Throughout his career in public service, Tony Trenkle has never shied away from high-profile technology projects, whether the assignment was to establish electronic commerce programs or design online services for his fellow citizens.
Trenkle’s current position at the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) underscores his penchant for programs that affect and improve government services, in this case the U.S. health care system. Trenkle, who is the chief information officer and director of the Office of Information Services (OIS) at CMS, said he enjoys jobs that allow him to use the agency mission to help improve how government works. “I’ve liked working at agencies with big levers that can be used to create real change,” he said.
His first job in government was as an intern at NASA working on telecommunications programs. Although he was there after the Apollo program had successfully landed a man on the moon, the excitement of the endeavor still resonated with him. It was that strong sense of mission that motivated Trenkle to spend most of his career in government.
“What has always brought me to work in the public sector is the idea that I can make a difference,” he said. “My career wasn’t a defined path as much as it was trying to get things done and lead in various ways.”
Trenkle has worked on many major federal information technology initiatives during his career, but there has been one constant, he said: “I have always spent my time at the intersection of technology and business.”
That’s true of his job at CMS, where Trenkle has worked for seven years, the past two in his current position. He oversees a $1 billion annual IT budget and directs a national operational infrastructure that supports CMS claims processing and other business services.
CMS is one of the largest purchasers of health care in the world, running Medicare, Medicaid and the Children’s Health Insurance Program. Health care reform has been an impetus for CMS to make changes to its IT infrastructure and improve how it processes rapidly increasing amounts of data. Trenkle has helped lay the foundation for the agency to “take advantage of all these trends and have them work for us and not get overwhelmed by them.”
“What has always brought me to work in the public sector is the idea that I can make a difference. My career wasn’t a defined path as much as it was trying to get things done and lead in various ways.”
This requires not only new technology, but also a new way of thinking. Traditionally, CMS’ IT infrastructure has been decentralized and funded on a mostly programmatic basis, Trenkle said, but in a time of tight budgets, that wasn’t a practical approach.
Under the umbrella of health reform, CMS “is bringing together different funding sources and business requirements to produce shared services,” Trenkle said. “Even with the funding that we get, there is no way we could support building all these program-specific IT processes.”
There are four enterprise shared services that Trenkle has chosen to launch first: enterprise identity management, an enterprise portal, master data management and a business rules engine. His three-year plan, which began last year, set his shared-services strategy in motion. “This year we are beginning to implement it in terms of real applications,” he said.
By fiscal 2014, Trenkle said, CMS will start to consolidate systems, and shared services will begin to show some real results. None of this could happen without establishing a security strategy, Trenkle said, noting that people can connect to systems anytime from anywhere. “As you move to more sharing of data to produce better health care coordination and reduce costs, the old security and privacy requirements need to be reviewed,” he said.
A Doubling of Big Data
Measuring the success of health reform focuses on data, Trenkle said, and CMS will be inundated with new types of information as that reform gains momentum. “For health reform to succeed, we need good data to make better decisions — whether you are changing how you make payments, measure quality or improve health care coordination.”
Currently, CMS stores and maintains about half a terabyte of data each month. That is expected to double by 2015, with Medicare claims data growing to 700 terabytes from 370 terabytes, and Medicaid data growing to 100 terabytes from 30 terabytes.
The growth is attributed to more beneficiaries enrolling in the Medicare and Medicaid programs,states creating insurance exchanges, and providers moving away from a traditional fee-for-service pay model to one based on performance, quality and shared savings. The nature of the facts and figures will change, too, as CMS collects more unstructured data that will require more analytics. Data analytics puts power in end users’ hands, Trenkle said. “Someone with an mobile device can access this information to make quick decisions.”
This means CMS must adjust how it receives and analyzes the information it collects, so that changes to health care policy will happen faster.
“It’s dependent on having a data infrastructure that can support that,” Trenkle said. The Affordable Care Act “gave us some strong business imperatives that have forced us to step back and think about how we are doing data management here at the agency.”
One vision is to create an enterprise data warehouse. Trenkle said this would allow CMS to combine new information, such as quality and clinical data with traditional claims, beneficiary and provider records. CMS is an information clearing house, he said, that can support external researchers doing sophisticated analytics. Last year, CMS partnered with Oak Ridge National Laboratory to test better methods of data management. The lab, which works with the Defense Department and the National Weather Service on big data issues, introduced CMS to Hadoop open-source software. That “caused us to think about how we can look at data management differently,” Trenkle said.
