4. Participation and Collaboration
The IDEA Lab has several initiatives focusing on participation and collaboration among HHS agencies: HHS Innovates; HHS Entrepreneurs; HHS Ignite; HHS Ventures; HHS Competes; and HHS Buyers Club. HHS Innovates is a mechanism through which HHS recognizes, rewards, and inspires innovation. Launched in 2010, this contest has undergone six rounds of competition to date. HHS employees have submitted nominations of innovations for nearly 500 exciting new staff-driven innovations, and over 60,000 votes have been cast by our employees during the community voting phase. Over the last two rounds of the contest, we have opened up the voting to include input from the public. During this time, over 55,000 page hits were recorded, with our analytics demonstrating viewings from all 50 states and the territories. The opportunity for open voting on the selection of winners by the public brings opportunities for the Department to engage with the public to learn about innovation activities at HHS. As a result of the public engagement, a number of HHS-led innovations have scaled and been further adopted outside of the confines of HHS. Over the coming years, we plan to make continual enhancement to the program as we experiment with new ways of recognizing employee-led innovation.
The HHS Entrepreneurs Program is a cross-cutting opportunity focused on leveraging the expertise, knowledge, and skills of experts from outside the federal government in partnership with internal teams to address major mission-related challenges. This program was launched in early 2012 and is now in its third cohort. Additionally this program has served as the model for the Presidential Innovation Fellows Program. The HHS Entrepreneurs Program aims to bring external ideas and expertise into HHS’s own innovation process and rapidly create, develop, engage, and accelerate innovation. Startup organizations have demonstrated that rapid iteration between various versions or features of a product can yield success. Rapid iteration techniques create valuable products and/or solutions quickly while minimizing waste (time, effort, money) in the development cycle. HHS would like to boost innovation by working with external expertise to create a risk-taking culture that encourages dynamic new models of business. More information about the fellows program can be found at: http://www.hhs.gov/idealab/pathways/hhs-entrepreneurs/.
HHS Buyers Club
The HHS Buyers Club, launched in April 2014, is a project primarily focused on addressing a critical problem in Government, effective and efficient procurement of information technology. Given the expansion and impactful role of digital services throughout government, there are many opportunities to improve existing procurement methods used to support government services, directly benefitting the public. Government access to and use of technologies that support data and information management are lagging behind the private sector. According to the 2013 Chaos Manifesto (http://www.versionone.com/assets/img/files/CHAOSManifesto2013.pdf) from the Standish Group (http://www.standishgroup.com/ ), all IT projects in excess of $10 million were found to be challenged or failed, 52% and 48%, respectively. Of course, this only leaves a 10% success rate. Innovative strategies to leverage federal acquisitions processes are needed to seek both better value and outcomes for the services we provide the public. Increasing the success rate requires participation and collaboration by key stakeholders throughout each acquisition, from identifying the problem/need to ensuring deliverables are met. The following three elements are essential for the aforementioned:
- Testing innovative procurement methodologies for IT service acquisition (and sharing the results in Use Cases for everyone to benefit),
- Developing newer, easier, and effective procurement models and processes, and
- Engaging all key stakeholders with effective Education/Outreach
Collaboration and participation by OPDIVs and STAFFDIVs is encouraged as it will exponentially improve outcomes, eliminate barriers, and lead to concentrated strategic sourcing across the agency.
HHS Ignite & Ventures
HHS Ignite and HHS Ventures support projects at different stages of maturity: Ignite is for the testing of new ideas; Ventures is for the scaling of proven ideas. Both efforts catalyze internal project ideas that can be completed within very compressed time frames. Teams selected into HHS Ignite are provided support over a 3 month period; Ventures teams are given 9. These projects are exploratory in nature. Selected teams are introduced to lean startup as a methodology for problem solving and project implementation. In the entrepreneurial spirit, Ignite and Ventures projects are iterative, their impacts measurable, and their solutions scalable.
By exposing teams to a network of innovators and equipping them with the methodologies and tools used by successful startup companies, HHS Ignite and HHS Ventures provide a space in which small HHS-led teams can try new ways of carrying out the HHS mission.
As these efforts are cyclical, the milestones are as well. Milestones include: solicitation of proposals; reviewing and selecting proposals; a ‘Boot Camp’ to kick-start the projects; a ‘shark tank’ at the end of the projects where results are presented; evaluation of the projects’ impacts.
Ignite supports small teams with ideas that come from all across HHS. While operating within Ignite, project teams are exposed to modern ways of operating which include those upheld by the President’s Open Government Directive. Teams are asked to report on a regular basis the progress of their efforts. Teams are encouraged to “get out of the building” and interact directly with potential end-users within Industry and the populace. Ignite and Ventures also employ “mentors” from the private sector to provide feedback and methodological coaching to the HHS-led teams.
Further, while these teams must be led by HHS-staff person, many teams include individuals from outside of government.
