ARIES

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ARIES AIDS Regional Information Evaluation
System
Presentation at the RWCA Grantee Meeting,
Washington D.C. August 31, 2006
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• PRESENTATION OUTLINE
• Introduction
• Background
• ARIES Benefits
• ARIES Security
• ARIES User Requirements
• Demonstration of Selected Features
• Future Efforts
• Questions
• Contact Information

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• INTRODUCTION

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Introduction of Presenters

• Terry Cunningham, Title I, San Diego EMA,
  California, ARIES partner lead for 5 years
• Daniel Perez, Title I, Riverside/San Bernardino
  EMA, California, ARIES partner lead for 3 1/2
  years
• Darla Metcalfe, Title II, Texas, ARIES partner
  lead for 6 years
• Susan Sabatier, Title II, California, ARIES
  partner lead for 6 years.

Introduction
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What is ARIES?

• ARIES is a custom, centralized, Internet
  browser-based client case management information
  system that fulfills administrative and reporting
  needs for HIV/AIDS care.
• Staff at local HIV/AIDS provider agencies access
  the ARIES application through an internet
  connection, where they enter, manage and report
  back information on their clients.

Introduction
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What does ARIES Do?

• ARIES improves services for clients by creating a
  single point of entry, centralizing eligibility
  documents, and creating one comprehensive and
  coordinated care plan.
• ARIES enables providers to improve service
  delivery by unduplicating clients, coordinating
  client services among providers, monitoring
  health outcomes, tracking staff productivity, and
  managing contract compliance.

Introduction
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What does ARIES Do? (cont)

• ARIES improves grantees ability with monitoring
  fiscal and program compliance (by tracking
  multiple funding streams, screening for
  eligibility requirements).
• ARIES generates the CADR and WICY for Titles I,
  II, III and IV RWCA-funded providers.
• ARIES assists providers and grantees in
  generating client-level data reports and
  facilitating quality management and evaluation
  activities.

Introduction
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• BACKGROUND

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Identification of the Problem

• Starting around 1998, the California Title II and
  Riverside/San Bernardino Title I grantees
  independently began discussions on developing a
  consolidated database for publicly funded HIV
  care services. Each grantee conducted internal
  analyses.
• These analyses to consolidate and improve data
  systems were partly in response to concerns
  expressed by clients (multiple intakes) and
  providers (using multiple client data systems).
• At the same time, the developer of a particular
  HIV/AIDS client database, COMPIS, began exploring
  options to improve and enhance COMPIS.

Background
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A Collaborative Beginning

• In March 2000, the Riverside/San Bernardino
  grantee convened a meeting with COMPIS system
  users to explore converting the system to a more
  modern technology while keeping the desired
  client management features. At this meeting
  other available management information systems
  were discussed.
• Along with Riverside/San Bernardino, also present
  at this meeting were the Texas, California and
  Hawaii Title II grantees and the San Diego Title
  I grantee. Hawaii did not participate after this
  initial meeting.

Background
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Continuing the Collaboration

• Due to the technological complexity of converting
  COMPIS, and because of contracting constraints,
  the grantees decided to start anew by specifying
  system requirements.
• Each of the remaining four grantees contributed
  funds to hire a consultant to enumerate their
  current data collection systems and needs. Each
  grantee was interviewed, its business flows
  documented, and client care data collection
  system needs identified.
• This system specification process concluded that
  a custom, centralized, web-based system should be
  developed instead of attempting to modify an
  existing system.

Background
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Common Needs and Limited Resources

• This process also concluded that the four
  remaining grantees shared core data collection
  and reporting needs, basically due to RWCA
  reporting requirements.
• Because of the overlap in system needs, it made
  sense to consider jointly developing a custom
  client management information system.
• Furthermore, each grantee would have difficulty
  finding sufficient funds and staff resources to
  develop a custom system.

