Brought to you as a Public Service by your local cable or satellite provider. Aneesh chopra, in your book, innovative state, the first three words are government doesnt work. Why do you say that . Guest i think it captures the spirit if you ask the American People in general, are you satisfied, the numbers are at an alltime low, and the perception is it isnt working. And even early days in the Obama Administration we saw some of the more challenging launches of services that really we shouldnt expect today in successful, modern, techdriven economy. And closing this gap was a big part of the motivation both for my term of duty in Public Service as well as why i wanted to write the book. Host the subtitle is how new technologies can transform government. Guest yes. Host how does the u. S. Government use technology, and does it do it successfully . Guest well, were moving in the right direction, to be sure. I try to spend a lot of my time thinking about American History in the book. You go back to our Founding Fathers who have had a long tradition of actually having government not just keep pace, but often lead the private sector in the use of technologies to solve problems. I noted, for example, that one of the founding technologies of ibm had its origins in a Census Bureau employee who faced seemingly insurmountable odds to calculate the number of people in this country in the late 1800s. So governments have long experience and history of having the capability to solve and deliver better services. Its really been in the last several decades where weve seen atydivergence between the capacy of the private sector and the public, and i think were ready to close that gap. Host why did that diversity happen . Guest well, there are a lot of reasons. In the late 1990s, there was a bipartisan movement and it is bipartisan to modernize the government. At that time while there was political consensus, there wasnt as much technological capacity. At the time that president clinton and al gore launched their reinventing government initiative, there were only 200plus web sites on the worldwide weapon. Web. The technologies of the day really hadnt reached what were seeing in the private sector of big data, mobile technologies, Cloud Computing. These are more recent capabilities, and for history, culture, act acquisition, thesee not been part of our oppositional dna in the Public Sector. Host what was your goal when you became the chief Technology Officer . Guest serve my president. Really as an enabler to advance the broader agenda that he put forward, whether it be fixing health care, helping us not only recover, but to build upon a new foundation for our economy and strengthening our Public Safety system, to name just a few. Host what was some of the issues you ran into in that position . Guest first and foremost, i think you struggle from three perspectives if you take a big picture after this. First and foremost, there are longstanding ways of operate. If you ask the average employee in the government how likely are you to be able to open up your information to the public, the perception is, no, no, i cant, ive got limits. Ive got a cultural, technical or maybe even a policy barrier that says i cant open up. So we kind of walked into an environment where some of the entrenched circumstances made it more difficult to achieve the objectives. The second thing we came across was just a bit of i wouldnt call it a gap in technology and talent, but i might say thats a shorthand for it. I literally walked in on my first day, had a computer that was connected to the internet but wouldnt allow me to access my Linkedin Profile or other social media sites for fear it was going to cause risks for white house personnel. So i was literally constrained in my literal access to technology. And last but certainly not least, weve had wouldnt call it much of a talent gap, but if you think about the private sector, the idea of new Product Development and innovation and r d have been central to the success of large swaths of our american economy. We didnt have that same r d focus on transforming Government Services delivery. And so that wasnt a muscle wed historically worked on in the proverbial gym. So with these limits and constraints, the one advantage we had that trumped all of it was a president who focused on this and was commitmented on day one. And that really trumped a lot of those limits in those early days. Host do you think that you made heldway in the culture headway in the culture gap . Guest i think we planted seeds, and my successor has built on those seeds, and were now seeing a much broader impact on the principlings that i outline in innovative state; the opportunity to open up more day day ty to, to collaborate, thinking about tapping new problem solvers through challenges and prizes, and on occasion like in recovering healthcare. Gov after its challenging launch, putting together a bit of a lean startup in how do you organize and manage such things so that specific projects get delivered at Internet Speed and with success as opposed to some of the more traditional challenges we face. Host you talk about the procurement process and how that let me just quote our government has gotten bigger, more bloated and not necessarily better. Its modern acquisition culture accepting of exorbitant costs and lengthy delays, rarely considering novel alternatives, etc. , etc. Guest and thats a legacy born of relatively good intentions, and that is a couple things. One, that in the interest of fair play, that we wanted to make sure everybody had a shot to compete for government business. And, thus, you have to be very specific about what youre looking for so that you can have an objective way of evaluating whether you choose a partner a or partner b to provide that service. Well, thats great if youre buying