Healthcare reform may still be up in the air, but this much is certain: Health information technology will be the foundational element in any reform effort — and  contractors will play an important role. That was made clear this past year by the American Recovery and Reinvestment Act and accompanying HITECH Act. From electronic health records to health information exchanges, technologies are being envisioned and deployed on behalf of government customers like never before. The opportunity is now. So, who’s taking the reins?

ExecutiveBiz brings you its first annual list of Healthcare IT Game Changers in Industry to Watch. (For our list on the government side, see here.) Our selection is based on specific metrics including: noteworthy projects that are proving replicable for future customers; thought leadership on standards setting and other pressing healthcare-related issues; new solutions in the works to modernize existing infrastructures; and nomination by industry colleagues. Check out our list below — each offers their forecast for what’s ahead — and what it takes to succeed in this space.

AGILEX’s LARRY ALBERT: Serving up CONNECT

Few companies have had as meteoric a rise in healthcare IT as Agilex. Since its founding three years ago, the Chantilly, Va.-based company has gone from an initial focus within healthcare on the Military Health System to a high-profile project that’s become a prototype of how healthcare IT can fuel interagency cooperation — and drive cost-saving results. The CONNECT Gateway, as the project’s known, allows more than 20 federal agencies to share health information. So far, the platform has resulted in more than $200 million in government savings, leading InfoWorld to name it  one of the most successful IT projects of this past year.

Helping to navigate such wins is Larry Albert, president of Agilex’s healthcare sector business. A long-time industry veteran, Albert traces his passion for healthcare IT to a single event, back in the mid-1990s, when he was leading the healthcare practice at a previous company, Integic Corporation. “There was a tragic situation where a young soldier in the Army lost his spleen at an early age in an automobile accident; he had a depressed immune system and had to periodically get vaccinations,” recalls Albert. In a world of paper records that requirement got lost over time and a vaccination was missed; the soldier caught meningitis and died. “That death precipitated officials to take a look at what we were doing with DoD’s medical system, AHLTA (Armed Forces Health Logitudinal Technology Application) … we were able to show how the system could generate [medical] alerts,” says Albert. “It was a bit of an epiphany,” he adds, “because you suddenly go, ‘This isn’t just about collecting and maintaining data, it’s about saving lives.’”

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CGI’s CHERYL CAMPBELL: Helping modernize Medicare.gov

These days, CGI Federal is surveying the scene from a pretty unique vantage point: Its work spans federal, state, local, and commercial markets. “Our ability to work across this ecosystem helps us keep a macro view on issues, challenges, and opportunities,” says Cheryl Campbell, vice president of U.S. healthcare at CGI. Among the company’s range of services, its work over the past year with Centers for Medicare and Medicaid Services (CMS) stands out. Under Campbell’s watch, CGI has been leading the modernization of Medicare.gov, a consumer beneficiary website that provides access to information about the program.

At Medicare.gov, CGI has contributed a series of online tools that make government data more open, accurate, timely, and accessible. Among those tools is Hospital Compare and Nursing Home Compare, which “mash up” healthcare provider and quality of care information collected by CMS onto geographical data from Google Maps. That combination allows users to locate and assess healthcare facilities near them or their loved ones. Beyond that, CGI’s work on Home Health Compare and Dialysis Facility Compare allows beneficiaries to evaluate service providers based on quality measures. It’s something that Campbell, whose career spans 20 years in healthcare IT, is excited about. “Under this program, the client can view beneficiary ratings of hospital providers based on the experiences of others,” she says. “These services are empowering the patient to make more informed choices about their healthcare,” she adds.

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MAXIMUS’ BRUCE CASWELL: Putting focus on patient-centric tools

When it comes to healthcare IT, deploying electronic medical records gets a lot of air time. Providing patient-centric business models less so. That’s something Bruce Caswell is helping to change. “The discourse around meaningful use, health information exchange (HIE), and the technology itself often fails to consider the customer relationship management element — how beneficiaries will be incorporated into the process and how to assure their interests and their rights are recognized,” says Caswell, president of Health Services at MAXIMUS. “Going forward, a lot of information will be shared among key stakeholders, which means patients will demand — and there will be a requirement — that consent management be handled in a way that’s conformant not only with law but is accessible to all patients, including those with low literacy,” he says.