In the last 2 years, HHS, through its HHS Competes program, has seen a tremendous growth in the use of crowdsourcing tools to openly engage and partner with the public to identify and solve solutions to tough problems. Over 100 crowdsourcing prize competitions have now been run by or in partnership with HHS since 2011 under the America COMPETES Reauthorization Act, P.L. 110-69. Many of these competitions were designed to solicit direct input from the public on important issues such as smoking, maternal health, cancer survival, accessibility of health information, suicide prevention, high-risk drinking, patient empowerment, ulcer prevention, and heart disease. Some notable highlights on past and current/future are below:
- Office of the National Coordinator for Health IT – i2 (Investing in Innovation)
ONC concluded its trailblazing i2 challenge contract, through which it ran 27 individual competitions were administered, many of which were done in collaboration with other HHS agencies and even other federal agencies outside HHS. The initiative resulted in a number of advances in creating, through crowdsourcing with the public, a suite of software and mobile applications that impacted healthcare across many domains. ONC is currently following this up with another initiative to pilot health IT products in hospitals, communities, and direct to consumer settings.
- FDA launching Food Safety Challenge
The FDA will soon announce a prize competition that will challenge the public to identify and demonstrate the feasibility of next generation technologies for food-borne pathogen detection. This is a direct effort by FDA to employ collaborative and participatory tools to truly identify the most promising solutions from across the United States.
- My Air My Health Challenge
HHS’s collaborative effort with EPA led to a successful prize competition called My Air My Health to challenge the public to propose technologies to better collect personal health data linked with air quality data in an effort to better understand their relationship.
Additionally, HHS is currently expanding its offering of resources to agencies interested in participating in crowdsourcing activities. HHS is in the process of awarding a series of contracts, each in a specific category of prize competition (ideation, communications, scientific, hardware, and one for a simple DIY web platform) to crowdsourcing management and platform vendors. HHS has also begun creating a crowdsourcing learning series that will be publically available and offer lessons drawn from past experiences and current expertise. In the spirit of open government, HHS is also making data on its past crowdsourcing activities, including success metrics, open and publically available on its IDEA Lab website.
The Office of Family Assistance (OFA) HHS Entrepreneurs Project
The Office of Family Assistance (OFA) was one of six programs approved by former Secretary Sebelius to participate in the HHS Entrepreneurs Program. The HHS Entrepreneurs Program is a Departmental initiative established to create a culture that supports risk-taking and accelerates innovation. By participating in the HHS Entrepreneurs Program, OFA seeks to improve grantee program implementation to better meet the needs of the low-income populations it serves through the adoption of a low cost, replicable methodology to better assess grantee client problems and identify solutions.
OFA provides $235 million in discretionary grants annually to improve the lives of low-income families by promoting economic self-sufficiency, responsible fatherhood, healthy marriages, and family strengthening. Two issues arise with monitoring awarded grants:
- service delivery does not always align with the day-to-day realities and challenges faced by low-income individuals and families, interfering with their ability to access and benefit from the programs that grantees provide; and,
- grantees may not have the staff, time, or expertise to conduct analyses and/or develop solutions to address these barriers.
To address these issues, OFA seeks to learn the design- thinking discipline to equip its grantees and staff with replicable approaches, to assess, create, identify, and implement innovative solutions, to common challenges related to service delivery and program implementation. OFA’s interest in learning design thinking is not only to provide technical assistance to its grantees and to build capacity of its grantee organizations, but it also seeks to integrate the discipline of design thinking internally, so as to become a more design-minded organization. A simplified acquisition solicitation was posted in March 2014. For more information on the content of the contract related to this initiative, please view the solicitation in FedBizOpps (https://www.fbo.gov/index?s=opportunity&mode=form&id=607315225e4bd1b3c745de8db2fd0010&tab=core&_cview=1).
OFA is in the process of transforming its internal culture to one that is more design-centered and providing formal training in design thinking for both grantees and OFA staff.
Pill Image Identification Challenge
The 3D Informatics Program at NLM has created an open source database of over 5,000 pill images, complete with their associated identification metadata. As the only open source resource for prescription solid form pharmaceuticals, it offers an important research opportunity in automated pattern recognition. To speed the development of algorithms to dynamically recognize and identify unknown pills, NLM is planning a public challenge initiative for FY2015. The pattern recognition community will be invited to develop pill recognition algorithms that will be tested against a series of pill pictures taken on mobile phones. The submission that accurately identifies the most pictures will be the winner.
NIAAA’s New Twitter Program
Addressing the need for transparency, participation, and collaboration, NIH, National Institute on Alcohol Abuse and Alcoholism’s (NIAAA’s) Twitter account (@NIAAAnews) provides timely updates on alcohol-related news to thousands of individuals and organizations. In its first year, the NIAAA's Twitter feed attracted more than 8,000 followers, a level of popularity that illustrates the NIAAA's success in providing needed information in a "form that the public can readily find and use." The NIAAA's Twitter followers receive messages highlighting scientific advances, free publications, public exhibits, and other current events related to alcohol use disorders. Through Twitter, the NIAAA is able to engage the public and "tap into the expertise of individuals and organizations across the country" -- private stakeholders, nonprofit groups, academic research centers, health professionals, treatment providers, and government agencies. It is a transparent platform that gives the public the opportunity to learn and ask questions about publicly funded alcohol research. To date, the NIAAA has hosted two Twitter chats (one on holiday drinking and another on treatment options) that allowed a public conversation with NIAAA experts. Additional chats are planned.
