We're the only country that has tried to reduce burden this way, and it hasn't worked. Especially with capacity being gutted, we should learn from what the rest of the world is doing.
The UK’s Tell Us Once service is another good example - it reports a death to most national and local government organisations in one go e.g., taxes, benefits, pension, passport, driving and vehicle licenses, electoral register, disabled badge.
In addition to being a more recent state, Estonia also has the advantage of being a unitary rather than federal state for its "Ask once" policy. I imagine that most people do not consider (or care) whether they are providing information to their state or federal government, let alone the different agencies or departments within the federal government.
This is a real factor and true here in Canada too. We have strong provinces, much more akin to American states than anything subnational in Europe. They sometimes get along with the federal government depending on which parties are in power at each level, but they very much are separate entities with their own IT systems.
It isn’t too dire because there’s a pretty good division of responsibilities between the levels. The provinces handle the biggest most expensive public services: electricity, health care, education, child services, etc. Federal government does immigration, passports, defence, and handles the national pension plan (CPP).
But then there are some areas where both levels do it, like unemployment. Employment Insurance for parental leave and in-between jobs is a federal insurance scheme paid by a special excise on paycheques, and welfare/disability is supplemented at the provincial and municipal levels … so this is an area plagued by the “giving government the same information multiple times” problem driven by federalism.
I will say Canada does a good job at one thing: taxes. You do one filing, federally, run by the Canada Revenue Agency (CRA) and it handles your provincial taxes too. It was always super annoying for me doing two completely separate filings when I lived in the US (Massachusetts) for a while 15 years ago.
I’m a big fan of the slide that you show to the Hill staffers. As a career bureaucrat the challenge of executing mission is often distorted with a lack of clarity of authorizing language and compliance with both legislative intent and policy intent. As a result bureaucrats have a difficult job of having clarity of intent and outcome that is required and end up resorting to compliance with process and procedure as the metrics of success or they simply matters by meet the expectations of their boss or principal. Lost in the sauce is the outcomes the agency is created for. Solving these challenges requires improved leadership that focuses more on outcomes and enabling people to achieve those outcomes.
Lots of good stuff in here. From my experience, the PRA addressed but created a trifecta: bad forms, bad data collections, bad procedures. Digital transformation won’t really affect either of these but empowerment, collaboration and oversight might.
This is an excellent post with a huge amount of truth!!
Here is my own digital service story, and I will try to be brief (maybe I'll do a longer Substack on it). In 2005, our group at PhRMA came up with a project that would allow the use of mining observational medical records to assess drug safety and efficacy (the industry is not as evil as some believe). We engaged Boston Consulting Group to help us and engaged IT professionals and pharmacoepidemiologists from member companies. We also invited the FDA to send observers and contribute as well. One of the problems with the US healthcare system is that almost everything is focused on reimbursement which led to a whole coding system that is used to that end. This does not help out those of us in the pharma industry who want to use data in other ways.
Once a drug is on the market, companies have to monitor for adverse drug reactions and file reports with FDA on a yearly basis and sooner if an important side effect is noted. We spent two years developing the concept and the FDA individuals were highly supportive of our work. I had the task of going before the PhRMA Board (CEOs of major companies) and requesting $20M for the first year of a two-year pilot project. They were on board with this. The project came up with a common data model that could be implemented using existing ICD reimbursement codes and also developed some new database query approaches. We even created some synthetic "needle in a haystack" data sets and ran a competition to find better search algorithms. There was a $10K prize awarded to the winner!
After two years the program was transitioned over to the Reagan/Udall Foundation for the FDA but they did little with it. Fortunately, several of the company people who were involved along with some data scientists from Columbia University kept the project alive. It morphed into the Observational Health Data Sciences and Informatics program is a multi-stakeholder, interdisciplinary collaborative to bring out the value of health data through large-scale analytics. https://www.ohdsi.org/
We took a kernel of an idea and translated this into a world-wide effort to better use observational data. Fortunately, a large number of countries that have government run health systems do not have to worry about reimbursement codes and are much better able to utilize their health data.
