It took over 13 months to award a contract, but finally the State of New Jersey Department of Motor Vehicles awarded the Enhanced Digital Drivers License (EDDL) and Central Issuance contract to L-1 Secure Credentialing. The contract, valued over $6 million, will span 7 years and will put New Jersey at the forefront of digital driver's license systems. The first year of the contract will include the planning and implementation of the new licensing system, while the subsequent six years will consist of card production and equipment/software maintenance.

The state began this process in September 2008 when they released a Request for Proposal (RFP) for the EDDL system. Proposals were due December 2008. The previous driver's license contract was held by Digimarc, now a part of L-1 Identity Solutions.

New Jersey is changing its pre-existing workflow process for driver's license issuance to incorporate photo-first capabilities as part of the State's effort to curb identity-related fraud. In addition, the State is implementing a secure card production solution as part of its over-the-counter system that will exceed the recommended standards set by the American Association of Motor Vehicle Administrators and the U.S. Department of Homeland Security, making the cards compliant with proposed standards set forth in the REAL ID Act.

More information on what other states are doing in regards to REAL ID and driver's license systems please see INPUT's REAL ID vertical profile.

The American Recovery and Reinvestment Act of 2009 (ARRA) appropriated $17.2 billion for Medicare and Medicaid providers to adopt certified electronic health record (EHR) technology. Industry estimates of the actual total cost of incentive payments for providers demonstrating meaningful use range from $20 billion to $36.4 billion. As the meaningful use criteria is still being hashed out at the federal level, states are beginning to move forward by partnering with banks and establishing loan programs to provide financial assistance. These loan programs are another way to encourage providers to purchase and implement health information technologies (HIT) and then seek federal incentive payments down the road. Additional government support will be provided through the Regional Extension Centers (REC). Meanwhile, some vendors such as GE Healthcare have opted to offer interest free, deferred payment plans to alleviate concerns over IT costs.

One example is the North Dakota HIT Revolving Loan Fund recently establish via Senate Bill 2332. The state is partnering with the Bank of North Dakota to offer low-interest loans to health care entities looking to make investments in health IT. The process includes submitting an application for review and approval by the HIT Director and the HIT Advisory Committee. Approved applicants are required to complete an on-site readiness assessment then the next step is to complete the Bank's loan application for final approval.

Will states seek vendor support? Yes, it does appear that some states will be seeking vendor assistance, particularly for operations support and quality assurance (QA) services. New York recently completed a HIT Planning Advanced Planning Document (HIT P-APD) which indicated plans to obtain contract services through the New York State Technology Enterprise Corporation (NYSTEC) for planning services. NYSTEC staff will then assist the Department of Health with developing Request for Proposals(s) and procurement(s) to obtain contractors for operational support and program auditing/QA services.

HIT vendors should continue to consider offering financing options to assist providers with purchasing EHR solutions and to streamline purchases with a given states loan program and partnering bank to make the process simple and efficient. In addition, while meaningful use criteria will be the essential guideline for a system, don't forget to be innovative within those confines. Professional services HIT vendors should expect to see more states following New York's lead; as states begin to roll out plans for loan programs over the next couple of months they will have a better idea of where they will be seeking vendor's assistance.

Currently, the State of Maryland and the City of Boston, Massachusetts have Request for Proposals (RFPs) on the street for Computer Aided Dispatch and Records Management Systems. Both projects are very large in scope and will include multi-million dollar contracts for vendors and subcontractors. Given their size, I thought it would be interesting to compare the list of vendors who attended the pre-proposal conferences for both of these projects.

First, the vendors who attended the pre-proposal conference for the State of Maryland CAD/RMS RFP include: Gantech, NetApp, SONA Networks, ARINC, CapWIN, Morcom, ACS, Communications Electronics, Trilogy, Frequentis, Young Enterprise Systems, Oracle, Denali Solutions, TriTech, Ciber, DataWorks Plus, FDM Software, Tiburon, Intergraph, Unisys, Capegemini, InterAct Public Safety Systems, Telecommunications Development Group, Bio-Key, Verizon Business, Cisco, and Motorola.