PRISM Online Training
PRISM Online Training is an hour-long Web-based workshop that helps researchers and other health care professionals use clear, audience-centered language in consent forms and other print materials for patients and study subjects. The training is based on well-documented health literacy principles and includes: background information on health literacy and readability, a detailed overview of plain language writing and editing strategies, before-and-after examples, editing exercises, and links to other helpful resources. The training is in the public domain and has reached more than 1000 users to date, with more than one-third completing a course evaluation and providing consistently high ratings. NIH, CDC, and Health Literacy Missouri are among dozens of organizations nationwide that drive traffic to PRISM through links on popular resource pages.
National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) College Presidents Working Group and Interventions Matrix project:
Each year, almost 2,000 college students die from alcohol-related unintentional injuries, nearly 100,000 are victims of alcohol-related sexual assault or date rape, and approximately 700,000 are assaulted by another student who has been drinking. To help prevent these and other harmful outcomes, the NIAAA has sponsored a longstanding initiative to bring research to the forefront of the national discussion about college drinking. Currently, the NIAAA is spearheading a collaborative process known as the College Presidents Working Group. The purpose of this working group is to engage university presidents in an ongoing dialogue about the problem and to create a tool that will help administrators evaluate what they are currently using and choose wisely from among dozens of possible college drinking interventions going forward. This initiative embodies the open government call for participation and collaboration. Two development teams, each comprised of three highly respected college drinking researchers, created a comprehensive data base that characterized available interventions, according to a long list of attributes including the quality of the research supporting them. The data was then reviewed by 10 top researchers in the field, as well as, student life staff from the participating schools in the working group. The NIAAA is receiving additional input from 30 schools participating in Dartmouth College’s National College Health Improvement Plan, a multi-year learning collaborative to address the problem of excessive alcohol use and related harms on campuses across the nation. Collectively, these ongoing activities are informing the work of the NIAAA, as well as being disseminated throughout HHS, through the NIAAA’s participation in the Behavioral Health Coordinating Council.
An AHRQ Research Grant Program on Patient and Consumer Input for Implementing Evidence-Based Health Care
The purpose of this research grant program is to develop and demonstrate the use of deliberative methods in convening patients or the public to address complex issues related to the implementation of evidence into health care policies, programs, or other decisions that are designed to improve care, health outcomes, and research on improvements in a specific setting.
In an ideal clinical decision-making context, the patient plays an active role in deciding the best course of care based on his or her own values and preferences in relation to the available evidence. Equally important, patients and the public have a role beyond the immediate clinical decision-making context, providing important insights at all levels of the health care system to assist clinicians, researchers, administrators, and policymakers in developing, designing, and managing health system policies, health care delivery, and research programs to best meet public needs.
Increasingly, our society is gaining an appreciation of the differences in viewpoints and priorities that can occur among patients, clinicians, researchers, and policymakers around an objective but often incomplete body of evidence. As such, there is an expanding need to learn how best to bring the patient’s and public’s perspectives into research and policy decisions that affect health care. AHRQ completed a Deliberative Methods Demonstration project in 2013, with results identifying promising attributes of these methods for gaining insight into public views. This newly initiated AHRQ research grant program will fund innovative projects that promote the active contribution of patients and the public in learning how best to implement and integrate evidence-based health care information in specific, community-based decisions affecting the quality of care.
Research projects funded under this new grant initiative will:
- demonstrate the use of deliberative methods for obtaining information from patients, consumers, or the public that is directly relevant to health care or health care research decision-makers;
- feature a partnership with an organization that is committed to patient or public input and the use of that information to inform specific decisions to improve health care or research; and
- evaluate the effectiveness of the particular deliberative approach used.
The National Vaccine Program Office Annual Report: The State of the National Vaccine Plan
The NVPO released an inaugural annual report: The State of the National Vaccine Plan in early 2014. This comprehensive progress report details the individual and collective efforts of HHS offices and agencies, along with many other federal and non-federal partners, to achieve the vision of the 2010 National Vaccine Plan.
The report highlights the advances and accomplishments made by HHS and its agencies in collaboration with its partners, including the U.S. Agency for International Development, the VA, and the Department of Defense (DoD). Accomplishments in the report reflect the ongoing coordination efforts undertaken by NVPO in fulfillment of its mission, and detail the breadth and scope of the vaccine-related activities of HHS agencies.
Initially created in 1994 and updated in 2010, the National Vaccine Plan provides a roadmap for maximizing the impact that vaccines can have on the health of individuals and communities, and provides a guiding vision for vaccines and immunization in the United States. It includes strategies and objectives for advancing vaccine research and development, financing, supply, distribution, safety, global cooperation, and informed vaccine decision-making among consumers and health care providers. The Annual Report details the many accomplishments in service to the vision of the National Vaccine Plan, and discusses the impact that these activities and goals achieved throughout the year.
The report highlights the advances and accomplishments made by the HHS and its agencies, in collaboration with its partners, including the U.S. Agency for International Development, the VA, and the DoD. Accomplishments in the report reflect the ongoing coordination efforts undertaken by NVPO in fulfillment of its mission, and detail the breadth and scope of the vaccine-related activities of HHS agencies.