Background
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ARIES Partnership Formed

• After spending almost a year working with each
  other in the system specification process, a
  partnership was formed between the four grantees
  California Office of AIDS, San Diego County, San
  Bernardino County, and the Texas Department of
  Public Health.
• The partners agreed to jointly fund the
  development of a web-based client demographics
  and services tracking tool which would include
  referrals, medical indicators, and quality
  management indicators ARIES.

Background
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Implementing the Partnership Project Management

• Because of the different governmental structures,
  it was determined that a separate entity was
  needed to receive funds from each partner,
  oversee the project development process, and
  coordinate and manage the needs of each partner.
• The ARIES partners contracted with the University
  of California, Office of the President, the
  Universitywide AIDS Research Program (UARP) to
  act as the ARIES Project Manager. Each partner
  contributed 300,000.
• This contract decision reflected months of work
  by the partners, trying to determine a strategy
  that would work for each partners contracting
  requirements.

Background
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Implementing the Partnership Memorandum of
Agreement

• The four ARIES partners signed a Memorandum of
  Agreement, which delineated project expectations,
  voting structure, acceptance/rejection of
  deliverables, intellectual property ownership and
  licensing rights, and the request for proposal
  process.
• The development and signing of this document took
  months and involved legal representatives from
  each partner.

Background
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Selecting a Developer

• While hammering out the details of implementing
  the partnership, the partners continued with
  their work to document the system specifications
  for inclusion in a request for proposal (RFP).
• On December 19, 2002 UARP released the ARIES
  RFP.
• Architier (a San Francisco bay area based
  company) received the highest score and entered
  into a contract with UARP on June 2, 2003.

Background
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ARIES Local Design Teams

• Each partner put together local project teams
  consisting of partner staff and local HIV/AIDS
  service providers.
• Architier met three times with each partner and
  their local project team to elicit system needs,
  for a total of twelve multi-day meetings.
• The delineation of provider business workflows
  influenced the structure of ARIES.
• This process ensured that provider needs were
  included, and helped with provider buy-in.

Background
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Development Process

• The partners teleconference weekly, facilitated
  by UARP, the project manager.
• UARP oversaw the development work of Architier,
  and subcontracted with a technical expert to
  assist with this oversight.
• Architier submitted deliverables in a phased
  manner, with the partners reviewing and approving
  each phase.
• An Issue Tracker program is used to manage
  proposed system changes, system bugs,
  enhancements, and decisions.
• The contract with Architier concluded February,
  2006. UARP has contracted with new programmers
  for system maintenance and enhancement activities.

Background
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Implementation Status

• On January 3, 2005, Texas was the first partner
  to implement ARIES.
• Riverside/San Bernardino and San Diego
  independently implemented ARIES with selected
  providers in December 2005.
• California just began to roll out ARIES on July
  17, 2006. This grantee encountered significant
  project management requirements from its
  organization.

Background
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Change in Implementation Expectations

• The partners original intent was to collaborate
  in the development of the ARIES software, then
  implement independently (separate applications).
• Texas continues to implement separately from the
  California partners.
• However, the California grantees realized the
  benefitsboth financially and for the clientsof
  implementing just one statewide ARIES system.

Background
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Change in Implementation Expectations California

• This change in thinking is a result of the six
  years of collaboration, realizing the common
  needs of and the relationship between a Title I
  and Title II grantee, and simply establishing a
  working relationship based on trust and the
  shared goal to effectively provide services to
  our clients.
• The California partners have been presenting
  ARIES to the other California Title I grantees.
  Two additional Title I grantees have decided to
  join the states ARIES installation, with others
  still evaluating the option.

Background
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Current ARIES Usage

• Texas has 1,344 providers using ARIES, with an
  unduplicated client count of just over 30,000.
• California, including Riverside/San Bernardino
  and San Diego, has 28 providers using ARIES, with
  an unduplicated client count of nearly 5,000.
  These numbers are increasing every week.
• Early in the development process, and to increase
  provider buy-in, California agreed to build data
  conversion programs from existing state-supported
  data collection systems. A conversion program
  for CAREWare version 3.6 is also being developed.

