An eGovernment strategy has become an important part of virtually every government whether it be municipal, county, state/provincial, or federal. Governments are under constant pressure to deliver significant cost savings with job titles starting to appear with new names like “eliminating red tape” and “finding efficiencies”. Citizens are increasingly frustrated with the way government works and want to interact with their government the same way they do their banking, arrange travel, or make purchases. Society wants government to reduce service inequality, be environmentally responsible, and be more transparent.
Are these demands at odds? Can you meet these demands while eliminating costs? At IMT, we believe that examining the transformation Healthcare has undergone over the past decade can provide some valuable answers.
Healthcare has undergone a significant transformation spurred on in many countries by government setting priorities and providing funding to create an Electronic Health Record. It was widely accepted that true transformation of healthcare delivery required a complete longitudinal health record of a patient across the entire enterprise. With healthcare information literally scattered across tens or even hundreds of systems, the foundation for this was to create a 360-degree view of a patient across all systems. The solution became the Enterprise Master Patient Index or EMPI. An EMPI links patients across all systems and creates a virtual “registry” showing where each patient had previous healthcare encounters and how they identified themselves. This was not an easy task and a great deal of time was spent solving how governance, data stewardship, information sharing agreements, data masking, and privacy must be dealt with. Today, virtually every healthcare organization has an EMPI. Asking a healthcare organization why they need an EMPI is akin to asking a business why they need an accounting or inventory system – how could you run your organization without it?
In many ways, we see governments today where Healthcare was a decade ago. Government is exploring how to transform services, transact with citizens online, and reduce costs. And like healthcare, government works in silos that don’t share information (many times for good reason). Ask yourself, who in government has a complete picture of a citizen or resident across all of the government departments and programs? How can you make better decisions without knowing this? Healthcare came to the realization that transformation required “Know Your Patient”. Today, governments need to realize that transformation requires a 360-degree view of each citizen across all of government – “Know Your Patient” becomes “Know Your Citizen”.
In many ways, moving government to a more holistic and citizen-centric service approach will be even more difficult than the challenges healthcare went through. Many government departments are currently precluded from sharing information by their acts or regulations. Most elections agencies are governed by an act that provides them with the authority to collect any government data to create an accurate voter roll but are explicitly prohibited from sharing any information back. As one electoral officer told us “if it is not explicitly in our act, it is explicitly out”. There are also many situations where information sharing is deemed inappropriate due to privacy or safety concerns. A government initiative attempting to save money by creating a smartcard with a driver licence on one side and a health insurance card on the other was eventually cancelled in large part due to privacy concerns – “if I give my driver licence to a car rental agent they have access to my health insurance number without my consent”.
Does this mean that government should give up? The answer of course is no. The question is not “should a government create a 360 view of a citizen?” but “HOW should a government create a 360 view of a citizen that respects a citizens privacy and improves service equality”? Based on over 15 years of working with healthcare and government organizations to deploy over one hundred 360 view registries, we offer some lessons-learned and best practices:
- Recognize the role as a business role. Far too often we have seen these types of initiatives start in the information technology group only to bog down once stakeholders become aware of it. In extreme cases we have seen initiatives cancelled to be reset in the future. Recognizing that a citizen-centric 360 view does not exist and creating a role at the policy level through legislation / passed motion/ etc. is a critical success factor. Successful initiatives have created owners such as “office of transformation” or “services integration”.
- Senior leadership must be engaged. The selection of the right business owner is critical. Recognizing that there will be resistance and inertia from stakeholders to this change the business owner must be extremely adept at change management and relationship building. As one government owner told us “there are hundreds of people in every government with the power to say no but only a handful of people with the power to say yes”.
- Make the initiative visible but not too visible. We have seen initiatives kicked off with great aplomb and fanfare only to have this backfire later due to unrealistic expectations being set and media frenzy. Your communications strategy and your ongoing steering committee makeup are critical success factors.
- Get governance and stewardship right the first time – leverage lessons learned. We have seen far too many initiatives want to get started and jump right in to the technology. To get stakeholder buy-in and find champions you need to first address their governance, stewardship and privacy concerns. The good news here is that there is no need to reinvent the wheel. There are many lessons-learned and best practices that can be leveraged. Templates exist for information sharing agreements, business associate agreements, information exchange protocols, privacy impact assessments, etc. And there are experienced resources that can help you adopt these for your initiative.
- Share what is only absolutely necessary. A citizen 360 view is not about putting all government data in one place – in fact that’s a recipe for disaster. One of the biggest challenges is determining what data needs to be shared, under what conditions, and to whom should this data be shared. Answering these questions forms the basis for your governance and stewardship framework. In our experience, less information is better and still gets the job done.
- Start humble and be pragmatic. Although this may sound like change management 101 it is amazing how often it is overlooked. Find a champion and a real use case however humble the benefits may be. In our experience there is no better way to accelerate adoption and support for your initiative than to have a real champion describe a benefit driven approach and advocate for you.
One question that has not been discussed thus far is “are there real benefits to a citizen 360 view?” Governments are early in this process with a limited number of initiatives to examine but here is an anonymized “amalgam” of actual benefits realized by early adopters:
- Seeing which services are being provided to which citizens and examining usage patterns has allowed for better budgeting, workforce planning, and resource funding.
- Funding has been increased by knowing the exact population count of residents. And this has been done with a significant decrease in the effort required.
- Hundreds of hours have been saved in responding to requests for information by examining one source vs numerous separate systems.
- Voter roll accuracy and integrity has been increased substantially and the time and effort to create an accurate voter roll has been dramatically decreased.
- Changes have been made to provide citizens a more effective service or program.
- Through auto verification of a citizen/resident across government, fraud has been uncovered and costs recaptured in the areas of benefits entitlement payments, illegal subsidies, and erroneous claims being paid.
- Purchases of third-party data has been decreased.
- Citizen-centric and holistic case management across government departments has been implemented in areas such as troubled families, children at risk, and disenfranchised, homeless and vulnerable persons.
- Streamlined government processes have been created. For example, the renewal of a driver’s license triggers the update of the voter roll and in future the auto-renewal of a health card without the person having to show up in person again.
- Innovative new online digital services have been created for citizens on mobile apps to update their information, receive notifications from government, and conduct business online.
Implemented correctly, the benefits from a citizen 360 view are significant. At IMT, we believe a citizen 360 view is foundational to starting real government transformation. But it is not about the technology which healthcare, banking, and the airlines have proved out for a decade now. The real secret is in working with experts and getting sponsorship, governance, change management and data stewardship right the first time.
At IMT, we offer our citizen 360 view solution – Citizen:ID built on the IBM Master Data Management platform that has been the gold standard in creating 360 view solutions for over 20 years. We have successfully deployed over one hundred 360 view registries in healthcare, human Services, education, and most recently eGovernment. Give us a call and our team of experts would love to start a discussion with you.