Some the highlights in the report include:
- Vaccine research and development: Development of new influenza vaccines through collaboration between vaccine manufacturers, NIH, FDA, and the Biomedical Advanced Research and Development Authority.
- Vaccine safety: CDC and the FDA made important contributions to the monitoring of rotavirus vaccine safety.
- Vaccine communications: Several HHS agencies came together, under the leadership of the National Vaccine Program Office, to develop Vaccines.gov, a one-stop federal resource on vaccines and immunization.
- Vaccine supply, delivery, access, and use: Many HHS agencies have contributed to advances in the use of electronic health data to improve the vaccine tracking, coverage, and monitoring.
- Global immunization: FDA, NIH, and CDC worked with other federal and non-federal partners to support the creation of MenAfriVac®, which over 100 million people in Africa have received
Appellant Climate Survey
OMHA Appellant Climate Survey is a survey of Medicare beneficiaries, providers, and suppliers who had a hearing before an ALJ at OMHA. The Appellant Climate Survey will be used to measure appellant satisfaction with their OMHA appeals experience, as opposed to their satisfaction with a specific ruling.
The survey is conducted annually by a third-party vendor using sampling methodologies to ensure a random selection of hearing participants. The contractor also conducts the survey and compiles and analyzes that data for OMHA. Results from the survey are used to make program improvements for case processing and identify training needs for OMHA staff, as well as generally gauge progress made in increasing satisfaction among appellants.
Request for Information for Workload Mitigation
OMHA will release a request for information in the Federal Register for the Medicare claims appellant community. The request will solicit ideas and suggestions related to mitigating the backlog in the processing of Medicare appeals at the OMHA-level of the administrative appeals process. It is expected the request for information will be published in the Federal Register in summer 2014.
The appellant forum operates to provide updates to OMHA appellants on the status of OMHA operations; relay information on a number of OMHA initiatives designed to mitigate a growing backlog in the processing of Medicare appeals at the OMHA-level of the administrative appeals process; and provide information on measures that appellants could take to make the administrative appeals process work more efficiently at the OMHA-level. To help achieve these goals, the Department of Health Human Services agencies that administer the Medicare claims administrative appeal process (i.e., OMHA, the Departmental Appeals Board, and CMS provide updates from their areas of responsibility. Moreover, members of OMHA headquarters staff and Administrative Law Judges present information on key areas related to the appeals process.
Modernizing National Vital Statistics System (NVSS) to Improve Timeliness of Mortality Data and Associated Analytic Tools for Surveillance
CDC/Office of Public Health Scientific Services (OPHSS)/National Center for Health Statistics (NCHS) Division of Vital Statistics and OPHSS/Public Health Informatics.
Public health surveillance guides efforts to detect and monitor diseases and conditions, assess the impact of interventions and assist in the management of and recovery from large-scale public health incidents. Today’s ever-present, media-hungry environment pressures public health scientists, researchers and frontline practitioners to provide health information, on an almost instantaneous basis, responsive to public and policy maker concerns about specific geographies and specific populations. Actions informed by surveillance take many forms, such as policy changes, new program interventions, public communications and investments in research. Local, state and federal public health professionals, government leaders, public health partners and the public are dependent on high quality, timely and actionable public health surveillance data.
CDC recently developed the Surveillance Strategy to improve overall surveillance capabilities, and by extension, the public health system at large. This Strategy proposes to make essential surveillance systems more adaptable to the rapidly changing technology, more versatile in meeting demands for expanding knowledge about evolving threats to health, more adept at accessing and leveraging healthcare data, and more able to meet the demands for timely and population-specific and geographically-specific surveillance data. It also seeks to consolidate systems, eliminating unnecessary reporting redundancies and burdens.
One of the systems targeted for improvement in the CDC Surveillance Strategy is the mortality component of the National Vital Statistics System. The ultimately goal is for the states and territories to be able to collect and transmit information on at least 80% of their deaths to National Center for Health Statistics within 10 days of the date of the event. This level of timeliness is critical for near real-time surveillance in detecting and defining pandemic and other calamitous events, for statistical analyses in showing shifts in causes of death by age, race/ethnicity and sex, and for more making policy and programmatic decisions at the state and federal levels. Achieving a next-generation electronic data collection tool for deaths will require an evolution in business and systems thinking about electronic reporting, one that minimizes the continuing cycle of expensive and inefficient systems with short “shelf lives”.
This project entails securing the services of a private-sector technology entrepreneur to help guide the conceptualization and development of an innovative plan for the cost-efficient collection of death information that leverages new and/or emerging technologies, and then, through federal/state partnerships or through federal/state/private sector partnerships, assist in the building of this tool that will facilitate the efficient capture of death information at the state and local levels and the intergovernmental transfer of that information between the states and the federal government within the desired timely standards. It also entails conceptualizing, developing, creating, and/or testing informatics tools for enhancing and analyzing mortality surveillance data that can be generalized to other surveillance systems or activities; and identifying pilots and projects that may help turn these tools into practice. Both set of activities will require the active involvement of federal, state and private sector partners in conceptualization, design, building and implementing of these tools.
