SAMHSA’s Donald Cox on IT in Health Agencies

SAMHSA frames IT as business technology

Donald Cox, chief information officer for the Substance Abuse and Mental Health Services Administration, took the position just earlier this year. Generally, his job description includes supporting internal offices with technology needs and sitting on the Health and Human Services Department's CIO Council to address departmentwide IT projects and how to approach them.

However, Cox prefers to refer to information technology as business technology “because it’s really the technology that enables the business,” he told GovernmentCIO Magazine. “So I find myself sitting with these centers and offices and saying, ‘what do you need to do your mission, and how do we go forward and get it implemented.’”

Cox is referring to the internal offices within SAMHSA and his role to support those offices with the technology infrastructure needed to facilitate tasks like updates to the websites, mobile applications and analytic-type applications. Ultimately, these tasks allow the offices to better target and deliver their resources to the right people but are met with challenges specific to both the health IT world and government IT as a whole.

Identifying IT Pain Points

“There’s always the challenge of contracts,” Cox said. “That’s the conversation that we are constantly having in the government.” In terms of acquisition reform, CIOs are looking for more efficient ways to get technology faster and cheaper while still maintaining product quality.

Cox also stressed the fair, yet lengthy, process of hiring federal employees. It is difficult for the government to acquire confident, talented and interested parties when competing with the salaries major companies in the private sector are able to provide.

Additionally, Cox said government employees in lower positions often move from agency to agency looking for promotions. To reduce this turn-around rate, he suggested the government create more advancement opportunities within agencies that attract employees to stay longer.

Hiring contracting officers specifically with IT knowledge is crucial, too. For example, though the administration went to cloud before Cox’s time, SAMHSA’s implementation of Amazon Web Services was likely challenged with not having the right government skillset trained and knowledgeable in understanding what AWS is and how to set it up.

”So how do you hire the right contractors that have that,” Cox said. “That would have been an obstacle they had to overcome and they’ve picked some really good partners that we’ve been working with to help out.”

The wealth of technology and the constantly evolving options available to the government pose additional challenges. CIOs must decide how to pick the right, scalable tool for the right job amid dozens of software and applications built for the same tasks.

SAMHSA is also focusing on data (or the “new gold,” according to Cox) initiatives that have met more project-specific roadblocks.

The administration is constantly doing business intelligence projects to turn that collected data into actionable information, or “finding the signal in the noise,” Cox called it. SAMHSA is creating databases with schemas and data dictionaries in order to make finding and sorting the data easier in legacy systems. However, sometimes that means reverse engineering to understand those legacy systems, and once the data is there, making sure it’s normalized, standardized and usable in other systems.  

All the while, health IT must adhere to the Health Insurance Portability and Accountability Act laws for protecting data. This is especially important as health agencies explore ways to share medical data internally and with providers and the health care industry, according to Cox. However, the CIO finds HIPAA to be an opportunity.

“How can I buy, purchase, develop the best technology that protects that data, still within a budget, and then how do I seek funding,” he said.

Yet, these IT pain points, as described, often rise when agencies are dedicated to stirring innovation and positive change. According to Cox, this trickles down from the departmental level as well, as he supports internal projects and HHS’ greater IT missions.

Putting Practice to Use  

In HHS’ recently released IT Strategic Plan for fiscal years 2017-2020, the department’s CIO Beth Anne Killoran identified five strategic goals and initiatives to drive the department forward in IT. Those include focusing on the IT workforce, cybersecurity and privacy, shared services, interoperability and usability, and IT management.

Cox described this initiative as a “welcome change.” In the past, IT offices were accustomed to being told what was needed and building a system that, in the end, did not always fit. Now, with a proper roadmap and infrastructure, Cox and his team are able to gather requirements, use agile development techniques and even dabble with DevOps.

“We’re trying to help HHS utilize all of the data resources that it has,” Cox said, in order to create systems that allow the operating divisions to use their data to drive and meet HHS’ mission.

Internally, one of SAMHSA’s current projects is on a Behavioral Health Analytic, Scientific and Clinical Information Component system. According to Cox, SAMHSA is looking to partner with an entity that has natural language processing capabilities for BASCIC, which would be a web service that allows people to search by symptoms and receive contextual behavioral health information (like treatment facilities, psychiatric help counseling and information about medicine).

SAMHSA has already received responses back from a Request for Information, developed a statement of objectives for BASCIC and will soon release a Request for Proposal. According to Cox, this project is met with its challenges, too, starting with a steering committee that the chosen contracting company will help stand up.

“I’m sure there will either be nobody that wants to participate, or there will be a hundred people that want to participate, and how do you whittle it down to those people that will help drive that forward?” Cox said.

The administration must also address privacy. For example, making sure the information searched by an individual isn’t later used by a big corporation for targeted advertisements. Other factors include getting big companies interested in participating and then deciding how the program will live on in the future. That includes maintenance, whether or not it will continue to need funding from the government and keeping it updated with new algorithms as mental health illnesses evolve and more are added.

Ultimately, these challenges circle back to ensuring IT project and application outcomes stick to standards and follow the business needs, “in order to continue to do what’s expected of us,” Cox said.