Since taking the reins of the Reston, Va.-based company’s Health Services segment in 2007, Caswell has made that focus among his top priorities. Leveraging the company’s traditional lines of business with state customers in areas such as Medicaid and the Children’s Health Insurance Program (CHIP) has been an element of that approach. “We are fortunate to serve, through our state clients, millions of beneficiaries each year. We’re putting a lot of effort into multi-channel customer service, including electronic portals,” says Caswell, whose team has developed a portal for CHIP clients to do renewals online. The company has also developed a proof of concept for a Medicaid portal that supports a medical home model. “Online technology, like a portal, lends itself well to the evolving priorities of state Medicaid directors, and the changing face of program beneficiaries,” says Caswell.

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DELOITTE’S DR. MICHAEL COWAN: Bringing healthcare IT best practices to military health

Michael Cowan’s passion for healthcare IT goes back to his days as Surgeon General for the US Navy, between 2001 and 2004. “I saw systems and implementations consistently falling short of expectations, and, frequently, at great expense,” says Cowan, who oversaw 40,000 personnel working in 120 medical, dental, research, and teaching facilities worldwide. Cowan went on to develop a “very strong feeling” that IT was a brass ring opportunity for healthcare — on three levels: clinical, operational, and administrative. At the time, Cowan was coming up on retirement. “It seemed to me that the most important thing I could do was to direct my efforts toward health information technology as an enabler of good medicine as my second career,” he says.

These days, Cowan is doing just that as Chief Medical Officer for Deloitte’s Federal Health practice. A key project that Cowan is working on has to do with the U.S. military; Deloitte is helping create a more efficient relationship between health practitioners and their patients. In particular, Deloitte is assisting participants of the project in leveraging interactive online technologies such as self-appointing personal health records and patient portals. These technologies allow patients and their physicians to better manage care and share health information. While still in the early stages, it looks like the program is on its way to becoming a successful adjunct to existing electronic systems — it’s already caught the attention of other branches of the military.

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DELL PEROT’s DR. KEVIN FICKENSCHER: Building on Massachusetts Connector’s success

Dr. Kevin Fickenscher’s passion for healthcare IT goes way back. To North Dakota, to be exact when he served as an active physician practitioner. In 1980, Dr. Fickenscher founded The Center for Rural Health, which identifies and researches rural health issues across the state. That moment proved a turning point for Dr. Fickenscher, who was a family physician up until that point. “That piece got me interested in the IT field,” he says. “I was really convinced that if we could deploy the right kind of information systems, health advocates could enhance the quality of care for people living in rural America.”

Today, Dr. Fickenscher brings his dual passion for healthcare and technology to Dell Perot Systems (formerly Perot Systems), where he serves as Vice President of Strategic Initiatives. First and foremost, Dr. Fickenscher remains a physician, just on a larger scale. Among the company’s healthcare IT initiatives, its work in Massachusetts stands out for the replicable lessons it provides state governments and contractors in advancing healthcare solutions — together.  Among the company’s projects is the Massachusetts Connector, a program that allows low-income Massachusetts residents to sign up for health insurance.  Dell Perot Systems provides information technology and business process services for the program, while also overseeing Commonwealth Choice, a health insurance plan for individuals, families, and small group employers throughout the state who aren’t eligible for Medicaid. What’s next? Look for Dell Perot Systems to help healthcare leaders replicate that model nationally, regionally, and state by state as healthcare reform continues its ascent.

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NORTHROP GRUMMAN’s AMY KING: Strengthening public sector health

When most people think of Northrop Grumman, its work in defense contracting is the first thing that comes to mind. But the company also has a significant presence in what it calls the “public sector health.” As Vice President of Health IT Programs, Amy King is helping strengthen that presence. Since coming on board in 2006, King has helped the company maintain its focus on public health, benefits management, health information exchange, and life sciences on the federal, state, and local level.

Among its healthcare IT contributions, the company’s work with the CDC, which has been ongoing for the past 10 years, stands out. Most recently, Northrop Grumman helped the CDC stand up and operate an H1N1 emergency operations center. It also traveled to Mexico to investigate the origins of the virus, and developed databases and analytical tools to help monitor the virus at the federal, state, and local levels. “I’m really excited to have a seat at the table to solve some of these challenging problems,” says King. “Especially now,” she adds, “with the potential for healthcare reform.”

