Tennessee CIO Stephanie Dedmon stands by this idea when she talks about her state’s four 2019 NASCIO award finalists. Only one other state, North Carolina, has as many finalists this year, but Dedmon believes the prospect of winning comes second to her state’s realization that it should celebrate and promote its work.
“Over the last eight years or so, maybe even more, our state has been focused on technology as an enabler and willing to consider new and innovative ways to enhance our services,” she said. “In our journey, we have made great progress.”
Tennessee’s four projects have intriguing implications for how government can work. One project makes it easier for businesses to pay taxes. Another has transformed mental health patient care and safety. Another helps low-income participants get through the Medicaid eligibility process. Finally, a pilot utilizes facial recognition technology to process individuals who re-enter Tennessee’s prison system.
Still, there is a clear feeling in Tennessee that innovation isn’t just about the tech one uses. It’s also about how people, perhaps for the first time, learn to cross departmental and professional lines to accomplish complicated objectives.
This sort of cross-pollination within state government can occur more naturally when a central component, such as a CIO, assists everyone with redefining their focus as a team.
“These types of programs in the past have been viewed completely as an IT initiative,” Dedmon said. “We’ve really partnered more with the agency folks so they understand their role. These are business projects with an IT focus.”
“[Dedmon] has made herself available to us all along the way,” said Barbara Sampson, executive sponsor for the Rip, Replace, Revitalize! TR3 project.
Dedmon added that the projects benefited from the state IT department’s centralized position and recent staff consolidation.
“We’re pretty much finished [with the consolidation],” she said. “It’s given us more of a view into all of the many things our team is working on and accomplishing.”
Rip, Replace, Revitalize! TR3
This Tennessee Department of Revenue initiative has a straightforward purpose: Rip out every part of the state’s legacy tax-administration system and put everything into a single convenient portal for taxpayers.“It was very much an old mainframe system that had multiple stand-alone applications sitting beside it to support the overall business of tax processing,” Dedmon said.
Greer Allison, TR3 project director, said Tennessee once had no way to allow for online payment of certain taxes, including liquor-by-the-drink, tobacco, severance and some privilege taxes. Because Tennessee has no income tax, most of the taxpayers in question here are businesses, many of which expressed interest in “a system that they could access online like they do their bank account or credit card account.”
“It’s something our taxpayers have never had before,” Allison said.
The project was slated to take four years to complete. It’s now in its final phase, with a plan to have everything in place by May 2020.
Both Allison and Sampson emphasized the importance of collaboration in overcoming challenges during development. The project required “three very different groups” — the business side, the IT colleagues and the software vendor — to learn how to communicate about different problems as the project evolved.
“You need people who understand taxes, and you need people who can understand systems,” Allison said.
Another challenge concerned the externally facing piece of the system. The portal had to be tailored so that it could serve everything from small businesses to large corporations. From there, helping businesses learn the system took considerable effort.
For the system, the team decided to purchase GenTax, off-the-shelf software from Fast Enterprises. The total project cost was just less than $50 million, Allison said.
The revenue department has already experienced a profound change due to the portal. The department has a paper-processing division. Thirty individuals within that division have completely transitioned to customer service, thanks to a significant increase in electronic tax filings.
“We don’t need those people to do that [processing] work anymore,” Allison said.
TennCare Connect
TennCare is the name of Tennessee’s Medicaid system. TennCare Connect is the name of the Medicaid eligibility system that was launched in May. The goal of the system was to modernize the Medicaid eligibility redetermination and case maintenance process. The state, Dedmon said, had been using an approximately 40-year-old system to connect low-income individuals to Medicaid.“That particular implementation request was probably the largest implementation our state has ever done,” Dedmon said.
Today, people can apply for Medicaid, as well as for the state’s Children's Health Insurance Program, through the online TennCare Connect system, which includes a free mobile app. The app allows citizens to upload verification materials, choose which notices they wish to receive, undergo the annual renewal process, change personal information, view appeals they have filed, learn about fees and more.
“We’re moving from a faxing world to a very modern world of being able to take a picture and upload it to your account,” said TennCare eligibility services director Kim Hagan. “We’re trying to help move our members toward the 21st century.”
TennCare CIO Hugh Hale said the move to the electronic system was essential because of the population that his organization serves. Low-income individuals tend to be a more mobile population, moving from household to household. Thus, important mailings sometimes never reach their intended recipients. TennCare Connect increases the likelihood that a message from the state will reach its target.
“The more we can communicate with clients, the better we are able to serve them,” Hale said.
