The Transformation Behind Mississippi’s Health Revolution

In the heart of the American South, the Mississippi Department of Health (MSDH) is embarking on an ambitious journey of digital transformation. A state which has historically ranked among the lowest in the US for health outcomes, Mississippi faces several challenges, compounded by economic disparities and a healthcare infrastructure that, while improving, still faces significant constraints.

However, under the leadership of Chief Information Officer Kane Tomlin, the agency is reimagining its approach to technology, with a focus on breaking down data silos, enhancing citizen-centric services and leveraging emerging technologies to improve public health outcomes.

Assuming the role of CIO just three months ago after serving as the agency’s Chief Information Security Officer, Kane brings a unique perspective to the role. His background, which includes stints as an Army master diver, a Special Programmes Administrator for the Florida Department of Law Enforcement and a consultant specialising in organisational behaviour and enterprise service management, has informed his approach to modernising MSDH’s technological infrastructure.

“When I talk about IT in healthcare, it's fascinating because it's truly pervasive,” Kane explains. “We're seeing the same level of digitisation in law enforcement and healthcare that I witnessed in the military. These business challenges, which initially affected the high-tech sector, have since trickled down to state and local governments, and to some extent, the federal government.”

The MSDH’s mandate is exceptionally broad, encompassing not only public health surveillance but also direct healthcare provision in underserved areas.

“The mission of our agency is to protect and advance the health, welfare and safety of everyone in Mississippi,” Kane elaborates. “We cover a wide range of areas, including disease surveillance, environmental health, injury prevention, childcare licensing, immunisations, reproductive health and licensing for various healthcare-related professions. We also play a role in emergency management, especially during hurricanes and handle aspects of public health education.”

This dual role as both a public health agency and healthcare provider in certain counties adds complexity to the MSDH’s operations and, by extension, its technological needs. It's a challenge that Kane and his team are eager to tackle.

From compliance to a holistic approach

Since joining the department in 2022, Kane has overseen a shift in focus from compliance to a more holistic approach to information technology and security. 

“When I started, we were very compliance-focused and successful in that regard,” he notes. “We passed our Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) assessments and had a heavy information technology focus. But compliance is just the first step on the information security roadmap.”

The next phase involves reducing the pain points that security compliance can create in operational processes.

“It's about continuous improvement and making sure that security doesn’t create unnecessary friction,” he says. “Now, we’re moving towards being seamlessly compliant – reducing the pain points while maintaining security.”

This approach has broader implications for IT within the agency. The MSDH is now working on systematising institutional knowledge, improving training and modernising processes to better serve both the agency and the citizens of Mississippi. 

Kane’s vision for the future is ambitious: “If I had my way, in the next three years we’d reach a point where every citizen of Mississippi could access all their healthcare data through an app. It’s a bit of a pipedream, but it's the direction I'm excited to see us moving in.”

Breaking down data silos

One of the key challenges facing the MSDH is the federated and siloed nature of healthcare data. 

Kane explains: “No one planned to scatter data everywhere, but regulations like HIPAA and FERPA, combined with the nature of technology's evolution, created many siloed systems. Now, as we enter the age of data analytics, there's a big emphasis on breaking down these silos to help citizens.”

To address this challenge, the MSDH is focusing on three main areas for improvement: IT service management, cloud architecture and asset management. The agency is expanding IT service management to encompass the entire organisation, moving more systems to the cloud and improving its understanding and management of both hardware and software assets.

Kane is particularly enthusiastic about the potential of IT service management to drive improvements across the agency. “I’m particularly excited about IT service management because it provides valuable data and insights into how our organisation operates,” he says. “It allows us to be more proactive in supporting our customers – the rest of the agency – and ultimately the citizens of Mississippi.”

This initiative aims to streamline internal processes and improve transparency across the organisation. 

“There were just too many procedural black boxes within the organisation,” Kane explains. “People knew that whenever they needed to get new printer ink, they emailed so-and-so and then it just happened – or didn't happen. That’s the magic of the black box.”

The move towards IT service management has not just been about efficiency, however; it's also been about gaining valuable insights into the organisation’s operations. Kane is particularly excited about the data analytics possibilities this shift will bring.

“As a manager, it’s not about being overly Big Brotherish; it's not about finding the people who aren’t doing the work; it's just about making things better,” he emphasises. “There’s so much good organisational data that will help us improve all of our other processes.”

Enhancing citizen-centric services through telehealth

The MSDH’s technology roadmap also places a strong emphasis on enhancing citizen-centric services. 

Telehealth has emerged as a key component of this strategy, particularly in the wake of the COVID-19 pandemic, providing both convenience and cost savings. 

“We have a small number of oncologists who are contracted or full-time employees of the Mississippi Department of Health,” Kane goes on. “So, telehealth allows us to schedule those doctors across all of our districts.

“We can't afford to hire specialists like oncologists for every county, but with telehealth, a single specialist can reach patients across the entire state. We have 82 counties in the state and we can’t hire 82 oncologists. It’s not financially feasible. And if you’re in the northern end of the state and we only have one oncologist, are you going to drive six hours to the southern end of the state for your appointment? No, you’re not going to do that.”

The benefits of telehealth extend beyond mere convenience. “It’s particularly beneficial for routine check-ups where patients might otherwise skip an appointment,” Kane points out. “We've been running telehealth in earnest since late 2022 and we're already planning a second phase to expand its capabilities. It's a win-win for both the agency and the citizens.”

More than just spanning healthcare, Kane envisions a world where these citizen-centric support services would encompass all of the different state agencies in a seamless, Amazon-like experience. 