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SRA’s PAUL NEDZBALA: Helping mobilize response, strengthen bioinformatics

When CDC needed support to respond to the increasing threat of the H1N1 pandemic flu, they turned to SRA International’s Health Programs team led by Paul Nedzbala.  Nedzbala, Director of Health Programs for the Fairfax, Va.-based company, and his team have established a reputation for meeting the complexities faced  by the federal health market. Similar to the response to SARS in 2003, where CDC called on SRA to help them strengthen their global migration and quarantine program, under Nedzbala’s watch SRA is helping CDC meet increased response needs related to the H1N1 virus in vaccine safety, public health surveillance, and inquiry response about the disease from the public as well as health professionals.  It’s that ability to rapidly respond and scale that has secured SRA’s Health Program’s team, under Nedzbala’s watch, an increasingly important role in healthcare.

So has the company’s focus on bioinformatics. Over the past few years, SRA has been the primary support organization for the data coordinating center for the National Institute of Health’s (NIH) The Cancer Genome Atlas (TCGA). Launched in 2005, TCGA was recently heralded by President Obama as one of the most innovative and important programs that NIH is undertaking. The coordinating center that SRA supports is a central component of the program; all collaborators rely on it to provide access to data to support the program’s research mission. “Innovation is a key part of everything we do,” says Nedzbala, “whether it’s technology or a scientific process.”

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BAH’s SUSAN PENFIELD: Bringing multiple parties to healthcare table

You might call her the great convener of healthcare IT. As a senior vice president at Booz Allen Hamilton, Susan Penfield routinely brings together discrete parties to discover ways information technology can further healthcare goals. That facilitation role has paid off with agencies such as the Social Security Administration. A few years ago, SSA was looking for ways to increase the efficiency of eligibility determinations for disability benefits. The sticking point was medical evidence; the data was resident in paper-based records and electronic-based records in image format. Penfield’s team supported SSA in developing a medical evidence exchange pilot to utilize Health Information Technologies (HIT), fully leveraging the capabilities of electronic health records (EHRs).  At those pilot sites, SSA was able to greatly increase the efficiency and accuracy of eligibility determinations for disability benefits.  A year and a half later, SSA has recognized the benefits of the pilot and are moving into full production.

Food safety is another health-related area where Booz Allen is leaving its mark. Today, the company stands as a leader in data integration for the FDA, helping the agency collect and analyze data to advance food safety. That distinction began several years ago, when Booz Allen embarked upon building a system, Electronic Laboratory Exchange Network, in which FDA, CDC, USDA, and state and local public health departments could start tapping into a common database. Booz Allen created a “system of systems,” whereby each agency could look at an entire range of data to establish an early warning monitoring system for any food outbreak. The network, which the company still maintains, has since been used in food safety issues such as the spinach outbreak of 2006.

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HP’s DON PICARD: Continuing focus on medical systems, interoperability

Don Picard has been with HP Enterprise Services, formerly EDS, for 27 years. From his start in the company’s legal department, to his stint in the late 80s and early 90s working in its government affairs office on Capitol Hill, Picard eventually settled into the domain he’s since come to call home for the past 10 years: the company’s federal healthcare business. Picard’s focus originally centered on the Centers for Medicare & Medicaid Services (CMS), then known as HCFA. Since then, Picard’s role has grown to include responsibility of the company’s full federal healthcare portfolio: the rest of U.S. Health & Human Services (HHS), the U.S. Department of Veterans Affairs (VA), and the Military Health System.

Today, as the HP Federal Healthcare Leader, Picard maintains a focus on applications, business process outsourcing, as well as infrastructure support. “We’re going to continue to focus on supporting the government’s efforts related to medical systems and interoperability of those systems both within and across agencies as they look to improve processes and also focus on taking costs out of the administrative side of healthcare —that cuts across all of our clients,” says Picard.

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CSC’s DR. ROBERT WAH: Putting the “health” in healthcare IT

Dr. Robert Wah sees the benefits of healthcare IT firsthand. Along with serving as chief medical officer for CSC’s North American Public Sector, Wah has been a practicing physician for 27 years. “I just did surgery yesterday,” says Wah, who teaches at the National Institutes of Health and the National Naval Medical Center in Bethesda, Md., roughly one day a week. “We have a database where, when I enter a prescription, it provides feedback within two seconds on all medications that my patient has gotten from a military, mail order, or civilian pharmacy,” says Wah. That database, alone, helps avoid over 100,000 adverse medication events a year.

