From a practitioner perspective IT-related issues, not surprisingly, most often present themselves in terms of specific government programs and operations. Following is a brief discussion of the IT issues in the context of these categories.

Based on the preliminary analysis, several IT-related issues were identified in the area of economic development and commerce. These include:

• Taxing the Internet and online services
• Information flow between government and vendors of government goods and services
• Using IT to promote intra-state purchase of goods
• Telecommunications as an economic development tool
• Telecommunications law
• Increasing access to economic, demographic, and real property data to support economic development
• Using GIS to support the integration of environmental, real property, and economic data for economic development decision making
• Automating the provision of information about government regulations to businesses

Taxation of the Internet and online services was an agenda item for the 1997 National Conference of State Legislators. The National Association of Auditors, Comptrollers, and Treasurers focused on using IT to support transactions between government agencies and vendors for purchases of goods and services. A project submitted to CTG by the New York and New Jersey Port Authorities sought to develop a database to support the substitution of New York made products. The 1997 International City/County Management Association (ICMA) meeting agenda lists the US Federal Telecommunication Law as an issue of importance and further includes an item discussing telecommunications as an economic development tool. Two of the proposals to CTG focused on using technology to increase access to census, economic, and real property information to facilitate economic development decision-making while a third focused on the use of geographic information systems (GIS) to support the integration of environmental, economic, and real property information to balance economic development and environmental protection goals.

IT tools can support education in different ways for different populations. IT can support the delivery of educational programs to remote locations and can facilitate asynchronous learning. It can also reshape traditional classrooms. Following is a preliminary list of education-related IT issues:

• Telecommunications for medical education
• Tracking of training services
• Effective integration of technology, teaching, and learning in K-12 schools
• Telelearning

One of the proposals to CTG focused on the provision of medical educational services through the use of multi-media network services. Another proposal sought to use IT to facilitate the tracking of training services provided to staff. A third from twelve school districts seeks to study and improve the relationship between technology, teaching, and learning at the K-12 level by focusing on staff development models and school district technology policies.

Some of the most dramatic policy shifts involve IT are associated with changes in health and human services programs. Following is list of issues based on the preliminary research:

• Expert systems to support admission and treatment decisions
• Telemedicine
• Information access policies (genetic, adoption)
• Availability of information to support policy making
• Electronic benefits transfer
• Using IT to decrease instances of benefits fraud
• Using IT to determine service eligibility across programs

Welfare reform and the shift to Medicaid Managed Care will require substantial attention to information uses, flows, and policies. The Health Coverage Availability and Affordability Act of 1996 (commonly known as the Kennedy Kassebaum Bill) requires the Secretary of Health and Human Services to establish a unique identifier for each person, employer, health plan, and provider in the health care system. Data interchange standards accredited by ANSI have been or are now being developed. These policies will in turn have significant implications in the development of systems to support health and human services program operations and evaluation. These programmatic shifts will also underscore the criticality of addressing information sharing across government agencies.

The use of telemedicine, as a mechanism for increasing access to care, particularly in rural areas, has been identified as important. As discussed above, telecommunications and multi-media have also been identified as technologies to support medical education and training.

Information access issues are critical in the area of health and human services. Individual health information is highly confidential and must be maintained and transferred in highly secure environments. For example, the National Conference of State Legislators discussed the issue of access to genetic information at their 1997 conference.

At their 1997 meeting, The American Public Welfare Association discussed the issue of using electronic benefits transfer to distribute benefits to food stamp recipients. The National Council of State Human Service Administrators also identified electronic benefits transfer as an important topic for discussion. A project proposal CTG received from the State Office for the Aging and the Office of Mental Retardation and Development Disabilities focused on the development of a computerized application process for the elderly and disabled that would support simultaneous eligibility determinations across a range of services. Another, from the Department of Health sought to develop a screening and referral system for individuals with long-term functional impairments. An Office of Mental Health proposal involved the development of an expert system to support admission decisions in emergency rooms for persons presenting with psychiatric symptoms. A similar decision support system is discussed in the Medicaid Managed Care section below. The concept of developing distributed electronic databases of services and service providers was identified twice. The American Public Welfare Association/ISM meeting discussed the idea of a Virtual Human Services Pavilion and a proposal to CTG from a county BOCES focused on the development of a network to serve at-risk rural families through network-based online service referrals and information sharing.

The shift from fee-for-service to managed care for Medicaid recipients represents a dramatic shift in the way that services are provided to the Medicaid eligible population and will further require a number of changes in the way that information is exchanged between providers of services, federal, state, and local government agencies, and managed care organizations. Additionally, appropriate information must be collected to support the evaluation of this programmatic change. The following issues were identified based on the preliminary information:

• Expert systems to support service authorization
• EDI to support service authorizations
• Service utilization tracking
• Program evaluation & quality of care assessment
• Billing
• Electronic client records

One of the keynote speakers at the 1997 NYS Institute on Mental Health Management Information was entitled “Are we ready for electronic client records, communication, and Managed Care?” another presentation at the conference focused on the “capitation” experience of mentally disabled Medicaid recipients in New York State. An expert system was also discussed that reduced by approximately 80 percent, the number of phone calls between a hospital emergency room and the managed care provider regarding service authorization for individuals presenting with psychiatric symptoms.

CTG is beginning a project that will focus primarily on the flow of information between providers of services and managed care organizations to support enrollment verification and service authorization.

Designing and implementing systems to meet the rapid changes in eligibility determination and service provision in the welfare system pose substantial information and management challenges to government agencies at federal, state, and local levels. Following is a preliminary list of IT issues related to welfare reform:

• Interstate information sharing to support eligibility determinations
• Electronic benefits transfer
• Measuring outcomes

An issue, discussed at the 1997 meeting of the National Council of State Legislators is that of tracking information across state lines in order to support eligibility determinations. The American Public Welfare Association has also raised the issue of electronic benefits transfer. Another critical information management issue relates to measuring outcomes in welfare reform as indicated by the National Council of State Human Service Administrators and National Council of Local Public Welfare Administrators.

CTG has over the past three years, also received several proposals for projects related to environmental conservation and natural resources. One proposal submitted by the NYS Department of Environmental Conservation, sought to use electronic data interchange (EDI) as a mechanism for sharing oil and gas regulatory data, while another submitted by NYS Environmental Facilities Corporation sought to develop an electronic bulletin board system to provide small business owners with information on environmental requirements.

Emergency management is also highly dependent upon an effective exchange of information about the emergency itself, and the characteristics of the area in which the emergency is occurring, including the characteristics of the population and structures at risk. In addition, information must be readily accessible about the availability, types, and location of various resources needed to contend with an emergency. Following is preliminary list of IT-related issues associated with public safety:

• Information infrastructure to support disaster preparedness and mitigation
• Network-based statewide communication to support emergency management
• Automating Pistol Permit Issuance

A proposal submitted to CTG by the New York State Division of Military & Naval Affairs sought to develop a statewide communications network with electronic mail and file transfer capabilities to support the agency’s day-to-day operations and their ability to deal with emergency situations.

In addition to increasing the ability of agencies to communicate electronically to share information about emergencies as they are occurring, information and information technology can be used to identify potential for various types of emergencies and to estimate and mitigate their effects. Criminal justice is another area of public safety that requires the effective use of information and information technology. CTG received a project proposal from the New York State Police that sought to develop an application to support the issuance of pistol permits electronically. The 1997 International City/County Management Association presented a session on violent crime.