21st Century Integrated Digital Experience Act - 2021-2022 Report to OMB and the Public on Modernizing Agency Websites

Background

Section 3(d) of the 21st Century Integrated Digital Experience Act (21st Century IDEA)¹ requires the head of each federal executive branch agency to report annually (through 2023) to the Director of the Office of Management and Budget and the public on the agency’s progress to implement the requirements of the Act and modernize their websites and digital services.  The information below details the efforts of the U.S. Department of Health and Human Services (HHS) to modernize the agency’s websites and digital services in 2021 and 2022.

HHS Efforts to Date

Building on our work, HHS focused 2021-2022 on examining our impact, continuing to modernize to serve the public, and assessing agency and office budgets to support communications staff in improving the digital experience for customers.  To continue to support the American public during the COVID-19 pandemic and other health crises, such as the infant formula shortage and the mpox outbreak, HHS agencies and offices were called upon to be even more responsive and engaged.  As demonstrated in this report, we continued to deliver instant and impactful digital communications for the American public.

1. Response to the COVID-19 Pandemic and Other Health Crises

Response to the COVID-19 Pandemic

COVID-19 monumentally changed not only how HHS works, but also the Department’s relationship with the public.  Americans looked to HHS for real-time updates and guidance in a time of uncertainty and fear, and HHS delivered.  During the pandemic, HHS websites represented between 25 and 40 percent of all government traffic.

For 2021, the Centers for Disease Control and Prevention (CDC) website, CDC.gov, traffic accounted for nearly 14 percent of all Federal website traffic.  CDC.gov year to date views totaled 2.7 billion­ – the 2nd highest year on record.  Mobile traffic accounted for nearly 68 percent of CDC page views.  52 percent of CDC.gov traffic was on the CDC COVID-19 website.  Vaccines.gov had 56 million visits since its launch in May 2021, to the end of 2021, with CDC.gov driving 7 percent of traffic to the site.  63 percent of Vaccines.gov visitors selected “Find Vaccine” when coming from CDC.gov and only 26 percent from all other traffic sources went to “Find Vaccine,” illustrating the driving force that CDC.gov was during the COVID-19 response.

By optimizing CDC.gov’s infrastructure and content delivery network for massive spikes in traffic and employing digital first and user-centered design principles to the website, CDC was able to get critical, life-saving information out to the public in a time of national emergency.  HHS’s Office of the Assistant Secretary for Public Affairs (ASPA) managed over 543 COVID-19-related updates to HHS.gov, created a COVID-19 website hub for HHS and leveraged HHS social media channels to share more than 1,070 real-time social media updates with the public.  ASPA integrated user feedback to continually update and improve COVID-19 communications on the web and on social media, co-led federal-wide COVID-19 web coordination, and coordinated digital communications teams across HHS related to COVID-19 messaging, to meet the public’s needs.

In March 2022, in conjunction with the White House, HHS launched COVID.gov², a one-stop shop for individuals to access vaccines, tests, treatments, high-quality masks, and the latest updates on COVID-19 in their area.  Since its launch in July 2022, COVID.gov has reached 59 million page views, with mobile traffic accounting for 72 percent of page views.

COVID.gov/tests made up the vast majority of traffic to COVID.gov, accounting for 85 percent of page views.  Focusing on the public’s need to understand and access testing, COVID.gov features a Test-to-Treat locator to help individuals access over 2,000 locations that offer COVID-19 tests and antiviral pills.

In 2022, ASPA continued its efforts and managed over 350 coronavirus-related updates to HHS.gov, created an HHS COVID-19 website hub, and leveraged HHS social media channels to share more than 890 real-time social media updates with the public.  ASPA utilized user feedback to continually update and improve COVID-19 communications on the web and on social media, co-led federal-wide COVID-19 web coordination, and coordinated digital communications teams across HHS related to COVID-19 messaging, to meet the public’s needs.

Response to the Infant Formula Shortage

In 2022, Americans faced another health crisis: a shortage of infant formula due to supply chain issues from the COVID-19 pandemic and one of the largest baby formula suppliers recalling several major brands.  In response, HHS launched HHS.gov/formula with input from physicians and other experts within HHS, the American Academy of Pediatrics, and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition to help the public safely find formula substitutes and access resources for breast milk or breastfeeding.  HHS.gov/formula also streamlined information from the Special Supplemental Nutrition Program for Women, Infants, and Children to help Americans locate community resources and learn about updates and government guidance as the shortage unfolded.  At the end of 2022, over 500,000 visitors spent an average of over 3 minutes on the website.  Visitors of HHS.gov/formula clicked on over 72,000 outbound links, downloaded over 12,000 PDF resources, shared over 1,400 emails, and made over 1,100 phone calls through the site using their mobile phones.