Administration for Children and Families (ACF) Tribal Advisory Council (TAC)
The ACF Tribal Advisory Council (ACF-TAC) was established at the request of tribal leaders. The purpose of the ACF-TAC is to assist and provide advice to ACF offices in carrying out their missions in tribal communities. Specifically, the ACF-TAC will inform ACF leadership on tribal priorities relating to social service programs and provide an avenue for ongoing dialogue on substantive issues impacting children and families in tribal communities. The ACF-TAC is an enhancement to the tribal consultation process and does not take the place of consultation.
Using Design Thinking to Reimagine Technical Assistance to Health Profession Opportunity Grants (HPOG) Grantees
Authorized by the Affordable Care Act (ACA), P.L. 111-148, the Health Profession Opportunity Grants (HPOG) program prepares, trains, and supports TANF program recipients and other low-income individuals for stable, well-paying careers in health care. The demonstration projects are intended to address two pervasive problems: the increasing shortfall in the supply of qualified health care professionals in the face of expanding demand, and the increasing requirement for a postsecondary education to secure a job with a living wage for families.
The Office of Family Assistance (OFA), within ACF, administers HPOG. In September 2010 and each year since, OFA awarded approximately $67 million in grants to 32 postsecondary educational institutions, government agencies, Workforce Investment Boards (WIBs), community-based organizations, and tribal entities in 23 states. The 5-year grants may be used for training, education, and support services to prepare TANF recipients and other low-income individuals to enter and advance in the health care sector in occupations such as nursing, long-term care, allied health, health IT, and child care health advocate occupations.
The HPOG program is a demonstration project designed to build and share knowledge. An integral part of HPOG's success has been the program's technical assistance efforts with grantees. In the spring of 2013, OFA and JBS, the HPOG team’s technical assistance contractor at the time, partnered with Peer Insight to go through a design thinking process with a primary objective to:
- better understand the needs of HPOG grantees, and
- reimagine Technical Assistance (TA) to HPOG grantees.
Design thinking is a deeply empathetic process used to understand the customer or end-user of a product or service. In order to really understand how an individual thinks and feels the discipline of design thinking borrows tools from anthropology, sociology, design, and engineering that help to uncover individuals’ motivations, aspirations, and needs. Ultimately, it is a problem-solving technique that uses empathy to find the root cause of an issue, so that companies or organizations can create solutions that truly meet the needs of the people they are serving. One of the tools commonly used in design thinking is empathy interviewing. Empathy interviews are “an approach to finding out as much as possible about a person’s experience as a ‘user’ of a space, a process, an objective or an environment” (http://dstudio.ubc.ca/toolkit/temporary-techniques/new-6-toolkit-techniques-3-empathy-interview/). The HPOG Program Staff, together with members of our contracting teams, conducted a series of in-person empathy interviews with project directors, case managers, job developers, and instructors at a number of grantee locations over the course of a few months. Through the empathy interviews, we realized that we had neglected the instructors in the capacity building and knowledge sharing activities that we provided to grantees. With that realization, we continued to use the design thinking process to figure out what types of TA initiatives would be of value to instructors. We plan to continue working through the design methodology in order to deliver valuable TA interventions to our grantees and their partners.
We plan to continue to utilize Peer Insight’s design thinking methodology (http://www.peerinsight.com/approach/), which consists of the following steps:
- Frame the Opportunity
- Build Empathy
- Visualize Concepts
- Co-create the Solution
- Experiment in the Market to Validate
Interagency Career Pathways Workgroup/Request for Information
On April 23, 2014, the Departments of Education (ED), Labor (DOL), and HHS announced the release of a Request for Information (RFI) to support the development of high-quality career pathways systems. The RFI solicited information and recommendations from a broad array of stakeholders in the public and private sectors, as well as in state, regional, tribal, and local areas. This RFI marked the first time that the Departments were jointly collecting and analyzing information, a process that would yield important insights on: (1) benefits of and challenges to aligning diverse funding streams, programs, and stakeholders around career pathway systems; and (2) the current and potential future use of career pathways systems to help at-risk populations gain skills and access the middle class. At-risk populations include low-income youth and adults, low-skilled youth and adults, out-of-school youth, individuals with disabilities, TANF recipients, tribal communities, English learners, immigrants, rural populations, veterans, currently and formerly incarcerated individuals, dislocated workers, trade-affected workers, and many others.
The joint analysis will generate essential information that will inform policy development and the next generation of investments and technical assistance by providing greater clarity on the catalysts and obstacles to career pathways systems development.
Enhancements to the Audit Resolution Tracking and Monitoring System (ARTMS)
The Audit Resolution Tracking and Monitoring System (ARTMS) was built to respond to the Department’s challenge to provide consistency and uniformity in audit resolution and debt management processes. ARTMS allows ACF to generate more reliable data of each fiscal year’s financial activities in an effort to reconcile with OIG and the Program Support Center (PSC). ARTMS facilitates and simplifies the audit resolution process (OMB Circular A‐133) that involves resolution and audit follow‐up (OMB A‐50) on audit findings. Automating this process has and continues to increase productivity, reduce costs, and improve customer service.
ARTMS was designed to limit the number of ACF’s overdue audits by implementing responsibility and accountability for resolving each audit. The audit resolution process is 180 days before the audit becomes overdue by the OIG. Using ARTMS reduces the number of audits that shows up on ACF steward report for OIG.