“As a citizen of Mississippi, it would be great if you could just open an app and say, ‘Okay, I need to pay my property taxes, pay my water bill, schedule my next appointment with my primary care physician and upload my child's vaccine card for school,’ all in one smooth, app-like environment,” he muses.

“I often use Amazon as an example with my team. Amazon just works. You go there, find what you need, pay for it and it shows up. Easy. There’s no training required – everyone's figured it out. Amazon is a very successful company, so they’ve cracked the code on user experience. That’s a good role model, in my opinion, for what citizen-centric government services can look like.”

Embracing cloud computing

Another critical aspect of the department’s digital transformation is the move towards cloud computing. Kane acknowledges that the agency currently lacks the internal cloud architecture capabilities needed to fully leverage this technology. 

“We're looking at a lot more either lift and shift to a cloud environment or modernising systems and moving them to a cloud environment,” he says.

This shift towards cloud computing brings with it new challenges, particularly in the realm of API management and data integration.

“The more you push to the cloud, the more APIs become a critical piece of your organisation's data structure,” Kane notes. “We need to understand where our data is going and what systems are connecting to what systems.”

Asset management is another area of focus for Kane and his team. In an increasingly decentralised work environment, keeping track of hardware and software licences and their usage has become more complex and crucial than ever.

“We're in the anywhere workforce, anywhere workplace. So where is that laptop? Where is that mobile device?,” Kane asks rhetorically. “How many Microsoft 365 licences can I not renew right now? If you don't have an answer, then we need to do some more asset management because that is money that you're just giving away to your vendor because you're not utilising that service.”

Balancing innovation with compliance

The department’s digital transformation efforts are not without their challenges, particularly when it comes to balancing innovation with compliance in a highly-regulated healthcare environment. As a HIPAA-covered entity, the Mississippi Department of Health must navigate strict data privacy and security requirements while pushing for technological advancement.

Kane credits the department’s strong culture of compliance for giving him the freedom to innovate within these constraints. 

“We have a strong culture of compliance,” he says. “We have, of course, data governance, we have IT security, emergency management and disaster recovery. That culture of compliance is already in place and that is fantastic, and it really gives me the freedom to get in there and say, ‘okay, we know we have to be compliant, but let's do it cooler than we currently are’.”

Partnerships: Taking a collaborative approach

This balance between compliance and innovation is particularly evident in the department's approach to partnerships with technology vendors. 

To further enhance citizen-centricity, the MSDH has partnered with DocuSign to streamline processes with digital signatures and HIPAA-compliant workflows. This partnership has allowed the agency to reimagine its onboarding process using DocuSign's Contract Lifecycle Management (CLM) tool. 

“This reduces the ‘black box’ effect where requests go into a different department, and you just hope they get done. Instead, it provides transparency and efficiency, which benefits everyone involved,” Kane explains.

To navigate these challenges, Kane emphasises the importance of strong partnerships with vendors. Rather than viewing them as mere suppliers, he sees vendors as true collaborators in problem-solving. 

“Instead of dictating exactly what we want, we give them the freedom to propose solutions that might be better than what we initially envisioned,” he says.

This collaborative approach has yielded significant benefits. For instance, when discussing how DocuSign’s per-transaction billing model was a barrier to expanding usage, the company invited the MSDH to participate in a pilot programme for unlimited usage. 

“This provides financial predictability and allows us to fully leverage their tools,” Kane notes.

Similar partnerships with cybersecurity vendors like Rapid7 and Palo Alto have proven equally fruitful. 

“We present them with our challenges and ask for their best solutions,” Kane says. “This collaborative, problem-solving approach makes the work more enjoyable and productive for everyone involved.”

Navigating challenges in digital transformation

Implementing such ambitious changes is not without its challenges. 

“In government, we sometimes underestimate this, which can be to our detriment,” Kane says. “A big challenge is understanding both our organisational capacity – how much IT work we can produce – and how much change the agency can absorb. The technology might exist to move everything to the cloud, but the chaos it would create in the organisation could be overwhelming.”

Balancing competing priorities within the agency is another significant challenge.

“For example, the head of epidemiology and the head of county health services both believe their needs should come first,” Kane explains. “So, we have to balance these demands while reducing redundant systems, streamlining data flows and breaking down silos.”

The future: AI and data analytics​​​​​​​

Looking ahead, Kane sees artificial intelligence as a potential game-changer for the department, particularly when it comes to enhancing data analytics. However, he acknowledges the need for caution when implementing AI in a government healthcare setting.

“The first big use case that's going to put AI into production with the majority of government agencies, in my humble opinion, is removing the technical competency and the technical complexity of data analytics,” Kane predicts. “I have incredibly smart disease surveillance folks, epidemiologists. I have incredibly smart research and analytic folks in healthcare. They probably aren't database administrators with 20 years of experience in data structure, data queries, how databases work, one-to-many relationships, normalisation of data and so on. But they don't need to be because they're really smart at the thing that they actually need to be smart at.”

As the Mississippi Department of Health continues its digital transformation journey, Kane remains focused on the ultimate goal: improving health outcomes for the state’s citizens. By leveraging technology to push healthcare delivery closer to the patient edge, the department aims to provide more responsive and effective care while maintaining cost-effectiveness for taxpayers.

“Our digital initiatives are reshaping our approach to healthcare delivery, especially after COVID by demonstrating in real-time the power of technology to make the agency more responsive and more productive by pushing our healthcare out closer to the patient edge,” Kane concludes. “By leveraging technology, it's allowed us to support a wider audience, more varied audience while still being cost-effective to the taxpayer of Mississippi.”

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