Secondly, the vendors who attended the pre-proposal conference for the Boston, MA CAD/RMS RFP include: ACS, Brandon Associates LLC, Capgemini Government Solutions, Comtronics, Datamaxx, Denali Solutions, ESRI, Galain Solutions, GovCentric, IBM, ICA Consulting LLC, Interact Public Safety Systems, Intergraph, Motorola, New World Systems, Northrop Grumman, Tiburon, TriTech Software Systems, Verizon Business, and Versaterm.

Looking at the two lists, it is clear that these two projects are popular among the big names in the CAD/RMS market. Northrop Grumman currently holds the CAD contract for the City of Boston, so it could be tough for vendors to compete with the incumbent contractor. As for the State of Maryland, it is really up in the air as far as who has the advantage given that this is a totally new endeavor for the state and involves multiple departments. More information and updates can be found within these two opportunity reports.

For a short month February sure packed in a lot of activity, especially for the health care market. Reports from last month continued to make headlines that health care spending reached $2.5 trillion in 2009 and is projected to be $4.7 trillion in 2019. The recession gets the blame for this largest one-year increase on health care spending in 50 years. Since there is much money being spent on healthcare it is no wonder it is front and center as an industry for opportunities to drive vendors' revenue. February found Maximus adding DeltaWares' electronic health record (EHR) technology to its repertoire. EHRs have likewise spurred a partnership between NextGen and Ingram Micro. Microsoft and Eclipsys announced they will combine certain Eclipsys health care IT applications with Microsoft's Amalga Unified Intelligence System. In addition, IBM is expanding its analytics business by acquiring Initiate Systems and ACS now has its new position in the marketplace branded as "ACS, A Xerox Company". Expect to see more activity in months to come.

A whole lot of spending money
Forty states agencies and State Designated Entities received awards in the first round of health information exchange (HIE) grant funding which totaled $386 million. Plenty of participants are happy to receive the HIE funds but they are still trying to figure out their strategies. Providing matching investments will be no small matter for most states and some are still looking for information on how the HIE will work and exactly what it will provide. There are concerns that there may not be enough done to ensure that the money isn't being wasted. Some states are finding it difficult to become invested when they don't ultimately understand the HIEs and how they will be self-sufficient once the money is gone. Despite some concerns, states are detailing their statewide planning approaches to determine where they are, what is needed and ways to get there. This will help states determine how they will need to utilize vendors. Here's a sample of state activities:

Pennsylvania wants to piggyback on the Delaware Health Information Network's existing contract because they feel it is a proven platform based on interoperable standard, is scalable to meet their needs and would satisfy the Office of the National Coordinator's request for states to look into multi-state collaboration to make the best use of federal incentive funds. INPUT is tracking the opportunity under INPUT ID # 57863.

Missouri plans on releasing a Request for Information (RFI) to help gather more information on the technical approach and financing assumptions of their HIE. Missouri has their eye on submitting their plans to the Office of the National Coordinator for Health IT (ONC) by May 31st. INPUT is tracking the opportunity under INPUT ID # 60207.

Illinois intends to release a solicitation soon for HIE technical planning services. They will be looking for project management and planning assistance, including the development of strategic and operational plans as well as the state HIE roadmap to help determine next steps for the procurement process of the HIE system. INPUT is tracking the opportunity under ID # 59517.

Massachusetts released a draft Health IT plan in January. They are looking at a statewide HIE with collaborative governance and sustainable funding model. Their strategy is to leverage existing electronic health record and HIE efforts. INPUT is tracking the opportunity under ID # 59998.

Also in February, the Health and Human Services announced $100 million in grant funds from the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to 10 states to improve health care quality and delivery systems for children enrolled in Medicaid and CHIP. These states will use the grants to utilize health IT for quality improvement initiatives.

On a path towards interoperable health information exchange
During February's State Alliance for e-Health meeting, presentations focused on ways to improve the adoption of health IT and operations states should take in order to jumpstart the process. Representatives from various departments and states facilitated conversation pertaining to HIE deployment, sustainability and future activities for the State Alliance. Farzad Mostashari, MD, MSc., the deputy national coordinator for Programs and Policy from ONC explained how states need to focus on incremental changes for the HIEs, by first working on simple exchanges and focusing on factors such as authentication and validity. For further insight into the meeting check out INPUT's Analyst Recap report.