Single Audit Metrics Initiative
The Single Audit Metrics Initiative focuses on the use of Single Audit metrics to reduce ACF program risk. In July 2011, HHS introduced the Single Audit Metrics Initiative to the Program Integrity Coordinating Council to use the results derived from Single Audit metrics to reduce HHS program risk. This initiative was prompted by the Executive Order 13520, Reducing Improper Payments and Eliminating Waste in Federal Programs, which required federal agencies to conduct analysis of their programs, determine the extent of improper payments, and report on actions taken to reduce or identify and recover improper payments.
In November 2011, ACF volunteered to participate in the Single Audit Metrics Initiative. The TANF program was selected to pilot the Initiative, due to significant program dollars at risk and the high number of unclean audit opinions.
ACF identified TANF grantees that received an unclean audit opinion and reviewed these grantees’ Single Audits to identify those findings that caused the unclean audit opinion. To address these audit findings, ACF incorporated cooperative audit resolution principles, like those contained in the Association of Government Accountants (AGA) Guide to Improving Program Performance through Cooperative Audit Resolution and Oversight Initiative (CAROI). Analysis of TANF’s material non-compliant audit findings focused on the following:
- What is the issue that caused the finding (e.g., condition, criteria, cause, and impact)?
- Is the issue valid?
- Were other HHS programs or federal agencies affected by the audit finding?
- Are there impediments to correcting the issue?
- What actions are needed to successfully correct this issue?
Through implementing the Single Audit Metrics Initiative in the TANF program, the HHS/ACF Team identified the following best practices:
- Work collaboratively.
- The HHS/ACF Team consisted of HHS staff, ACF financial and program staff from the Central Office and Regions, OIG staff, and staff from other OPDIVs (when applicable).
- The HHS/ACF Team built upon existing relationships with the grantee and auditor to discuss the audit findings and learn the issues from the grantee and auditor’s perspectives.
- Conduct meetings with the states and auditors to learn the issues surrounding the audit findings, obtain updates on likelihood of repeat audit findings, and assess risks.
- Actively follow up with states on corrective actions taken, with the goal of obtaining a clean audit opinion.
- Assess changes needed to applicable Compliance Supplements.
The Initiative: (1) broadens the process from ‘closing the audit finding’ for audit resolution purposes to using cooperative audit resolution techniques to truly understand the underlying conditions and then working with the grantee to obtain corrective action and achieve a clean audit opinion; (2) strengthens the tone with grantees and their auditors on the agency’s stance on conditions identified by audits that are likely to cause improper payments, fraud, waste, or abuse, and must be corrected; (3) promotes the proper implementation of the TANF program to ensure taxpayer dollars are used for their intended purpose.
As a result of this initiative, the following improvements were identified ACF-wide and Federal Government-wide:
- The interagency Council on Financial Assistance Reform Strong Program Oversight initiative includes Single Audit metrics modeled after the HHS approach.
- The American Institute for Certified Public Accountants (AICPA) modified standard report language to more clearly identify audit findings causing material non-compliance.
- ACF clarified compliance requirements to auditors and states during discussions held as part of gaining an understanding of the issue and the cooperative audit resolution process.
- ACF revised program compliance supplements for clarity (e.g., TANF and Foster Care).
- The 2013 update to the Federal Audit Clearinghouse Data Collection Form added collection of data in electronic format to allow the Single Audit metrics to be expanded to identify material weaknesses in internal control, significant deficiencies in internal control, and other risk indicators by audit finding and by federal program.
Through the Single Audit Metrics Initiative, ACF is encouraging grantees to implement necessary changes to achieve clean audit opinions.
Child Support Intergovernmental Reference Guide
The Intergovernmental Reference Guide (IRG) offers access to resource information for the child support community as well as the public. It provides child support agency contact information and child support policies and profiles. The IRG also contains Federal Information Processing codes for states, Bureau of Indian Affairs codes for tribes, and International Standards Organization codes for international countries used as identifiers in child support activities. The site provides policy profiles and contact information for state agencies and U.S. territories with federally funded child support programs: Guam, Puerto Rico, or the Virgin Islands. Within each state or territory, the user can drill down to the Profile tab, which contains the policy on topics such as age of majority, paternity, income withholding, and order establishment, enforcement, modification, and review; or the Contact tab, which contains phone numbers for the child support office and related programs. This same information is available for tribal agencies and countries that have agreements with the U.S. to exchange child support information.
The federal Office of Child Support Enforcement (OCSE) communicates with parents through the Families page on the OCSE website. The Families page provides contact information, features timely government-wide initiatives and campaigns, and gives parents access to the Commissioner’s Voice - a blog.
The state contact map provides accurate contact information (website, mailing address, and phone numbers) for all 50 child support state agencies and over 50 tribal child support programs. This allows parents direct access to their state and tribal child support program to discuss case-specific information or to facilitate access to child support services. The OCSE Families page also promotes government-wide initiatives that support families such as the Internal Revenue Service, Earned Income Tax Credit Campaign, and HHS’ Insure Kids Now, Medicaid and CHIP enrollment efforts. Families are also able to provide feedback about our program and engage with the Child Support Commissioner through the Commissioner’s Voice. A link to the blog is accessible on every page on our site.