Data center consolidation is another effort underway at CMS. Under a multibillion-dollar virtual data center procurement awarded last year, the agency will consolidate a number of its dozens of data centers to eliminate redundant spending and solutions and make the most of shared resources.
Collaboration Lessons Learned
Throughout his career Trenkle has played a central role in developing IT standards for government, which underscored for him the importanceof collaborating with others. “All that experience has helped me understand both sides of the equation,” he said. “Standards are a compromise. They are a way of bringing different industry needs together to form something we can all utilize.”
Before becoming CIO, Trenkle headed CMS’ Office of E-Health Standards and Services (OESS), where he coordinated policy and standards related to “meaningful use” under the Medicare and Medicaid Electronic Health Records (EHR) Incentives Programs. Meaningful use establishes certain thresholds for EHR programs that, if met, result in financial incentives to providers.
“I heard from the health plans, from the provider community and other parts of industry,” Trenkle said. “Now being on the user side with OIS, I can better understand where those groups were coming from. At the same time, from my OESS experience I also know how policies developed and how we work with the standards organization in implementing the EHR incentive program.”
“We are a service provider, but we are also a partner with the business side, industry and others. We have to support them, but it is a partnership with responsibilities on both sides.”
Standards are crucial to making various electronic processes work, Trenkle said, including insurance exchanges and Health Insurance Portability and Accountability Act standards for claims data and information. “If you don’t have good standards in place or implementation guides that help you, then you create more problems on both ends,” he said. “I think they are the glue that holds a lot of the work we do together.” Compromise is important in other areas besides standards, Trenkle said. “In the IT area, we are a service provider, but we are also a partner with the business side, industry and others. We have to support them, but it is a partnership with responsibilities on both sides.”
Trenkle has spent much of his career building relationships between business and government. He worked for eight years in the private sector after leaving his internship at NASA. As a result, he is familiar with IT mandates that the business side must adhere to and some of the frustrations IT workers have with missing or undeveloped business requirements, he said. Keys to health reform include payment reform and health care coordination, which require working with other organizations, Trenkle said. The rise of multi-payer databases, data analytics tools, new sources of personal data and the collection of more clinical data emphasize the need for cooperation and agreement on standards.
“We have to look at standards from a larger perspective, thinking about how you can do business with each other,” he said. Several techniques work well when it comes to collaboration, Trenkle said. “None of us have perfect knowledge. Even as we get more information, we get less knowledge,” he said. “So you have to be willing to listen and to meet the other person where they are. But you also have to educate them on your point of view and why you are proposing a certain way of doing business.”
Building strong relationships within the vendor and government communities is important to making progress, Trenkle said. “The key is to keep a sense of perspective, calm and humor,” he said. “Over time, you find people who want to have a collaborative relationship. So even if you are not on the same side of the fence on every issue, you can at least work toward a common goal.” But in the end, “sometimes you have to take a stand and be willing to support a position that they might not agree with.”
Trenkle thinks strategically when it comes to making changes in government IT. His work has helped develop groundbreaking programs, including e-commerce programs at the General Services Administration and online services at the Social Security Administration.
“Sometimes you have to take a stand and be willing to support a position that they might not agree with.”
“I’ve enjoyed being part of some major changes in how government conducts business over the past couple decades,” he said. “In the early 1990s we looked at how we could use technology to improve services to the public. Here we are a couple decades later still fighting the good fight.”Trenkle understands that progress and change aren’t easy, but leading by example and taking a measured approach are important — whether it’s in IT or life. In his office, he displays a famous quote from Gandhi: “We must become the change we want to see.”
Even before he joined NASA, Trenkle said, he saw how the government “could create change for this country, whether it was the space program, civil rights or providing opportunities for people.”
That idea was reinforced by a college professor who suggested a career in government because it presented the opportunity to do great things. Trenkle clearly remembers the excitement of his NASA internship and meeting people who helped put a man on the moon. It’s the same excitement he feels about being at CMS, which is at the center of change in U.S. health care.
“I’ve worked at different places with different missions,” he said.” But they all make you want to come into work and do what you can to make the world a better place.”
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