Turns out, CSC runs that database. These and other initiatives attracted Wah to the company in 2007. But it’s not the technology that drives Wah. “I continually make sure we take the perspective that technology is a tool, not the end goal,” says Wah. That focus has guided contracts over the last few years. Among them, the Commonwealth Connector, the first state-based insurance cooperative, in Massachusetts; the Blue Health Intelligence project, which connected Blue Cross Blue Shield association members into a single claims database (the initiative allows for monitoring nearly 100 million lives’ worth of claims to detect best practices in disease trends and prevention); and the Observational Medical Outcomes Partnership (OMOP), a consortium involving FNIH, FDA, Industry, Academia and CSC to develop and test the feasibility of new methods to use existing healthcare data to monitor the safety and benefits of drugs. CSC developed and manages the Research Lab, a high performance data management and analytical computing system used to support this initiative.

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VANGENT’s KERRY WEEMS: Navigating the sociology of healthcare IT

When Kerry Weems wrapped up a 28-year career with the federal government in January 2009, he had some thinking to do. “I spent a lot of time talking to people in healthcare IT,” says Weems, whose government career included several senior positions at the Department of Health and Human Services (HHS). What followed, upon retirement, was an in-depth look at what the private sector had to offer. “Frankly,” says Weems, “there are people out there doing great things but also a lot of snake oil salesmen … some companies say they have a health practice but that just amounts to a help desk in a hospital.”

One look at Vangent offered a refreshing counterview. “It was making a strong and particular effort to deepen its health practice,” says Weems, who cites the company’s building of a traumatic brain injury component of the Military Health System’s electronic health records — a pivotal undertaking given the number of traumatic brain injuries that have resulted from improvised explosive devices in Iraq and Afghanistan. “It’s that kind of work that’s a real health practice in my view,” says Weems, who currently serves as senior vice president of health solutions for the company.

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Present: President and General Manager, MAXIMUS Health Services Segment

Career history: Prior to joining MAXIMUS in 2004, Caswell was at IBM Corporation for nine years, in a variety of roles focused on federal, state, and local governments. Before then, he served as manager for Price Waterhouse, in its Office of Government Services’ Policy Research and Analysis practice unit.

Personal: Caswell is a devoted marathoner. “I turned to running just after September 11, 2001 as a way to get more focused and disciplined in my life,” says Caswell. He’s since done 14 marathons and one ultra-marathon — a 50-mile race, this past fall. “It certainly tests the body and the spirit when you’re running that long,” he says.

TIPS

• Get in on the standards-setting conversation. “Many states have put together workgroups to help govern how they’ll deal with the $19 billion [government healthcare IT investment] as it comes down,” says Caswell. “Getting engaged in standards committees and workgroups is critical…that’s a great forum in which to have your ideas heard. You end up potentially having a bigger impact on the outcome than just sitting around and waiting for the news to be reported.”

• Broaden your vision of potential health IT partners. “You’re going to see companies form partnerships that customarily you might never have seen. For example, we recently looked at an opportunity to bid on the core backbone of a health information network; a requirement of the bid was that the prime contractor had to have done it before. It caused us to look at who we could partner with in order to meet the requirements and give us capabilities in a new area.”

FULL INTERVIEW

ExecutiveBiz: Let’s start with the $19 billion for healthcare IT that Congress set aside this past February. What contracting opportunities do you see continuing into 2010?

Bruce Caswell: First of all, we’re thrilled that the efforts funded under the stimulus package are progressing in the form of the HIE grants to the states and the creation of the Regional Extension Centers. There’s a real wave of opportunity being created for vendor communities to support states as they assist in the deployment of electronic medical records. We see a lot of opportunity in 2010 associated with states as they work through the procurement process to put the supporting contracts in place to meet the requirements of the stimulus bill in that area.

ExecutiveBiz: Turning to healthcare reform, what opportunities do you see there?

Bruce Caswell: Clearly, with large scale federal legislation losing momentum, we’ll likely see incremental change in the areas of Medicaid reforms, coverage expansions to include children and childless adults, and companion provisions to address subsidies, incentives for small employers, and insurance reforms (such as pre-existing condition exclusions). Opportunities, in the near term, will be centered on core programs like Medicaid and CHIP, and are likely to include the long-term care population, which represents more than 35 percent of Medicaid spending. Certainly, the vast majority of states lack the money to meet the funding requirements envisioned in the original legislation, and many have implemented or are contemplating cuts in their benefit packages. However, if states see some likelihood of an increased federal Medicaid match continuing for another 18 months, they’re more likely to maintain current benefits levels and may work to expand to selected new populations.

ExecutiveBiz: Patient engagement is something you speak a lot about. How can it be implemented for more effective healthcare reform?