Response to the mpox Outbreak

The responsiveness and engagement of HHS became crucial in the wake of an outbreak of mpox that spread across the United States starting in 2022.  The Department released effective health communication to reduce the stigma and engage communities to help the public make well-informed decisions to protect their health.  CDC launched cdc.gov/poxvirus/mpox/ to inform the public about the mpox virus symptoms and how to prevent the spread.  At the end of 2022, over 70 million visitors viewed the site, with mobile traffic accounting for 72 percent of page views.  Additionally, CDC identified and used specific channels to directly reach populations at an increased risk for mpox - across racial, ethnic, socioeconomic, and geographic backgrounds - by providing community toolkits, print resources, videos, and guidance on using stigma-reducing communication strategies.³

In tandem with CDC, HHS launched HHS.gov/mpox to provide the public with an index of information including resources from the CDC, Administration for Strategic Preparedness and Response, and Food and Drug Administration to efficiently find information from across the Department.  At the end of 2022, over 3,000 visitors - 52 percent on mobile and 48 percent on a desktop - have accessed resources on HHS.gov/mpox.

2. Website Modernization and Measurement Efforts

Digital Communications Strategy Implementation

HHS continued to meet the IDEA goals of website modernization and measurement through the implementation of the HHS Digital Communications Strategy.  Agencies and offices particularly focused on three content areas of the HHS Digital Communications Strategy: understanding audience needs and customer experiences and tailoring messages accordingly; developing content with the mindset that it will be delivered digitally through multiple channels and devices, including mobile; and simple and intuitive content using video images, clear language and user design to enhance understanding of information.

In 2021, HHS established a maturity scale model to measure and assess progress of agencies and offices and saw continued progress and evolution in all offices towards content modernization and empowerment of digital communicators to meet the goals of IDEA.  Continued challenges remain, especially in smaller agencies and offices, with getting budgets and resources to comply with IDEA and to mature across organizations.  HHS will continue to evolve the maturity scale and discuss progress based on the scale, as the importance of the scale lies in the discussions that it evokes among the leaders and decision makers in moving digital communications forward.

HHS measured the progress and evolution of agencies and offices toward content modernization and empowerment of digital communicators to meet the goals of IDEA through the maturity scale model established in 2021.  In 2022, HHS digital communications leaders continued to track progress based on the scale and discussed the findings.  The scale encourages discussion among leaders and decision-makers in moving digital communications forward by identifying best practices and challenges.  HHS agencies and offices shared best practices and tools to check quality assurance, accessibility, and review performance, and discussed the continued need to incorporate user data into communication efforts.  While challenges remain, especially in smaller agencies and offices due to budget and resource constraints, HHS continued to make great strides in its digital communication efforts in 2022.

Website Modernization

HHS also continued to take several important steps toward website modernization for its existing websites.

First, many key HHS websites continued to adopt U.S. Web Design System design principles, creating more impactful and focused websites to meet the American public’s needs.  HHS also continued efforts to publish content aligned with the Plain Writing Act of 2010.  In October 2021, the Center for Plain Language graded HHS as an “A+” for organizational compliance, and a “B-” for writing quality in its Federal Plain Language Report Card.  HHS took steps to consolidate websites, including moving vaccine content into HHS.gov and turning vaccines.gov into a COVID-19 vaccine finder website.  This change was based on analytical data showing that users were looking at the vaccines website mostly to find a COVID-19 vaccine.  At the National Institutes of Health, where the bulk of HHS websites are maintained, a large review and consolidation effort based on user analytic data is underway.

HHS conducted its second and third extensive combination budget and IDEA compliance data call to transparently quantify current costs for meeting the user needs and the tenets of IDEA.  In 2021, the total estimated cost to meet tenets outlined in IDEA stands at $36 million, while in 2022, it increased to $59 million.  HHS is using this information to impact and guide future budget requests to comply with IDEA and meet strategic goals.  HHS embarked on extensive outreach to track all of its unique and active websites in 2020, 2021, and 2022, inserting the Digital Analytics Program code onto Department websites, with a plan of using this information to automatically assess future compliance with IDEA.

In 2021 and 2022’s data calls showed that HHS has more than 3,000 unique and active websites, with several key websites actively using customer feedback to regularly assess and improve content and functionality.  These websites and other digital communications platforms were maintained by about 824 full time employees (FTEs) in 2021 and approximately 1,288 FTEs in 2022.  In 2021, HHS received 193 submissions for the Compliance Data Call and 148 submissions for the Budget Data Call.  In 2022, there were 232 submissions for the Compliance Data Call and 205 submissions for the Budget Data Call, both of which allowed agencies and offices to group multiple URLs into one response.  These submissions included a record number of URLs, with 1,394 included in the Compliance Data Calls (an 88 percent increase from 2021) and 834 included in the Budget Data Calls (a 75 percent increase from 2021).  See the Appendix for detail on both 2021 and 2022 responses to the Compliance Data Call.