The Families page also promotes plain language and features user-friendly manuals and instructions to help parents navigate the child support program. Some examples include:
- the infographic (http://www.acf.hhs.gov/programs/css/resource/how-do-i-apply-for-child-support-services) that outlines how to apply for child support services in three steps,
- the storybook illustration (http://www.acf.hhs.gov/programs/css/resource/lets-work-together) that explains how the child support program works with families to connect them to other services like health care and employment programs, and
- the child support handbook (http://www.acf.hhs.gov/programs/css/resource/handbook-on-child-support-enforcement) that provides detailed information about the program.
Food and Drug Administration (FDA) Transparency Dashboard
The objective of the FDA Transparency Dashboard initiative is to provide access to FDA data pertaining to inspections, compliance and recalls through data visualizations and an enhanced user experience. The Dashboard is supported by a commercially available dashboard tool, which allows for staging in a cloud environment and allows analysts with knowledge of FDA’s business processes to combine and present data (internally and externally) without being fluent in programming languages. The use of the Dashboard allows diverse sets of business and program people to work in concert to design their own dashboards, analyze them, and explore the value of FDA’s data for varied purposes and audiences. Such a tool helps leaders and managers make inroads to improve the Agency’s data quality. Additionally, it improves the Agency’s ability to easily access relational and comprehensive data on specific firms and products, as well as enhance the quality, efficiency and accuracy of data information being communicated to our external stakeholders including the public.
DS Connect™: The Down Syndrome Registry
It is estimated that there are about 250,000 people living with Down syndrome in the United States according to the Centers for Disease Control and Prevention. NIH has partnered with public and private organizations to create a centralized, secure national resource for storing and sharing health information about Down syndrome. The NIH-supported Down Syndrome Registry, DS Connect™ (https://dsconnect.nih.gov/), allows people with Down syndrome and their family members, researchers, and parent and support groups to share information and health history in a safe, confidential, online database. Users can create and edit their customizable online profiles, share their profiles with Down syndrome investigators and biorepositories, and view information about medical research and Down syndrome-related events. DS Connect™ also provides access to general information about Down syndrome as well as aggregate de-identified data based on user responses to survey questions. Those with Down syndrome and their families create their password-protected profiles after providing online informed consent to participate in the registry. If registered users give permission to be contacted about a research study, then the registry coordinator may invite those users who are eligible to contact the clinician or researcher directly to sign up for the study or trial. The Registry complies with all regulations and laws governing privacy, personally identifiable information, and health data, and has been created on a Federal Information Security Management Act moderate platform to ensure that the health and demographic information is protected.
Audacious Goals Initiative
The National Eye (NEI) Institute launched its Audacious Goals Initiative (AGI; www.nei.nih.gov/Audacious) in August 2012 with a prize competition that challenged members of the vision research community and general public to outline concepts for goals that would transform vision research or blindness rehabilitation yet would be achievable in a 10-15 year time frame. Ten winners presented their ideas in an open Audacious Goals meeting in February 2013, which brought together 200 scientific experts, clinicians, patients, and advocates for vision research to further develop the ideas. The ultimate selection to “Regenerate Neurons and Neural Connections in the Eye and Visual System” will focus on two target neurons, photoreceptors and retinal ganglion cells, which degenerate in major blinding diseases. AGI represents a bold departure from previous NEI planning efforts, and public participation and collaboration are not only consistent with the open government plan, but have pushed NEI to consider new perspectives while also energizing the research community.
Big Data in Genomics
NLM has been a focal point for "Big Data" in biomedicine for decades, a recognized leader in organizing and providing rapid access to massive amounts of genetic sequence data generated from evolving high-throughput sequencing technologies. NLM serves more than 30 terabytes of biomedical data to more than 3 million users every day, drawing on massive data archives. GenBank at the NLM’s National Center for Biotechnology Information (NCBI), in collaboration with partners in the United Kingdom and Japan, is the world’s largest annotated collection of publicly available DNA sequences, with 340 million sequences from 300,000 different species. Continuing development of large-scale data integration techniques with advanced information systems is key to expanding support for the accelerated pace of research made possible by new technologies such as next-generation DNA sequencing, microarrays, and small molecule screening. Some of the largest datasets, such as those from the NIH’s 1000 Genomes Project, are also available in the cloud. This allows faster access and analysis by researchers who may be otherwise hampered by insufficient bandwidth or computing power.
Health Information Exchange for Electronic Health Records
NLM continues to make advances that will facilitate health information exchange and meaningful use of electronic health records. Researchers have developed advanced and heavily used APIs for medication data and nomenclature, produced novel algorithms for validating vocabulary components of electronic quality measure specifications and analyzed frequency data from multiple health care organizations to produce manageable subsets of large standard clinical vocabularies. They have also developed effective techniques for mapping clinical vocabularies to administrative code sets and have established partnerships to test the use and impact of personal health records.
National Institutes of Health (NIH) RNAi Screening Facility
NCATS oversees a state-of-the-art RNAi screening facility that accepts proposals from any NIH researcher. NCATS staff assists investigators with all stages of project planning and execution, beginning with assay development through genome-wide siRNA screens, informatics/pathway analysis and rigorous follow-up. Genome-wide siRNA screens for humans and mice are available.