Bruce Caswell: Adequate provisions need to be made for dealing with low literacy populations. People who actively participate in their healthcare choices have better health outcomes. People who aren’t engaged in their own healthcare, who aren’t proactive and don’t understand their doctors, ultimately get worse care, are sick more often, and die prematurely. That has a huge economic impact on our country, as evidenced in a recent study published by the Center for Health Disparity Solutions at the Johns Hopkins Bloomberg School of Public Health. We think addressing that is ultimately traceable to improving health literacy or at least making provisions for it. To help address the issue, we have an organization, the MAXIMUS Center for Health Literacy, which develops communications that are culturally and linguistically sensitive to low literacy populations. For example, we build usability testing into the development phase of all our literacy projects, testing websites and print materials with people who represent the same demographics as the target audience. Our experience has taught us that in order to reach an audience we need to communicate in their language, at their literacy level, and use examples and illustrations that speak to their cultural experiences.

ExecutiveBiz: Turning to other markets. British Columbia, in many ways, leads other parts of North America in the e-health area. You’re a part of that effort, as evidenced by a 10-year $268 million contract with the British Columbia Ministry of Health. What’s the latest on this project?

Bruce Caswell: One of the major programs that we administer for British Columbia is PharmaNet. As the name would imply, that’s the system by which pharmacy claims are processed for prescription drugs, which are dispensed at the point of service. The claims are ultimately settled and the pharmacies are paid for their claims. We’re leading an effort to transform the entire PharmaNet program into what is called PharmaNet 2. An element of this includes the implementation of a new Drug Information System (DIS) that provides utilization review and can detect drug interactions prior to dispensing. This will effectively be the most sophisticated and functional e-prescribing DIS project in Canada when it is completed — a very significant stride. The PharmaNet2 project will conform to the new Pan-Canadian messaging standard, HL7v3. As such, there are direct functional similarities between this effort and the developing ePrescribing/eDrug environment in the United States. MAXIMUS recently completed the acquisition of a Canadian firm, DeltaWare, who provides this leading DIS platform. We’re optimistic that our efforts in Canada can be of benefit to our U.S. government customers as well.

ExecutiveBiz: The future of healthcare IT belongs to analytics. What’s MAXIMUS doing in that area?

Bruce Caswell: Certainly, there’s already a lot of great data out there in the form of Medicaid claims that can be used initially to populate electronic records or personal health records. We’re working with our State Medicaid clients to design portals that can reach back into the Medicaid claims database and populate Medicaid personal health records so that you have basic information on a patient to use while these health information exchanges are being implemented and starting to gain traction. While this area is still “early days,” as it’s tied to the State HIE grant activities, we’re finding that Medicaid administrators see the need for such a gateway to include their beneficiary population, and the supporting services (like consent management) that must accompany this.

ExecutiveBiz: What’s your view of the current definition of “meaningful use”?

Bruce Caswell: It’s a good general standard, but there’s still a lot of ambiguity. Most of the discourse right now is centered on the definition of quality standards. But it doesn’t specifically address hybrid situations; for example, a cardiology practice where the cardiologist provides some primary care. In that setting, it isn’t clear what the responsibilities are of the cardiologist who provides that primary care. The good news is that the five areas broadly addressed in the current meaningful use standard do incorporate the concept of patient engagement and a focus on patient-centered rights. We’re thrilled that that’s at least reflected in the current standard. But it doesn’t really get implemented until 2013. That isn’t soon enough, in our view.

ExecutiveBiz: Where will MAXIMUS be contributing on the patient-centric side of healthcare IT next?

Bruce Caswell: While advancing the need for healthcare IT to be more patient-centric, our activities address the roles of patients, providers, and program administrators. Specifically, working with Intel and Initiate Systems, we are bringing a Medicaid Gateway offering to our state customers, comprising a software application and services that can enable the integration and participation of the Medicaid population in the new State Health Information Exchanges. Additionally, I previously mentioned the Recipient Portal that we’ve developed with particular emphasis on low literacy populations. This effort benefits not only the patient, but can enable providers to comply with Meaningful Use criteria for Federal incentive payments.  Finally, a cornerstone of any patient-centric approach is privacy. We have authored white papers and are developing solutions to address Consent Management. This is a complicated area, as there are laws and regulations that supersede HIPAA and HISPC rules for eHealth data. It is, however, essential to creating the environment of trust that is ultimately essential to adoption. As you can see, our view is that a patient-centric perspective is critical to the success of healthcare IT.