Hagan added that the mobile app is whitelisted, so if a citizen is accessing their Medicaid data, that action will not affect their data usage.
“It’s a very sophisticated system,” Hagan said. “The rules engine associated with the online app can actually result in a real-time decision for some applications.”
The TennCare Connect project started in May 2016. A pilot was launched in October 2018 before the system reached full functionality in May 2019, Hagan said.
Hale said the cost of the program, including software, system services from partners, and staff hours, totals to about $450 million, which was covered by state and federal dollars.
The system has had significant non-financial costs too. Hagan said the TennCare staff had to be strategically segregated to keep up with the department’s usual work in addition to supporting the new system. Hopefully, the workload will be reduced once the first annual process is done, as no staff were added for the undertaking.
“We couldn’t stop our day jobs while we were doing this,” Hagan said. “We were still working on applications.”
Despite this challenge, the team stayed on time and on budget. Hale said this would have been impossible without considerable communication.
“If we had disagreements, we would go into a room, and we would come out together knowing that we are in sync,” he said.
Electronic Clinical Record
An initiative within the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), the Electronic Clinical Record (ECR) project transitioned the state’s four Regional Mental Health Institutes (RMHIs) from paper records to an electronic record system. The ECR effort began in 2016, and all RMHIs implemented the system by November 2018.“The program is transformative in how we operate the four RMHIs,” TDMHSAS communication director Matthew Parriott said in an email to Government Technology. “The documentation of patient charting in an electronic format increased efficiency, as it has eliminated the faxing of documentation, transcription of orders, and [it] allows reporting that can identify missing documentation or missed timeframes.”
During this project, TDMHSAS also instituted other complementary and interconnected parts, including automated dispensing cabinets and a new pharmacy system. The elimination of medication carts and the streamlined medication process have increased both patient safety and staff efficiency.
“Under the old process, staff had to scan the medication order, send it to the pharmacy, [and] the pharmacist filled the order, and a nurse had to go to the pharmacy, retrieve the medication, bring it to the unit and then administer it,” TDMHSAS chief nursing officer Laura Young said in an email. “Under this [new] process, with automated medication-dispensing cabinets on each unit, the order is placed in the computer, the pharmacist approves it, and the nursing staff can retrieve it and administer it to the patient.”
The ECR project’s cost was about $5 million. This figure covered software, cloud-based hosting, and infrastructure improvements, including buildingwide Wi-Fi, upgraded cabling, computer equipment and automated dispensing cabinets.
According to Parriott, electronic clinical records in U.S. inpatient psychiatric hospitals are uncommon due to insufficient funding and a lack of vendor system design that fits inpatient psychiatric settings.
“In my opinion, the most innovative aspect of the project was the setting in which we executed it,” TDMHSAS Executive IT Director Richard Zhu said in an email to Government Technology. “We had to work collaboratively with our vendor to create ways to integrate the electronic clinical record software with all of the other features … [a]nd then, we successfully implemented it at four working psychiatric hospitals over the course of about nine months. As a result of the successes we’ve seen, several other states have reached out to us to see how we did it.”
Halt, Who Goes There?
In some cases, former inmates must be incarcerated again, but they might have changed their names after release, which can result in duplicate records. This pilot project aims to use facial recognition technology to help Tennessee Department of Correction (TDOC) workers identify returning inmates. The system, which is in beta stage, compares incoming inmate images with historical data to see if a match can be made — a process that cannot be done by hand.“The initial capability demonstration allows an inmate’s incoming mugshot to be compared to the existing database of close to a million records,” TDOC Deputy Commissioner Debbie Inglis said in an email. “That basic capability is refined to produce an aid for TDOC QA personnel to go back and de-duplicate the existing inmate’s data and consolidate their records if necessary.”
The project started in September 2018, and an initial demonstration of the system will occur before the end of this month, Inglis said.
The pilot was specifically structured to lead to a quick and inexpensive demonstration that may prove interesting to other state entities and stakeholders. Facial recognition technology could potentially address different challenges in Tennessee, but many questions remain.
“It turns out that our primary issues relate to the enthusiastic embracing of the potential for using [facial recognition] in other aspects of the state’s enterprise,” Inglis said in an email. “Adopting the technology to areas outside of inmate images brings the necessity of addressing statewide governance issues related to security, privacy [and] access to and accountability for use of the technology. These issues are minimized in the POC [proof of concept] because of the nature of the current image sets. Moving outside that realm will necessitate addressing these issues.”