HHS’s Digital Communications Governance Council is using this information to roadmap and assess continued strategic modernization funding, staffing, resourcing, training, impact assessments, and prioritization.  Not including FTE salary costs (about $79 million in 2021 and approximately $121 million in 2022), annual digital communications efforts cost HHS about $465 million in 2021 and approximately $591 million in 2022 to maintain.  These costs include operations and maintenance of websites, social media, email newsletters, phone apps, chatbots, etc.

3. Agency Success Stories

Throughout these Department-wide efforts, HHS agencies and offices continued to make progress on implementing the Digital Communications Strategy and modernizing to meet IDEA. Efforts from CDC, the Centers for Medicare & Medicaid Services in 2021, and the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2022, showcase recent modernization successes and impacts:

CDC’s Rebranding of New Vaccine Website

CDC’s Vaccines.gov serves two important purposes in the COVID-19 pandemic response:

1. HHS/CDC extracts data feeds from VaccineFinder.org to see vaccine inventory levels by each provider enrolled in the COVID-19 Vaccination Program; and
2. The public facing website shows authorized COVID-19 vaccine providers and their vaccine availability, to guide consumers to confirm eligibility and schedule a vaccine appointment.

CDC, in partnership with HHS and the US Digital Service, was able to successfully transition the public-facing site from VaccineFinder.org to Vaccines.gov and launched on May 1, 2021, as a unified federal resource to help connect Americans with vaccination locations near them.  This required moving existing vaccine content from vaccines.gov to a new location in HHS.gov, building out a new interface in conjunction with the national We Can Do This campaign and completing all the necessary security and infrastructure requirements for a national launch tied to a presidential address.

Since the initial launch in May, the website has had 61.5 million users.  At the end of 2021, the site showed over 52,000 locations that had COVID-19 vaccines in stock.

CMS’s Website Consolidation Efforts

In 2021, as part of the eMedicare initiative, CMS consolidated two separate Medicare websites into a single consumer website.  Medicare.gov was a public-facing open website with information about the Medicare program and a variety of plan and provider tools.  MyMedicare.gov served as a secure portal for Medicare beneficiaries to access their personal information about claims, communication preferences, online premium payments, and other features.

All functionality from MyMedicare.gov was migrated to Medicare.gov, creating a single website for all Medicare beneficiary needs and information, expanding support for users.

Following this consolidation, the agency has seen an increase in customer satisfaction from Medicare.gov visitors and an uptick in usage of some of the authenticated functions, especially online premium payments.

SAMHSA’s Transition to the 988 Suicide & Crisis Lifeline

On July 16, 2022, SAMHSA led the U.S. transition to the 988 Suicide & Crisis Lifeline as the new, easy-to-remember way to reach the former National Suicide Prevention Lifeline.

SAMHSA.gov created a 988 digital hub with resources and information designed to help states, territories, tribes, mental health, and substance use disorder professionals make the transition to the new number.  This digital-first approach included the 988 Partner Toolkit, with key messages, frequently asked questions, fact sheets, social media sharables, logo, and branding guidelines to facilitate collaborative and aligned 988 communication planning.  The 988 Volunteer and Job Opportunities webpage was created to help over 200 centers in the 988 network bring on new volunteers and paid employees.

SAMHSA.gov’s 988 digital hub allowed partners and stakeholders to get information on understanding the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services.  The transition to the 988 Lifeline was an important step towards strengthening and transforming crisis care.

SAMHSA’s 988 Suicide & Crisis Lifeline meets the user-centered, authoritative, customizable requirements within IDEA.

Appendix

Figure 1: IDEA Data Call Findings

*Based on 845 URLs in 2020 and 741 URLs in 2021 included in the Compliance Data Call responses.
~Based on 1,394 URLs in 2022 included in the Compliance Data Call responses.

Endnotes:

¹  Public Law 115-336, 132 Stat. 5025-5028.

²  “Fact Sheet: Biden Administration Launches COVID.gov.” whitehouse.gov, 30 Mar. 2022, www.whitehouse.gov/briefing-room/statements-releases/2022/03/30/fact-sheet-biden-administration-launches-covid-gov-a-new-one-stop-shop-website-for-vaccines-tests-treatments-masks-and-the-latest-covid-19-information/#:~:text=In%20January%20of%20th.

³  “Reducing Stigma in mpox Communication and Community Engagement.” cdc.gov, 18 Oct. 2022, https://stacks.cdc.gov/view/cdc/122627.