HIV/AIDS Interface Technology Systems (HITS): A Program Update

1
HIV/AIDS Interface Technology Systems (HITS) A
Program Update

• SPNS IT Grantees Meeting
• March 17, 2004
• County of Los Angeles Department of Health
  Services
• Office of AIDS Programs and Policy

2
Project Staff

• Ijeoma Nwachuku, Ph.D.
• Principal Investigator
• Eduardo Alvarado, MPH
• Epidemiologist, Prevention Services
• Assefa Seyoum
• Application Development Manager, Information
  Systems
• Sophia Rumanes, MPH
• Section Manager, Prevention Services

3
Estimated Persons Living with HIV/AIDS in Los
Angeles County
12,000-15,000
19,000-27,000
18,000
4
CDC Funded HIV TestingCTS 2002, Los Angeles
County

• Number of Tests 70,229
• New HIV Diagnoses 908
• New Positives Who Did
• Not Return for Results 19.71
• 67 of new positives who did not return for
  results were anonymous testers

5
HITS Project Objectives

• Increase Disclosure Rates for HIV-Positive Test
  Results
• Decrease Time Between Disclosure and Entry Into
  Care
• Improve Eligibility Screening of Enrolled Clients

6
HIV Information Resources System (HIRS )

• Standardized Data and Processes
• Integrated Data and Application Systems
• Accurate Data Maintenance and Management
• Highly Secured Systems

7
Prevention Systems, HIV Counseling and
Testing (HCT) Services
8
Information Management of AIDS Cases and
Services IMACS/Casewatch

• Used by OAPP-Contracted Care Providers
• Client-Server Architecture
• Maintains Information
• Client Registration
• Demographic
• Services Utilized

9
HITS Process Flow
10
HIV Status Follow-up SystemInterface

• Electronic Client Tracking System
• Prompts HCT Staff Follow-up With Confidential
  Testing Clients Who Do Not Return for Disclosure
• Encourages Clients to Test Confidentially

11
HIV Referral Follow-up SystemInterface

• Tailored Referrals Using On-Line Resource
  Directory
• Referred Client Information Sent to Care System
• Documents Entry Into Care
• Prompts HCT Staff With Various Follow-up
  Notifications About Referred Client

12
CARE Act Services Eligibility System Interface

• Electronically-Enhanced IMACS/Casewatch Client
  Eligibility Screening Module
• Enhances Screening for Eligibility
• Screening Begins at HCT Site
• Allows Client-Tailored Referrals

13
HITS Process/Interface Flow
14
HITS Implementation

• Evaluate Capacity
• Hardware
• Software
• Internet Capability
• Implement Security Policy
• Install, Configure and Test
• Virtual Private Network (VPN) Tools
• Internet Tools

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HITS Implementation (Contd)

• Phase I Sites (3) July 2003
• Phase II Sites (2) September 2003
• Phase III Sites (6) March 2004
• Phase IV Sites (9) by June 2004
• Phase V Sites (6) by August 2004

16
HITS Implementation (Contd)

• Training by OAPP
• Information Systems Division
• Educational Services Division
• Prevention Services Division
• Initial Training and Follow-Up
• Users Manual

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HITS Implementation (Contd)

• Support
• Technical Assistance Help Desk
• 9½ Hours per Day
• 5 Days per Week
• Systems and Database Administration
• Application Programming
• Process, Forms Reports
• Database Programming, Administration and
  Management
• Database, Applications and Operating Systems
  Security

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Implementation Plan

• Staggered Implementation
• Highest Volume Agencies
• Outpatient Medical Providers with Casewatch
• OAPP-Contracted HCT Providers 18
• Sites (gt300)
• Medical Outpatient Providers 23
• Sites (35)
• Certified HCT Counselors ? 500
• Confidential HIV-Positive
• Tests Annually ? 600

19
Orientation Process

• Steering Committee
• Community Based Organizations
• OAPP
• Capacity Building for Sustainability
• Assessment
• Batch to Business
• Training
• Monograph Development

20
Lessons Learned OAPP

• Changing Service Requirements at State and
  Federal Levels
• PEMS
• ELI
• Changing Data Collection Instruments
• CDC CTS
• HIV-6
• Policy Development

21
Lessons Learned Providers

• Technologic Issues
• Varying Levels of Capacity and Capability
• Changing Philosophies
• Confidential vs. Anonymous Testing
• Self-Referral vs. Outside-Referral
• Programmatic Issues
• Different Methodologies by Provider
• Client-Centered Philosophies
• Trust in System
• Training

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Evaluation

• Baseline Data Were Analyzed
• Calendar Years 2000 Through 2002
• HIV Counseling and Testing Database
• Care Services Databases
• Follow-up Years Include April 2004 Through March
  2006
• Anticipated Improvements
• Service Delivery
• Quality of Care
• Cost-Effectiveness

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Service Delivery Outcomes

• Decreased Time From Testing to Disclosure
• Median Time to Disclosure
• 2000 (13 days n605 P10 and P99112)
• 2001 (12 days n542 P10 and P9975)
• 2002 (9 days n566 P11 and P9962)
• More Clients Access Medical Care Services
• Utilization and Consumption
• Year Clients
  Service Units
• 2000 7,667 68,761
• 2001 12,301 111,861
• 2002 15,824 120,443

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Service Delivery (cont.)
Service Units
Clients
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Quality of Care Outcomes

• Improved Health Status on Entry
• Year HIV-Positive AIDS Unknown
• 2000 2,088 603 621
• 2001 1,485 890 0
• 2002 3,002 1,844 428
• Improved Referrals
• Comparison of HITS and Non-HITS Clients
• July 2004 Through March 2006 Survey Data

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Quality of Care (contd)
Status of Clients Entering Care
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Cost-Effectiveness Outcomes

• Increased Use of Payor Sources
• Identification of Non-RWCA Payor Sources
• Year n Proportion
• 2000 5,384 33
• 2001 6,571 49
• 2002 10,805 58
• Increased Efficiency at Provider Sites
• Comparison of Baseline and Follow-up Provider
  Survey Data
• March Through May 2004
• January Through March 2006

28
Cost-Effectiveness (cont.)
Third Party Payor Sources
29
Successes

• Improvement in Data Quality
• Integration of Services
• Increased Tracking of Linked Referrals
• Cross-OAPP Collaboration
• Monitoring of HCT Counselors for Compliance

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Next Steps

• Identify and Address Policy and Procedural
  Changes Needed to Sustain System
• Assist Users Transitioning from Current Systems
  to HITS
• Allow Resulting Data to Inform the Direction of
  HITS and Other Similar Endeavors