The UK’s Tell Us Once service is another good example - it reports a death to most national and local government organisations in one go e.g., taxes, benefits, pension, passport, driving and vehicle licenses, electoral register, disabled badge.
In addition to being a more recent state, Estonia also has the advantage of being a unitary rather than federal state for its "Ask once" policy. I imagine that most people do not consider (or care) whether they are providing information to their state or federal government, let alone the different agencies or departments within the federal government.
This is a real factor and true here in Canada too. We have strong provinces, much more akin to American states than anything subnational in Europe. They sometimes get along with the federal government depending on which parties are in power at each level, but they very much are separate entities with their own IT systems.
It isn’t too dire because there’s a pretty good division of responsibilities between the levels. The provinces handle the biggest most expensive public services: electricity, health care, education, child services, etc. Federal government does immigration, passports, defence, and handles the national pension plan (CPP).
But then there are some areas where both levels do it, like unemployment. Employment Insurance for parental leave and in-between jobs is a federal insurance scheme paid by a special excise on paycheques, and welfare/disability is supplemented at the provincial and municipal levels … so this is an area plagued by the “giving government the same information multiple times” problem driven by federalism.
I will say Canada does a good job at one thing: taxes. You do one filing, federally, run by the Canada Revenue Agency (CRA) and it handles your provincial taxes too. It was always super annoying for me doing two completely separate filings when I lived in the US (Massachusetts) for a while 15 years ago.
I’m a big fan of the slide that you show to the Hill staffers. As a career bureaucrat the challenge of executing mission is often distorted with a lack of clarity of authorizing language and compliance with both legislative intent and policy intent. As a result bureaucrats have a difficult job of having clarity of intent and outcome that is required and end up resorting to compliance with process and procedure as the metrics of success or they simply matters by meet the expectations of their boss or principal. Lost in the sauce is the outcomes the agency is created for. Solving these challenges requires improved leadership that focuses more on outcomes and enabling people to achieve those outcomes.
Lots of good stuff in here. From my experience, the PRA addressed but created a trifecta: bad forms, bad data collections, bad procedures. Digital transformation won’t really affect either of these but empowerment, collaboration and oversight might.
This is an excellent post with a huge amount of truth!!
Here is my own digital service story, and I will try to be brief (maybe I'll do a longer Substack on it). In 2005, our group at PhRMA came up with a project that would allow the use of mining observational medical records to assess drug safety and efficacy (the industry is not as evil as some believe). We engaged Boston Consulting Group to help us and engaged IT professionals and pharmacoepidemiologists from member companies. We also invited the FDA to send observers and contribute as well. One of the problems with the US healthcare system is that almost everything is focused on reimbursement which led to a whole coding system that is used to that end. This does not help out those of us in the pharma industry who want to use data in other ways.
Once a drug is on the market, companies have to monitor for adverse drug reactions and file reports with FDA on a yearly basis and sooner if an important side effect is noted. We spent two years developing the concept and the FDA individuals were highly supportive of our work. I had the task of going before the PhRMA Board (CEOs of major companies) and requesting $20M for the first year of a two-year pilot project. They were on board with this. The project came up with a common data model that could be implemented using existing ICD reimbursement codes and also developed some new database query approaches. We even created some synthetic "needle in a haystack" data sets and ran a competition to find better search algorithms. There was a $10K prize awarded to the winner!
After two years the program was transitioned over to the Reagan/Udall Foundation for the FDA but they did little with it. Fortunately, several of the company people who were involved along with some data scientists from Columbia University kept the project alive. It morphed into the Observational Health Data Sciences and Informatics program is a multi-stakeholder, interdisciplinary collaborative to bring out the value of health data through large-scale analytics. https://www.ohdsi.org/
We took a kernel of an idea and translated this into a world-wide effort to better use observational data. Fortunately, a large number of countries that have government run health systems do not have to worry about reimbursement codes and are much better able to utilize their health data.