furniture or pencils, because we sort of know what those things are. But youre trying to define a new way of serving Health Insurance to the American People through digital means, it may not be as easy to define at the outset all the thousands of requirements one would otherwise do to make a fair and open comparison. The notion of Agile Development that will build, learn, engage the public, solicit feedback, add revisions, that iterative process has a lot more to do with procuring talent than particular approaches to software development. And theres been a bit of a myth busting that needed to be dope to say we cant to be done to say we cant do some of these things. And we learn that fixing procurement is in part a congressional issue. But its also a sort of cleaning up operational administrative capabilities. And you see with the president s launch of the new u. S. Digital service one of its clear mandates is to mythbust what can or cant be done on procurement. Some of the stuff can be done administratively. Host i wanted to ask you about that, because there was a chief Technology Officer which was you for a while. Guest yes. Host theres a federal chief Information Officer. Guest yes. Host and now theres a u. S. Digital services administrator. Guest yes. Host are we starting a little bit of overlap here . Guest oh, no. Let me be a little clearer about responsibility and why this is so critical. At the outset, when the president appointed the chief Technology Officer, he named them an assistant to the president which basically means a policy adviser. And so as weve looked at the role that i played and how my successor, todd park plays, its a direct report to the president in the senior Staff Meetings and engaging on the policy issues to say as we craft new policy or reform old policies and manage really important initiatives on behalf of the white house, are we properly utilizing technology, data and innovation . Its really a collaborative role because Health Care Reforms focused on health care reform, but there were passages making sure we have a modern i. T. Infused infrastructure for the health care system. Thats an important role. The government managed 80 billion of i. The spending. You want to be effective and efficient in how you organize your purchasing power and operationalize the capability that is, you know, the servers that operate the medicare system or how we operate web sites at immigration. So we have a chief Information Officer who sets, basically, agencywide or, you know, kind of administrationwide policy on how we better utilize the 80 billion, get more with less. And now as an an extension of these two voices policy, focusing on the external, solving problems, and policies to fix the internal operations youre now seeing more support structures in place. The Digital Services arm makes government work better, and that is a very natural extension of some of the work we started early in the first term. Host when it comes to that can 80 billion 80 billion spent on i. T. , should is it centralized, is it coordinated, should it be . Guest you know, i find this a tough question because one can make the argument that centralization leads to economies of scale, but you lose that sort of focus, if you will, on end state applications. The truth is its going to be a dynamic continuum based on the need and the circumstances in question. At a minimum, you want to make sure that every decision at the agency level is made with the best information at hand as to how to go about solving a problem. As an example, the use of Cloud Computing technologies provided by the government, private sector or through hybrid means. An agency says im going to use the public cloud to service my needs to provide a function critical to my d. , but in another circumstance, i might want to have a lot of that infrastructure on premise so that i can actually meet the need. Its not a onesizefitsall in how do you manage the monies, its to make sure each decision is infused with the best decisions. What are my options for infrastructure . How do i staff up and get the talent i need to produce the applications . How do i engage my public cusser the to know what a theyre looking for, and how might i open up as many of these interfaces as possible . Host aneesh chopra, Something Else you address is whether or not those services should be contracted out or managed by a dedicated federal work force. Guest you know, i will say this, if theres one message in the book to take away, the notion that an innovative state is characterized by handshakes and handoffs. And this speaks to your question as to who should do what. The handshakes are what washingtons been doing lately, maybe behind the curtain and not as well reported in the media, which is shaking hands on some of the key principles of an innovative state opening up data, issuing challenges and so forth. That means that the opportunity to have a more open government starts with a bipartisan commitment to lay that foundation. But whats critical in an innovative state is that youre handing off to the more than people, entrepreneurs and innovators, academic, federal, state and local levels of government to take that raw data and build more interesting products and services. Lets take weather. You and i have the right to go visit weather. Gov. Wonderful service. Exciting that we have all the capability to predict the weather. And great to have a web site that the Government Supports that makes sure you can see what you want to see. But if that was the only option we faced, if that was the only way we could learn about what we should be wearing, wed be constrained and frustrated. Noaa, the agency thats responsible for the weather service, has opened up the underlying data and invites weather. Com, yahoo weather apps, your print and tv friends to do whatever they will