Google's plans to tackle broadband
A notable first this month is Google's plan to experiment with providing super high-speed Internet service. One of their visions is to "allow rural health clinics to send 3D medical images over the Internet". This could be a big step if any medical communities actually get involved in the experiment, potentially stimulating their digital records efforts.

INPUT's Take
I think last month's hodgepodge of activity is a good indicator of what is to come this year as states flesh out their strategies for operations and sustainability of statewide HIEs. They will be looking to leverage existing capabilities and lessons learned from already developed HIEs. Vendors should understand that states are at all different levels of maturity and even if a state had previously developed a Health IT roadmap, they will likely have to revisit plans to ensure they align with national requirements. Consultants should look to those HIE planning initiatives for opportunities as states are setting aside funds for environmental scans, cost benefit analyses, project management, advanced planning documents and so forth. Those that have already made investments will begin to develop plans on how to connect pilot projects and regional efforts. Broadband offers great promise in the medical area and Google's innovations offer a glimpse at the future as we wait to hear more about the federal government's national plans for broadband networks in the next couple of weeks.

The State of Colorado recently announced their intention to pursue a contract for an eProcurement system on behalf of Colorado and the Western States Contracting Alliance WSCA in an upcoming RFI and RFP.

This will extend WSCA's offerings of procurement related offerings beyond its current procurement analysis and consulting services contracts established by the State of Washington.

Stakeholders at WSCA ( state procurement officials primarily) establish cooperative contracts based on demand, they therefore must see a sizable need for a cooperative contract serving state and local government eProcurement needs. This need is no doubt driven by increased attention to efficiency and transparency in spending, combined with staffing challenges in most procurement offices.

The state and local eProcurement landscape seems to be dominated by a couple different types of governments. Those that were early adopters of eProcurement systems are now looking to upgrade to more robust, enterprise wide purchasing solutions, often integrated with other financial applications. Another group of states and locals are still limping along on legacy or in-house purchasing solutions. So while eProcurement is not new to them, they are considering their first foray into vendor solutions. A third set of primarily locals with little experience in ePurchasing or eGov, stand to benefit from web-based or SaaS purchasing solutions. This last group is likely not who the WSCA contract will target and will likely attract a different set of solution providers also.

So, enterprise eProcurement providers need to keep eye on the upcoming Colorado procurement and remember that Florida, Louisiana, Maryland, Nevada, and North Carolina may also be looking for eProcurement solutions. And you cloud computing eProcuement folks hit the streets with the locals, they may finally be ready to streamline.

The Commonwealth of Massachusetts, Information Technology Division (ITD), held a Bidders' Teleconference yesterday for their Web Content Management project for Mass.gov (INPUT Opportunity 58875). The Commonwealth is looking to replace the legacy tools currently used to support the web content management and delivery environment currently hosted on mass.gov. The Commonwealth plans to approach the solution in two phases. The first phase consists of Proof of Concept (POC) demonstrations provided by up to three vendors, and the second phase will consist of the configuration and implementation of the new Content Management System.

The teleconference acted as an open forum for interested vendors to pose their questions to ITD. Many questions came up regarding the requirement for all vendors submitting bids to use the current software vehicles the Commonwealth has in place. The two contracts in question are ITS14 and ITS19 naming Dell, SHI and Oracle as the software providers for the Commonwealth. The Bidders conference clarified that vendors interested in submitting bids for a content management solution must treat vendors on these vehicles as resellers when submitting proposals. An additional question in regards to the current state software contracts concerned a request for an extended deadline for the web content management solution due to the fact that one of the current contracts was recently recompeted and suppliers may be subject to change (INPUT Opportunity 60768). However, the Commonwealth reiterated they must adhere to a strict time table with the content management project because funds must be expended by the end of the current fiscal year.