Large-scale information on the biochemical makeup of small interfering RNA (siRNA) molecules is available publicly for the first time. These molecules are used in research to help scientists better understand how genes function in disease. Making these data accessible to researchers worldwide increases the potential of finding new treatments for patients.
As more gene-specific data arises through various approved and funded projects, more data will become available to the community. NCATS currently is working on a data release policy for RNAi data, once past a moratorium period, to be uploaded to a public database and made available to the scientific community.
Center for Scientific Review Contests to Gather Public Input on Ways to Maximize Fairness and Impartiality in National Institutes of Health (NIH) NIH Grant Funding
To identify and implement new approaches for NIH to better understand and address racial disparities in NIH R01 grant funding, the NIH Center for Scientific Review (CSR) invited the scientific community and the public to enter two America COMPETES Act Challenges (http://public.csr.nih.gov/Pages/Challenge.aspx) that will award cash prizes for contestants who submit the best ideas for identifying (1) new Methods to Detect Bias in Peer Review (http://public.csr.nih.gov/Pages/Challenge1.aspx) and (2) Strategies to Strengthen Fairness and Impartiality in Peer Review (http://public.csr.nih.gov/Pages/Challenge2.aspx).
International Alzheimer’s Disease Research Portfolio
A new database created to capture the full spectrum of current Alzheimer’s disease research investments and resources—both in the U.S. and internationally—is now publicly available. The International Alzheimer’s Disease Research Portfolio (IADRP), developed by NIA, in collaboration with the Alzheimer’s Association, enables public and private funders of Alzheimer’s research to coordinate research planning, to leverage resources, to avoid duplication of funding efforts, and to identify new opportunities in promising areas of growth. The newly developed resource, currently hosted and maintained by NIA, helps to track and implement research goals of the National Plan to Address Alzheimer’s Disease, announced by the U.S. Department of Health and Human Services Secretary Kathleen Sebelius in May 2012.
National Institutes of Health’s National Institute of Nursing Research Innovative Question Initiative
In developing a research agenda for nursing science, NIH National Institute of Nursing Research (NINR) is guided by its Strategic Plan, Bringing Science to Life.
Under this Plan, NINR continues to support science to promote and improve the health of individuals, families, and communities. Over its nearly 30 year history, NINR has supported critical advances in nursing science in areas such as symptom science, wellness, self-management, and palliative and end-of-life research, broadening the understanding of health and illness across the lifespan.
In FY 2014, NINR launched the Innovative Questions (IQ) Initiative, to implement its Strategic Plan. Inspired by similar, successful efforts at the NIH and other grant-making organizations; the IQ Initiative is intended to engage the scientific community and the public in shaping the future of nursing science. Through the IQ Initiative, NINR is engaging in a dialogue with its stakeholders to encourage creative thinking, identify novel and unanswered scientific questions, promote results-oriented innovative research, and guide NINR-supported science over the next five to ten years.
The IQ Initiative consists of two components: a series of scientific workshops and a public website. The workshops, each one hosted by NINR and focused on a particular science area, bring together leading scientists to identify, to discuss, and to debate research questions that will point the way forward for nursing science over the next 5-10 years. The public website solicits innovative research questions directly from the scientific community, professional organizations, and members of the general public. Visitors to the website have an opportunity to review and comment on questions submitted by others, and to submit questions of their own. The feedback and questions generated from the workshops and the website will be reviewed by NINR and potentially developed into new research opportunities. The research generated through the IQ Initiative offers the promise of advancing the health of the nation through nursing science. For more information, visit www.ninr.nih.gov/IQ.
Over the past decade, global concern about the disproportionate burden of disease and mortality in low-income countries, especially in sub-Saharan Africa, has led to a substantial influx of funding for research by many donor and research agencies. Questions have been raised about whether these international efforts could be better coordinated to increase efficiency and improve outcomes while ensuring that research institutions and universities are supported with these funds. The heads of the major research-funding and research organizations recognized the need to develop a public means to track these international research activities and partnered investments and to share their results with the broader research and funding community.
As a first step, the NIH Office of Extramural Research and Fogarty International Center created World RePORT (the World Research Portfolio Online Reporting Tool), a freely available online resource at http://WorldRePORT.NIH.gov that provides access to nine major research funding organizations' portfolio of research activities in sub-Saharan Africa. In addition to NIH-funded research, the site includes research funded by the Canadian Institutes of Health Research, European Commission Directorate General for Research, European and Developing Countries Clinical Trials Partnership, INSERM, Max Planck Society, UK Medical Research Council, Pasteur Institute, Swedish International Development Cooperation Agency, and Wellcome Trust. Each funding organization's projects are plotted geographically and can be searched with keywords in project titles and abstracts, and filtered by year, country, and funding organization. Project details include project title, abstract, principal investigators and their organization, city and country, and hyperlinks that lead to related websites for more information. A data-export feature allows the user to build individual datasets for further analyses and customized reporting.
In 2014, World RePORT is being expanded beyond sub-Saharan Africa to include research in the South Asia and East Asia/Pacific regions. The number of research funding organizations participating in World RePORT is also expected to increase.