Complete Software Solutions for

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Complete Software Solutions for Human Services
Agencies

• TOTAL Record
• Real-time information and management
• solution for financial and clinical operations
• Quickly adapt systems to new business lines
• Real-time information access
• Benchmark clinical and financial operations
• Comprehensive clinical records management
• Easily respond to new payor requirements
• Control authorization management, claims
  validation and collections

• TOTAL Quality
• Comprehensive organizational assessment
• and continuous improvement management
• Define and communicate operational quality
• Align organization around strategic goals
• Connect evidence of compliance to standards
• Real-time management visibility of performance
• Create common processes and language around
  quality improvement

www.esteam.net
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The Information Management Process in Human
Service Organizations
May 7, 2008 ARRM Annual Conference
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Introduction

• Background
• Venture Capital
• Pressley Ridge
• Esteam, LLC

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Rapid Changes Driving Adoption of New Solutions
Human Services Agencies
Constantly changing Reimbursement Rules
Growth of Internet
Privacy Regulations
Movement to Electronic Records
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Human Services Value Chain
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Census Data on IT Spending in Human Services (7
Billion Total)
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Sizing the Medicaid Funded Market

• Long Term Care for the Disabled- MR/DD
• HCBS grew from 6 to 25 billion in ten years
  before 2002
• Waivers grew from 37 of this to 67
• Mental Health and Substance Abuse- MHSA
• National spending at 100 billion
• Medicaid payments of 26 billion
• Total Spending
• State match brings total to over 100 billion
• Technology Spending
• 1-2 billion at 1-2 of revenues

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Overview

• History
• Toyota to Medicaid
• Provider Perspective
• Pressley Ridge and Outcomes
• Whats the Buzz (words)
• Narrow it down
• Information Management Process
• Performance Improvement Focus
• Practical Considerations
• Strategy and Tactics

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History Toyota to Medicaid

• IT facilitated quality revolution
• Early success in automobile industry
• Concepts moved though various sectors
• ROI controls adoption
• Manufacturing, banking, insurance
• Most recently healthcare and EHR
• Early stages in human services
• Medicaid funding one driver

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Deming Cycle- Scientific Method

• PLAN 
• Establish the objectives and processes necessary
  to deliver results.
• DO 
• Implement the processes.
• CHECK 
• Monitor and evaluate the processes and results
  against objectives and Specifications and report
  the outcome.
• ACT 
• Apply actions to the outcome for necessary
  improvement. This means reviewing all steps
  (Plan, Do, Check, Act) and modifying the process
  to improve it before its next implementation.

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Assessment Cycle
Changing the Approach is key to success
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Human Services Perspective

• PLAN
• Outcomes- objectives
• Service Models (EBP)- processes
• DO
• Client Assessment
• Treatment or Service Plan
• Decision Support
• Case or Service Notes
• CHECK
• Information Management
• ACT
• Performance Improvement

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Whats the Buzz (words)

• The DIKW model assumes the following chain of
  action
• Data come in the form of raw observations and
  measurements.
• Information is created by analyzing relationships
  and connections between the data.
• Knowledge is created by using the information for
  action.
• Wisdom is created through use of knowledge,
  through the communication of knowledge users, and
  through reflection.

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Data Governance

• Data governance encompasses the people, processes
  and technology required to create a consistent,
  enterprise view of an organization's data in
  order to
• Increase consistency confidence in decision
  making
• Decrease the risk of regulatory fines
• Improve data security
• Consistent information quality across the
  organization
• Maximize the income generation potential of data
• Designate accountability for information quality

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Information Management

• The organization of and control over the
  structure, processing and delivery of
  information.
• For illustration, consider reports.
• What information should a specific report
  contain?
• What is the purpose of a report?
• Who is to receive the report?
• What is its frequency?