Background
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• ARIES Benefits

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• Clients
• (When they choose to share their data with other
  providers)
• Initiates the single point of entry system
• Streamlines the intake process at subsequent
  provider sites
• Periodically verify eligibility in only one
  place
• Quicker access to services
• Easier referrals for additional services and
• May receive better care since providers have a
  better overall picture of the services provided.

Benefits
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• Providers
• Better global picture of the services provided
• Easier to track client outcomes and effectiveness
  of treatment alternatives
• Easier to plan and organize client care plans
• Elimination of data entry for referrals or repeat
  visits

Benefits
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• Providers (cont)
• Elimination of duplicate data entry for an agency
  with multiple funded care treatment programs
• Better quality data
• Ability to easily analyze client data using
  canned reports
• Ability to conduct complex analyses using the
  ad-hoc reporting feature

Benefits
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• Providers (cont)
• Simplified monthly reporting (no longer necessary
  to send monthly disks to OA) and
• Elimination of software updates and patches on
  individual provider computers updates will be
  made to the ARIES server by an ARIES
  administrator.

Benefits
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• RWCA Grantees (Titles I-IV)
• Unduplicates clients across ARIES providers
• Provides reliable client-level data
• Consolidates and updates client and service
  tracking tools
• Allows a grantee to administer each of its
  contracted providers and produce consolidated
  reports
• Allows for easier reporting to HRSA (CADR, WICY)

Benefits
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• RWCA Grantees (Titles I-IV) (cont)
• Provides relevant data to meet HRSAs quality
  management mandate
• Provides data for program monitoring and outcome
  evaluations
• Allows the grantee to provide data reports back
  to its providers and/or its Planning Council.

Benefits
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• ARIES Security

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Security at ARIES Forefront

• Security of confidential client data has been of
  primary concern throughout the entire life cycle
  of the ARIES project.
• Revisions and discussions on additional security
  enhancements continue to occur between the
  partners.

Security
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Security Measures in ARIES

• ARIES is divided into four separate applications
  ARIESClient, ARIESReportExport, ARIESImport, and
  ARIESAdmin. Users must have the appropriate
  authorization to access each of the four
  applications. This division was motivated by
  security precautions and limiting access to data.
• Encryption is used in ARIES to 1) secure
  communication over the network 2) secure files
  used by SQL server 3) secure the ARIES user
  password 4) secure database connection strings
  stored on the web server 5) secure the ARIES
  client ID and 6) secure client identifiers in
  the database.

Security
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Security Measures in ARIES (cont)

• ARIES uses dual factor authentication 1) User
  logins and passwords and 2) computers must have
  digital user certificates for each application.
  ARIES will configure these certificates for both
  the user and the machine.
• Within ARIES, there are set permissions to
  determine which screens and data elements users
  can view and edit. In other words, users will
  only be granted permission to view the screens
  that they need. This is implemented through a
  configurable role-based security mechanism.

Security
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Security Measures in ARIES (cont)

• ARIES contains a client share status option.
  When a client consents to share data, other
  agencies can view/edit his record. If a client
  does not want to share his data, then only that
  particular agency has access to his records. In
  sum, providers can only view/edit data that
  pertains to their clients and their agency.

Security
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ARIES User Requirements
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• Minimum User Requirements
• Internet Explorer 6.0 (currently, the system will
  be designed for IE 6 but will accommodate any
  future releases if they become available)
• Windows 2000 or higher operating system and
• 56k modem.
• ARIES will work more efficiently if the user
  is accessing the system through DSL, cable, or
  satellite connection.

Requirements
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• Demonstration of Selected Features

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Online Help

• ARIES contains a context-sensitive help manual.
  When a user presses F1 within the ARIES
  application, it takes the user to that area of
  the help manual.
• The help feature also includes a glossary, index
  and find features.

