Salient CRGT’s industry experts Melissa Chapman, VP Health IT Business Development and John Edgar, Chief IT Strategist recently spoke with FedHealthIT about the challenges Healthcare faces, where they see the market going, and their advice for others.

Leading a number of successful Government and private-sector projects—many of which have had lasting impact on the evolution of Health IT and the application of Health Data in the U.S. Healthcare system—Melissa Chapman, former CIO for HHS,  has a clear understanding of customers’ needs and complex technical solutions include HHS, FDA, CDC, and DoD. John Edgar, former VP of IT for USPS,  leads the company’s Innovation Centers with a focus on identifying and implementing transformative, mission-enhancing technologies and processes in digital services (Agile Development, DevOps, UX), data analytics and enterprise IT service management. Together, they offer unique insights.

What is One of the Challenges Healthcare Faces?

The evolution of wearables that once only collected Health Data such as pulse or blood pressure are now able to collect and transmit very valuable and specific data relevant to patient diagnosis and ongoing treatment – for example, newer pacemakers can transmit data about your heart, or an arm patch can let your doctor know if you took your medicine as prescribed. Access to real-time Health Data presents a challenge and an opportunity. We can accelerate toward patient-centered research and patient-driven care, but we must accommodate making the patient a bigger part of how data is collected and analyzed. From an IT perspective we are transitioning from highly controllable software, data and security on an isolated infrastructure, to a world where everyone walking about is a source of data entry, and a potential source of a security problem – however the potential to build new knowledge more rapidly is immeasurable.

IT modernization is a major challenge across all agencies, made more complicated when you understand that there is a both a gap in how we address legacy systems, and gap to exploiting new technologies.
  Although The Modernizing Government Technology (MGT) Act will free up funding, there is still the question of how to modernize a 20-year old system without replacing it all—a solution that doesn’t deliver rapid speed to value for the agency. Our approach uses tools and techniques that will isolate the legacy environment and its data so that we can more quickly modernize the front end and improve the end user experience. When you’re looking at a legacy system, you also have to consider that much of the history, business rules and processes built in maybe outdated and not be what the agency needs moving forward.

It’s also important to consider people within change models—both the experience of the end user and the internal cultural change required to shift to more modern solutions. Take the adoption of the cloud within the Federal space for example. While there has been a great deal of adoption, many concerns remain over security, as well as the organizational and operational changes that will affect the focus of jobs and skill sets for the current staff.

What Advice do You Have for Others Trying to Drive IT Modernization?

It’s important to understand that success is driven by adoption, and to develop a comprehensive strategy up front to address the concerns and challenges the staff and the organization will have in adopting the change. The view must be that the agency is addressing an evolving need, rather than simply replacing a tool, which will help staff understand the new direction and what it means for them and for delivery to their constituents.

CIOs in the health space have a relatively short period of time to advance a vision, and they should maximize what contractors are offering in terms of support—such as ideas for pilot projects and ways to educate staff. If CIOs can tap into some of the often unused opportunities, if contractors can guide them to stay true to their vision and support them with value added opportunities, then CIOs will find greater success.

Where do You See the Market Going?

The Internet of Things (IoT) is likely to create opportunities for health improvement through real-time access to individual patient data and longitudinal access to data about patients in different settings. Although a whole new level of risk may be created as a result of the interplay of devices and access to information, the resultant combination presents a greater opportunity to more rapidly provide care.

Where do We Stand with Artificial Intelligence?

In the health space, we’re sensitive to machine learning and Artificial Intelligence (AI), understanding that there is both the research side and the single patient side. Many agencies have data warehouses with tremendous stores of detailed historical information. It’s challenging to use the data for predictive and prescriptive analytics. While tools that can allow for an appropriate aggregation of Health Data can improve the ability for researchers to derive knowledge from that data, there is a more specific and nuanced need at point of care. That is where we’re looking for data to provide very specific conclusions about one person that can provide effectiveness in a very different way. We need to understand the data and the anomalies to drive the day to day challenges of agencies.

What is Needed to Identify and Integrate Emerging Technologies?

Looking at customers’ pain points and their technology challenges, we help them understand that the newest technology isn’t always the best solution. We work to create a visualization that can really help them complete their mission. Our clients hear buzz around new technologies and they don’t want to be left behind. However they also want to understand if that new technology is meaningful to the work they’re performing. We use publicly available data to show them the benefits of the technology and how it might fit into their current solutions—in essence providing a proof of concept before they invest.

By combining innovation, knowledge of the client experience, and domain expertise, we can deliver a project that the client then only has to refine and fine tune. Tackling the advance preparation ensures that the product is suitable and tuned to meet client issues, resulting in a stronger and much more usable end product.

What is Important on the Innovation Side?

Salient CRGT’s Innovation Centers provide proofs of concept for our customers by bringing leading technologies and innovative approaches to nagging problems, and demonstrating how they will work in real-world applications within our clients’ environments. Our Centers include digital services, with a focus on DevOps, Agile and UX; data analytics, with a focus on modern analytic technologies and practices; IT service management, which focuses on running large IT infrastructure effectively; and solutions architecture, which focuses on bringing together our own processes and solutions on the cloud. This team also helps us to understand where agencies are going and the technologies and skill changes needed.

