvements both in general usability and site navigation as well as targeted enhancements for increasing access for those with disabilities to government information.

G. Explain how the project applies effective capital planning and investment control procedures. 

• Hospital Compare is a component of CMS’ www.medicare.gov website system.  The Hospital Compare tool falls within www.medicare.gov processes and procedures that follow all aspects of the Capital Planning and Investment Control (CPIC) procedures and  requirements.  It is managed as part of an Exhibit 300, Beneficiary e-Services, and also follows Earned Value Management reporting procedures as a part of the larger Agency IT investment.  Through these processes, the website is in compliance with Enterprise Architecture procedures and actively updates and maintains respective Performance Reference Model, Business Reference Model, Service Reference Model and Technical Reference Models.  Performance information is captured and reported to the Department on a monthly basis and currently this investment is performing within acceptable thresholds and is meeting clear goals, milestones, and defined performance improvements each year.  Hospitalcompare.hhs.gov is part of the CMS Enterprise Data Center (EDC) at the Cherokee Data Center (CDC) in Tulsa, Oklahoma.  Hospital Compare goes through rigorous testing and review and as a part of this investment. 

CMS strives and meets all requirements of the HHS IT Investment Management (ITIM) process including all components that are a part of the CPIC procedures for the Medicare.gov applications including Hospital Compare.  Compare undergoes annual security and penetration testing by an independent contractor as well as certification and accreditation (C&A) as part of Medicare.gov.  CMS implements plans of action to address any findings and ensure the site is secure and meets Agency, Department, and Government security requirements.  It is also included under CMS’ Privacy Impact Assessment (PIA) for the Customer Service Systems family and follows and meets all FISMA reporting requirements including annually updating appropriate Risk Assessments (RA) and Secure System Plans (SSP).  CMS actively monitors contractor compliance with regulations and policy and performs on-site audits of contractor facilities. 

Hospital Compare strongly aligns with multiple strategic plans and initiatives including Health Transparency, Health Information Technology (HIT), Value-Driven Health Care (VDHC), and E-Government by providing easy access to helpful comparative information on health care quality for consumers, partners, and Medicare beneficiaries to use to make informed decisions and to increase access to and transparency of Government information.

Section 2 – Agency Information Management Activities

Please provide the link(s) to your agency’s website where the following information is located:

A. Your agency’s Information Resources Management (IRM) Strategic Plan:

• The Department of Health and Human Services Information Resources Management (IRM) Strategic Plan is located at: http://www.hhs.gov/ocio/plans/itstrategicplan.html

B. Final determinations, priorities, and schedules. Also include your agency’s information dissemination product catalogs, directories, inventories, and any other management tools used to improve the dissemination of and access to your agency’s information by the public:

• As required by Section 207 (f) (2) of the E-Government Act of 2002 and OMB Memorandum M-05-04 “Policies for Federal Agency Public Web Sites” HHS developed a comprehensive inventory located at:  http://www.hhs.gov/webinventory/
• Examples of specific information products available from HHS and its agencies are available at the HHS Information Quality Web site at http://aspe.hhs.gov/infoquality/

C. Your agency’s FOIA handbook:

• The HHS FOIA handbook is available at: http://www.hhs.gov/about/infoguid.html#foia

The link of your agency’s primary FOIA website:

• The primary HHS FOIA website is: http://www.hhs.gov/foia/

Frequent requests for records are made available to the public:

• Frequent requests for HHS records may be found on the primary FOIA page  http://www.hhs.gov/foia/ filed under the Frequently Requested Materials section

D. A list of your agency’s public websites disseminating research and development (R&D) information to the public, describing for each whether the website provides the public information about federally funded R&D activities and/or provides the results of Federal research:

• To comply with Section 207(g), “Access to Federally Funded Research and Development,” HHS makes available through Science.gov a database of federally funded Research and Development (R&D) activities.  Information about these activities is found on the CRISP (Computer Retrieval of Information on Scientific Projects) database at http://crisp.cit.nih.gov/
• The CRISP searchable database website provides information on federally funded biomedical research projects conducted at universities, hospitals, and other research institutions. The database, maintained by the Office of Extramural Research at the National Institutes of Health (NIH), includes projects funded by NIH, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Agency for Health Care Research and Quality (AHRQ). 

E. An inventory describing formal agency agreements (e.g., contracts, memorandum of understanding) with external entities (e.g., partnerships with State and local governments, public libraries, industry and commercial search engines) complementing your agency’s information dissemination program, briefly explaining how each agreement improves the access to and dissemination of government information to the public;

• The HHS Reference Collections website (http://www.hhs.gov/reference/) complements HHS information dissemination as it provides links to health-related dictionaries and glossaries; catalogs and indices of health information; and various other health resources, such as consumer health libraries, clinical trials databases, published medical articles, and medical encyclopedias.  The website provides links to health, human services, and general statistics and links to HHS Secretary reports, HHS performance and accountability reports, and HHS health publications and reports. 
• MEDLINE® (http://www.nlm.nih.gov/databases/databases_medline.html) is the National Library of Medicine's bibliographic database that contains over 16 million references to journal articles in life sciences with a concentration on biomedicine.  The majority of journals selected for MEDLINE® are based on the recommendation of the Literature Selection Technical Review Committee (LSTRC), an NIH-chartered advisory committee of external experts similar to the committees that review NIH grant applications. Some additional journals and newsletters are selected based on NLM-initiated reviews, e.g., history of medicine, health services research, AIDS, toxicology and environmental health, molecular biology, and complementary medicine, that are special priorities for NLM or other NIH components. These reviews generally also involve consultation with an array of NIH and outside experts or, in some cases, external organizations with which NLM has special collaborative arrangements. 
• MedlinePlus (http://medlineplus.gov/) is the National Library of Medicine's web site for consumer health information.  MedlinePlus includes extensive information on health topics with links to health information from NIH and other authoritative sources.  It includes a medical encyclopedia, interactive health tutorials, information on drugs, supplements, and herbal information, current health news, health dictionaries and local health care professional directories.
• The HHS Data Council Gateway to Data and Statistics (http://www.hhs-stat.net/) is a web-based tool that brings together key health and human services data and statistics. It is designed to complement other government resources such as FirstGov and FedStats and covers federal, state and local government sponsored information.

F. An inventory that describes your agency’s NARA-approved records schedules(s) or the link to the publicly-posted records schedules(s), and a brief explanation of your agency’s progress to implement NARA Bulletin 2006-02. For the brief explanation please report the number of systems for which a record schedule was submitted to NARA in FY 2007 and the number of systems still requiring records schedules.

• HHS posts records management information on its website at http://www.hhs.gov/ocio/policy/recordsmanagement/management.html.  HHS does not currently have an online inventory describing HHS records’ schedules and is currently developing plans to meet the NARA Bulletin 2006-02, NARA Guidance for Implementing Section 207(e) of the E-Government Act of 2002, deadline of September 2009.