Features
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(No Transcript)
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Demographics Contact Information
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Demographics Demographic Detail
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Demographics Living Situation
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Demographics - HOWPA
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Demographics Agency Specifics
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Eligibility Eligibility Documents
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Eligibility Documents - Financial
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Eligibility Documents - Insurance
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Programs CARE/HIPP
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Medical Basic Medical
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Medical Medical History
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Medical OB/Gyn Pregnancy
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Medications - ART
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Medications Other Medications
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Risk Factors
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Risk Factors Substance Abuse
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Risk Factor Mental Health
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Care Plan Needs Assessment
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Care Plan Care Plan Tasks
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Care Plan - Referrals
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Case Notes
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Agency Info - Main
Additional Site
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Agency Info Funding Contracts
Contract Set Up On 2 Edit screens
Benefit 1. Facilitates Contract Monitoring
Increases Accountability
Benefit 2. Facilitates Agencys Ability to Track
Services and Service Costs by Contract
Benefit 3. Facilitates Agencys Ability to Track
Service Delivery by Allowing for Point of Service
Screening
Benefit 4. Facilitates Grantees Ability to
provide Planning Council Useful and Accurate
Planning Data
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Agency Info Services Provided
Unduplicated Client Target
Contract Scope of Work Targets
Unit Cost
Contracted Budget Amount
Unit Of Service Definition
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Services
Benefit Allows Line Staff, Agencies, and
Grantee to Run Reports on Service Delivery
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Service Entry
Benefit 1 Facilitates Agency Ability to
Improve Screening by Attaching Service to Funding
Benefit 2 Facilitates Grantees Agencys
Ability to Track Services Service Costs by
Contract
Pre-established Default Unit Cost
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• Future Efforts

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Continuing to Improve ARIES

• The partners plan to continue to work together to
  improve ARIES.
• UARP will continue as the ARIES project manager,
  and oversee the programming support for continued
  enhancements and system fixes.
• Plans are currently underway to reconfigure ARIES
  into an n-tier architecture, and migrate to
  Microsoft SQL 2005 and the .NET 2.0 Framework.
• California funds an external help desk for its
  agency ARIES users. Texas uses their
  Administrative Agencies for first level help
  Texas state staff operate as the second level of
  help.

Future Efforts
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HOPWA Enhancement

• ARIES was built to produce the 2005 HOPWA
  Progress Report and meet HUDs reporting
  requirements.
• Analysis is currently underway with the intent of
  incorporating the new HOPWA reporting
  requirements recently released by HUD.
• The ARIES partners plan on working with HUD staff
  to include a new HOPWA Progress Report in ARIES.

Future Efforts
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Medical Flowsheet

• At the request of medical providers, a future
  ARIES release will include a major enhancement to
  produce a client medical flowsheet.

Future Efforts
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ARIES Governance Committee

• For the past five years the four ARIES partners,
  managed by UARP, have made all ARIES
  specification, content and enhancement decisions.
• As other California EMAs begin to adopt
  Californias ARIES installation, this partnership
  needs to be expanded. A new ARIES Governance
  Committee will be formed to make policy decisions
  and guide future enhancements.

Future Efforts
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ARIES Booth for Demonstration and Materials
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Questions
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Contact Information
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For General ARIES Information

• UARP Project Manager
• Jenny Martin
• Jenny.Martin_at_ucop.edu
• Californias project web page www.projectaries.or
  g

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Presenters Contact Information

• Terry Cunningham
• County of San Diego (California)
• HIV, STD, and Hepatitis Branch of Public Health
  Services
• Terry.Cunningham_at_sdcounty.ca.gov
• Daniel Perez
• San Bernardino County (California)
• Public Health Program Coordinator, RWCA Title
  I/II
• DPerez_at_dph.sbcounty.gov

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Presenters Contact Information

• Darla Metcalfe
• Texas Department of State Health Services
• URS Project Director
• Darla.Metcalfe_at_dshs.state.tx.us
• Susan Sabatier
• California Department of Health Services
• Office of AIDS, Care Research Evaluation
  Section
• ssabatie_at_dhs.ca.gov