Additional questions raised concerned whether or not the Commonwealth would request implementation services off of their ITS33 contract (INPUT Opportunity 40795). The Commonwealth confirmed all migration and implementation services will be performed in-house. A question was asked whether or not the Commonwealth would prefer cloud installation and cloud hosting services, to which the reply was that there was no preference at this time. However, though plans are to currently host the solution within their own data center, the Commonwealth is interested in seeing what cloud options vendors may provide.

The Commonwealth plans to address any questions not answered during the teleconference via a solicitation amendment that will be posted to Comm-Pass. Proposals for the Web Content Management solution are due March 18, 2010.

Although they did not receive a Health Information Exchange (HIE) grant in the first round of funding, the State of Mississippi Department of Information Technology Services (ITS) released a Request for Proposals (RFP) for consulting services for the development of the strategic and operational plans for their statewide health information exchange (HIE). Questions are due by March 12 and Proposals are due by March 24, 2010. INPUT is tracking the opportunity under ID #61702.

Once strategic and operational plans are in place, the State intends to procure and implement the infrastructure for their HIE, the Mississippi Health Information Network (M-HIN). M-HIN should be capable of interfacing with providers of care, public health organizations, and local and regional HIE's as well as the National Health Information Network (NHIN). The Mississippi Health Information Infrastructure Task Force will serve as the governing structure until June 30, 2010. ITS is serving as the State Designated Entity for the State HIE Cooperative Agreement Program.

It is anticipated that states' plans will reflect the existing variety of HIE approaches and levels of readiness. Mississippi already has experience in the HIE arena- in 2008 Medicity Inc was chosen to implement the Mississippi Coastal Health Information Exchange (MSCHIE), which helped to restructure and improve patient care delivery in the six coastal counties that were most affected by Hurricane Katrina. More information on Mississippi's Health Information Technology profile can be found here.

On March 2, 2010, the Federal Communications Commission held a forum to discuss the development of a national Emergency Response Interoperability Center (ERIC). The meeting was held in Washington, DC and was attended by members of the FCC, Department of Homeland Security, NIST, and a variety of private sector companies. The goal of the forum was to discuss the concept paper that the FCC had released on ERIC, and to field any questions or concerns industry players had on the development of this center. A majority of the questions/concerns centered on standards and the technical and operational framework of ERIC. While others had concerns on how this center will account for emerging technologies and who will be the key stakeholders.

The proposed primary mission of ERIC, as stated in the concept paper, is to establish a technical and operational framework that will ensure nationwide operability and interoperability from the outset in deployment and operation of the 700 MHz public safety broadband wireless network. While agencies are in the process of rebanding their radios to narrowband due to FCC regulation, there has been little work done in the field of regulation and framework development for agencies that plan to be interoperable with neighboring agencies.

While there were many questions asked, a few notable ones stuck out. The first concern was that ERIC would be duplicating work already done by other agencies/associations in the area of standards development. The second concern was that local agencies might be misrepresented in the development of a national framework. The third concern was that the Advisory Board for ERIC does not include everyone involved in emergency response, and should be expanded.

Overall, this forum was helpful in understanding the variables involved in developing an Emergency Response Interoperability Center. As Jaime Barnett, FCC Chief of Public Safety and Homeland Security, said, "We only get one chance at this...one swing. We need to get it right." In order to get it right, the FCC will need to take into consideration all the questions and concerns that were raised during this forum.

The Analyst Recap can be found HERE.

South Carolina solicits feedback from the vendor community to help determine a strategy for modernizing their legacy Medicaid Management Information System (MMIS) and interfaces.

The State of South Carolina, Department of Health and Human Services (DHHS) released a Request for Information (RFI) on February 10, 2010 for a Replacement MMIS. The state is currently planning a multi-vendor approach and Clemson University will continue to provide hosting. Project details include:

Current Status: DHHS and Clemson University have completed a Medicaid Information Technology Architecture (MITA) State Self-Assessment which is currently under review by the Centers for Medicare and Medicaid Services (CMS). The Department plans to make the MITA SS-A publicly available in the near future. RFI responses are due by March 4, 2010.