on top of that data. So now weve got a 5 billion private industry born in large part because weve opened up all that sensor, satellite data that would otherwise be cost prohibitive for any one company. Imagine if each company had to buy their own satellites. We bear that burden as a public utility. And if we do that across health, energy, education, safety, all these domains of government, we can start to see a much more vibrant, innovative state that isnt characterized by is the governments web site working, but rather, can i get the information i need whether i access directly from the government or through these more Personalized Services . Even healthcare. Gov has a handoff. The u. S. News world report, one of its first assignments is launching the Health Insurance finder powered by the data we released in the first version of healthcare. Gov back in july of 2010 focusing on an inventory of all the public and private Insurance Options available. That sites still live today. You can visit the Health Insurance finder and have a wonderful user experience, but the information that powers it is provided by the federal government. Host well, take it to a 2. 0. How else would this system of open government work in health care . Guest well, its an amazing opportunity because if you ask the question what do we ultimately want, whether youre a republican or democrat, you want a system thats high quality, lower cost and delivers satisfaction to the people who consume it. The former administrator of medicare and medicaid refers to this as the triple aim. I think its bipartisan in the goal. One of the ways you get there is you realize that a third of the money we spend in health care is wasted, and wasted could be defined as you could have gotten care in a cheaper setting that might have been better for you, or you shouldnt have sought that particular care at that time if youd known that you were getting worse earlier treatment, you might have prevented the need for that surgical procedure down the road. So wheres the biggest source of data . In one location its the medicare claims file. And for the first time we are opening up that data, protecting patient privacy, to be sure, but making sure folks can start to get a handle on if im at risk of blindness, should i see dr. Can x or dr. Y, and whats the likelihood he or she will prescribe a cheaper 50 drug to avoid blindness versus a 2,000 drugsome that practice pattern is now transparent and public to people can start making informed decisions about the care that they seek. And support services are increasingly being born to help aid you in making those decisions. Host what are some of the security and privacy concerns especially when it comes to Electronic Health care . Guest the most important thing we must do is strengthen if were going to use the internet, weve got to strengthen the internet so that it can provide more secure privacyprotecting capabilities. Ive often referred to this as an internet within the internet, and so in health care its the birth of the health internet. So you and i might interview each other to schedule this appointment today, but today you and your doctor arent emailing your sense thetive records on your gmail account. But, thankfully, we worked collaboratively with the private sector to say, hey, cant we use email but just add some encryption and security that werent present in the traditional forms . So within 90 days a coalition of public and private stakeholders kale together and came together and said lets achieve consensus, and today every american can, if they wanted to, get a secure health email account thats called the direct project where you can get a direct, standardized email system, and its in many cases. I have one for Microsoft Health vault, i get all of my Health Records transmitted to my personal account, but you can choose another option if you like, and thats just going to continue to flour you should. So you want to take advantage of the internet as a communications medium, but you want to have an internet on top of the internet thats more secure and more reliable and more focused on your privacy. And be thats coming, and thats working in a collaborative spirit to be brought to you. Host aneesh chopra, how did you become secretary of technology in virginia . Guest i was a constituent of virginia and working in a private sector at the Advisory Board company, writing Research Studies among things how to use the internet to make an impact in health care, getting back to the topic we just had. And thengovernor mark warner asked if i would serve on a couple of his boards or commissions. He asked me to serve on the meld care sorry, the medicaid board, and a task nows called the electronic records task force. So after i had done that when governor kaine was elected, governor warner said, hey, aneesh served me pretty well, i met with governor kaine, and we had a specific conversation. And his vision of a cabinet position called secretary of technology was not someone whod go off and do their own work, but would collaborate with the Health Secretary and say, hey, how might we Bring Technology to support your mission or education secretary or Public Safety. And so thats, essentially, the pitch i made and the conversation that we had. Had a wonderful time. Virginias been best managed state, place to raise a family, and its had a long bipartisan tradition on insuring that we infuse our government with the best technologies and the most appropriate models for innovation to solve problems. Very proud of that experience. Host people listening to this conversation are going to say, wow, thats all great and wonderful, but this revolution that youre talking about really hasnt occurred because so much is still dealt in paper and phone call. Guest you know, its funny, its changing. In just the last several ye