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Information Management a component of
Performance Improvement

• Performance improvement-
• organizational change concept
• measure current performance using indicators
• Compare to desired performance
• Generate plans for change to improve performance
• Essentially the Deming or Toyota process

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JCAHO Information ManagementProcess Requirements

• Identify information needs
• Information management system design
• Capture, organize, store, retrieve, process and
  analyze
• Transmit, report and display
• Security

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Information Management both-

• Facilitates Performance Improvement
• Data capture for indicators
• Reporting for comparison and improvement
• Analysis of validity of indicators
• Correlation of improvement with changes
• Subject to Performance Improvement
• Information Management Committee
• Data quality assurance standards
• Data definitions and structure
• Software should track data capture process
• Complete and on-time
• Efficient and effective security management
• New employee access and training

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Knowledge Management

• Making available increased knowledge content in
  the development and provision of products and
  services
• Facilitating and managing organizational
  innovation and learning
• Leveraging the expertise of people across the
  organization
• Managing the proliferation of data and
  information in complex business environments
• Allowing employees to access appropriate
  information sources
• Managing intellectual capital and intellectual
  assets in the workforce (such as the expertise
  and know-how possessed by key individuals) as
  individuals retire and new workers are hired

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Practical Considerations Strategy and Tactics

• Strategic plan for use of information
• Core to Performance Improvement
• Not a job for the IT Department
• Policies and procedures for data governance
• Process for data collection
• Deadlines
• Data Definitions or Dictionary
• Measures of quality
• Goal is to assure quality of date used in all
  performance improvement activities
• Organize for improvement
• Concept of an Information Unit
• Information Technology network design
• Universal, secure anytime access
• ERP software concepts
• NEXT

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Enterprise Resource Planning ERP

• Integrate several data sources and processes of
  an organization into a unified system.
• Uses multiple components of computer software and
  hardware to achieve the integration.
• Key is use of a unified database to store data
  for the various system modules.
• Using a common database allows information to be
  more reliable, accessible, and easily shared.
• Modular software design uses a variety of
  programs that can be added on an individual basis
  to improve the efficiency of the business.

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Enterprise IT

• Andrew McAfee in HBR
• Function IT- tasks
• Network IT- interactions
• Enterprise IT- processes
• Senior Management
• Purchased and imposed
• Creates-
• New interdependencies
• New processes
• New decision rights

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New Software ImplementationWhich category?

• Function IT- Tasks
• Local authority consistent with basic standards
• Established via Policy process
• Network IT- Interactions
• Common set of tools
• IT Department decision authority
• Enterprise IT- Processes
• Strategic role of information
• Board/CEO decision
• Key to Strategic Plan implementation

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Practical Considerations

• Network Design- ease of access
• Security- identity or password management
• Software compatibility
• Accounting, HR, other applications
• Role-based software and job descriptions
• Organization structure-Information organization
  chart

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Role Based Software

• Microsoft Word example
• Security Groups
• Front line staff
• Program management
• Executive
• Broader than job titles or descriptions
• Facilitates use of Dashboard concepts
• Training efficiencies
• Multiple roles is a complication

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Organization structure

• Information organization chart The information
  unit

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CCHIT Certification

• CCHIT was founded in July 2004
• CCHIT is a voluntary private-sector initiative to
  certify healthcare information technology
  products.
• CCHIT's mission is to accelerate adoption of
  interoperable EHRs by creating a mechanism for
  certification.

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California Guidelines for EHR Projects

• Functional Standards
• Provide secure, reliable, real-time access to
  client health record information where and when
  it is needed to support care.
• Support clinical applications such as
  computerized order entry and decision support
  tools.
• Capture and report specific cost and performance
  data
• Meet CCHIT behavioral health certification
  criteria within one year of BH availability

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Guidelines for EHR Projects

• Connectivity Language (Interoperability)
• Std codes-CPT, ICD 9
• Move toward HL7
• Consumer Access, Security and Privacy
• Must support HIPAA and laws covering privacy
• Support recording of informed consent
• Meet CCHIT Security Criteria 2007
• Access control
• Support audit trail

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Conclusions

• Adoption of information technology in human
  services is increasing
• Performance improvement concepts are already
  established in the sector
• A core aspect of accreditation
• Information management is an integral component
• Linkage of IT and Performance Improvement
  provides a context for strategic planning
• ERP approach helps to avoid waste of resources on
  silos of IT

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Conclusions

• Enterprise IT is fundamentally different and
  REQUIRES CEO and Board commitment
• Organizational power structure, reporting
  traditions, personal relationships will be
  changed