Background: South Carolina's current MMIS is a mainframe-based, batch-oriented claims processing system which resides on a Clemson University's HDS Enterprise Server utilizing an OS-390 operating system. A majority of the application programs are written in COBOL for MVS. The web applications are WINDOWS-based utilizing Microsoft Visual Basic, ASP and SQL Server.

Scope of Work: Respondents must address questions surrounding the implementation of a MITA-aligned systems and services, as well as, how to mitigate challenges when utilizing a multi-vendor design, development and implementation approach.

Funding/Contract Value: INPUT estimates the value of this opportunity to be approximately $50 million to $75 million based on similar projects with a likeness in size and scope.

For more information please see INPUT Opportunity #60218. Related SC Medicaid INPUT Opportunities include:

• Medicaid Operation Services #61133
• Medicaid Business Intelligence System #61446
• Medicaid Eligibility Determination System #60577
• MMIS Independent Verification & Validation Services #60575

INPUT's Take:

South Carolina's multi-vendor approach could mirror Iowa's best-of-breed Medicaid Enterprise, as well as, encourage partnering amongst vendors. While it's too early to discern how exactly the replacement MMIS will fit into the state health information technology (HIT) roadmap this will present an opportunity to align the state system with the MITA framework standard and for Medicaid and HIT vendors to begin to work together.

The State Alliance for e-Health Meeting (State Alliance) took place on February 19, 2010 in Washington DC. The State Alliance was created in January 2007 by the National Governors Association Center for Best Practices as a way for states to come together and discuss ways to improve the nation's health care system. The primary goal of the State Alliance meetings is to increase the efficiency and effectiveness of health information technology (HIT) initiatives as they develop. The meetings consist of various stakeholders sharing and exploring solutions to programmatic and legal issues related to health information exchange (HIE).

The main focus of the conference revolved around ways to improve the adoption of HIT and operations states' should be taking in order to jumpstart the process in an efficient manner.

The meeting consisted of five sessions where representatives from various departments and states facilitated discussion of various areas including:

• HIE
• Using collaboration as a tool
• Building critical infrastructure
• Sustainability
• Future activities for the State Alliance

The final session of the State Alliance meeting involved discussion about future directions for states regarding HIT adoption. A very interesting topic brought up was the idea of disease surveillance and its rightful place in HIT and meaningful use. The idea is that by monitoring disease, communities will be able to exercise prevention by lowering the number of health cases and reducing medical costs. Discussion was also made regarding the lack of attention placed on public health departments and how they should be more engaged and articulated as part of HIT.

Farzad Mostashari, MD, MSc., the Deputy National Coordinator for Programs and Policy , talked about how "real time surveillance" could be used to monitor what diseases are becoming widespread and harming members within a certain community. He explained that it would also serve as a way to engage clinical partners, describing it as, "working smarter". Mostashari went on to mention that a major part of funding for these types of systems relies on evidence that it would truly work. For example, the Beacon Community Program , a grant program that targets communities that have already proven history of using HIT to boost measures such as cost efficiency, health care quality, or population health, is a method used to conjure up this evidence-based data health officials are looking for, since right now there is a lack of it.

Other future activities mentioned in the State Alliance meeting were the need to give states technical assistance through regulations and state consultations. Moreover, this would help states in implementing the grants states recently received from the Health Information Technology for Economic and Clinical Health Act (HITECH). Emphasis was placed on how important it is for state representatives and other stakeholders to bring up issues and provide recommendations to health officials in order to improve the quality and execution of HIT adoption. Furthermore, it was stressed for representatives from ONC and the Center for Medicaid Services (CMS) to trade solutions, as well.

The key factor that must be taken into consideration by stakeholders is the central motive for HIT; the concept of meaningful use. As a result, proving certain systems offer the most efficient, and cost-effective outcomes, is a major driving force for states, in winning funding to pursue HIT adoption. Vendors should pay extra attention to their solutions in ensuring that their systems capture certain data measurements so as to provide the evidence federal health officials are so adamantly seeking. Moreover, some concentration must also be placed on commonalities, and synchronizing systems to make interoperability in HIE possible. Lastly, privacy and security of these systems should also be incorporated in order to ensure meaningful use.