How do You Define Success?

Although success is defined in a slightly different way by each client, at its core it’s about improving health—from research and discovery through the manufacture of safe product, to developing safe therapies and determining how we’re going to pay for those services and therapies. There is a strong, integrated approach within Government Health Agencies focused on understanding where they’re doing well and where they need to improve.

From a technology standpoint, it’s important that we bring solutions more rapidly to the customer. A failure to deliver quickly to support the end user is not a good position, and most CIOs don’t want to be the roadblock to an agency being able to deliver in a health environment.

Tell us a Bit About Your Focus

We are modernizing the tools and solutions our clients utilize to fulfill their health missions through digital services, data analytics and IT services management. Many of our clients’ DevOps and other application development work is related to regulatory oversight, electronic exchange of Health Data, safety, and benefits, including the VA and FDA. Our enterprise level cybersecurity, network operations and infrastructure support enables emerging applications and tools to perform effectively, and help our clients prepare for major improvements, such as, the VA’s plan to adopt the cloud, and to implement a new Electronic Health Record (EHR). Our modern data analytics capabilities are utilized by clients to meet their transparency goals, which enables them to make information readily accessible to patients, researchers, medical product manufacturers and the rest of the medical community. As an example, at the Defense Health Agency, we are providing technical research and analysis to help inform the standard of care for Warfighters and Veterans, who have unique exposures and conditions.

Our clients throughout the health space have a strong desire to modernize their applications, which is coupled with a need to keep legacy systems functional. Balancing these two desires is a common issue across the board. Our teams are well versed in mission priorities and functions, understanding what clients face and the areas that are critical for their success, and determining where we can use science and technology to help them achieve their goals.

What Keeps You up at Night?

The rate of change of technologies and solutions and the evolving risk of cyber threats make it hard to acquire and retain the skills needed to provide appropriate security to both the Health Agencies and the Health Data. The need to continuously improve data security is common across agencies and will be accomplished through a combination of Government and contractor support. However, the rate of change and the depth of skills needed must be addressed every day.

In addition, the lack of certainty about Government funding makes it hard to do long-term planning. There is a huge burden on Federal staff to deliver more and more within their day jobs and the load keeps growing.

About Salient CGRT

Salient CGRT is a leading IT service provider focused bringing qualified and capable technologists to its clients. The company has nearly 2,000 employees supporting agencies across the Federal Government, roughly one quarter of which are focused in the Federal Health space. The company’s Innovation Center is focused on the areas of application development support, data analytics and IT operations and homes in on the user experience and creating apps that are highly adopted by the end user. On the other side of the house, a robust team of domain experts, including medically and clinically trained professionals, add their expertise to supporting clients such as HHS, DHS and VA. Many of Salient CRGT’s projects within the Federal space date back more than 20 years.

John Edgar works closely with Federal customers to understand their mission challenges, analyze concepts, test ideas, and recommend the technologies, tools, methodologies, and practices to best address strategic needs. Before joining Salient CRGT, John served as Vice President, Information Technology for the United States Postal Service (USPS). There, he led one of the world’s largest corporate technology infrastructures providing robust, reliable, secure computing and innovative new services with a lean, Agile IT organization. John drove IT process modernization and partnered with business units to deliver new technology solutions to meet the evolving agency needs. This helped USPS continue to provide affordable, convenient products and services to U.S. citizens and customers worldwide.

Melissa Chapman is the former HHS Chief Information Officer (CIO) and Deputy Assistant Secretary, as well as former acting Chief Information Officer (CIO) for the Food and Drug Administration (FDA). Melissa currently leads business development strategy and growth in the Department of Health and Human Services (HHS), Veterans Affairs, and health IT market segments for Salient CRGT. Her unique understanding of our clients’ needs is influenced by her experience leading a number of successful government and private-sector projects—many of which have had lasting impact on the evolution of health IT and the application of health data in the U.S. healthcare system.



  1. Many EHRs really do suck, as ZDoggMD described in his very popular parody video ‘EHR state of Mind’. But without some nudge towards an improved user experience many of the “less than optimal” EHRs will only get worse as they grow and Engineering-centric developers add more and more features on top of a poorly designed information architecture.

    Vehicles are not allowed to be sold in the USA unless they have meet strict safety standards, why isn’t this the same for EHRs?

    Don’t like 30 clicks to order Ambien? How about 50!

    Usability in healthcare is critical to patient safety, but way too many vendors have short-cut their “Safety-enhanced Design” (ONC’s euphemism for Usability) in order to get their clients Meaningful Use funding.

    Is it just greed? Hhy do EHR vendors choose to ignore the research and develop a product that doesn’t match the mental model of their users? Or are they just uninformed? Do they choose to be uninformed? Is ignorance really bliss?

    We’ve had the tag line “Usability starts with you” for a while–and remember when a senior developer wrote back “that it ends in “Y.”” In healthcare the why is obvious – it saves lives.

    Don’t believe me? See the Joint commission alert 54


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