1. Client-Level Data Collection in the Houston EMA Elizabeth Love, MPH Harris County Public Health and Environmental Services Department HIV Services Section

2. FY 1998 The Ryan White Planning Council (RWPC) prioritized a client-level data collection and reporting system for the Houston EMA Desired capabilities included: –Compiling and tracking health, demographic and service utilization data –Centralizing client intake –Supporting a unit cost-based reimbursement structure –Assisting in the coordination of client care –Decreasing administrative burden on service providers

3. FY 1998 The RWPC assigned responsibility for procuring, developing, implementing and managing the system to Harris County Public Health Department’s HIV Services Section, the Title I administrative agent The RWPC determined that its role would be one of general process oversight

4. FY 1998 HIV Services facilitated a series of meetings with stakeholders to develop system criteria, cost estimates and timelines –Participants included service providers, consumers, RWPC members and representatives from other Ryan White Titles –Major issues included client confidentiality, secondary gain for providers, reduced paperwork for clients and cost

5. FY 1999 – 2000 An RFP was issued in order to procure a vendor A contractor was selected in October 1999 The logical and physical database designs were completed in March 2000 Beta version testing occurred March – May 2000 Training for system users began in April 2000 The data system went live in June 2000

7. What is the CPCDMS? The CPCDMS is a computer database application that enables Title I-funded agencies and other users to share client eligibility information and to document services delivered to clients

8. How does it work? The CPCDMS is a real-time database linking service providers together using advanced data management and communications technology Records are created, accessed and updated by providers via ISDN/DSL data linking using a unique 11-character code Client records are stored at HIV Services on a database server in SQL format

9. System Requirements – V1-3 In Versions 1-3, the system ran over an agency’s existing computer network using ISDN linking Agencies without an existing network were provided with a server and necessary workstations in a small LAN configuration All agencies were provided with an application server, workstations, printer and Cisco router

10. System Requirements – V4 In Version 4, the database runs over an agency’s existing computer network Agencies must have high-speed internet connectivity to access the system (DSL, T-1, cable modem) All agencies are provided with workstations and printers An intrusion detection and protection device exists on each side of the firewall

11. Confidentiality Clients sign consent forms agreeing to participate in the CPCDMS No client-identifying information is collected –Prior to CPCDMS Version 4, client-identifying information resided on the agency server, while non- identifying information was sent to HIV Services Client records are distinguished with unique 11- character codes

12. JHDE0727741 The 11-character code is a unique alphanumeric identifier derived from the first and third letters of a client’s first and last names, the client’s six-digit date of birth and the client’s gender –Male client John Doe, born on July 27, 1974 would have the 11-character code listed above

13. Confidentiality/Security Access to the CPCDMS is granted to specific users by HIV Services –Different database “rights” are assigned based on the duties of the user The database is password protected The data is encrypted

14. Data Collection Client Registration Service Encounter Information Medical Updates

15. Data Collection - Registration Client demographic information is collected through a process called registration, which also establishes a client’s eligibility for Title I services Examples of information collected at registration include race, ethnicity, income, mode of transmission, co-morbidities, insurance status, year of diagnosis, etc. At registration clients sign consent forms agreeing to participate in the data system

16. Data Collection - Registration Only primary care, case management and outreach/EIS providers may register clients Outreach/EIS providers must transfer “ownership” of client records to a primary care or case management provider within 60 or 120 days Registration and eligibility information is updated annually by the record-owning agency

20. Data Collection - Encounters All Title I service providers enter service encounter information for each client –This information, broken out into finite units of service, supports billing and all mandatory reporting activities A unit cost-based reimbursement structure is key for the collection of client-level data

23. Data Collection – Medical Updates In addition to encounters, primary care providers enter medical update information –Lab results, treatment information, opportunistic infection diagnoses, stage of illness diagnoses, mortality data, pregnancy status, etc.

25. Reports Agencies schedule reports using Seagate Info and Crystal Reports software Run at the central site, reports are viewed and printed at the agency site Reports are used by agencies to generate backup documentation for billing and to manage programs

29. Reports While providers can only run reports specific to their agency’s clients, HIV Services can run reports for all agencies, service categories and grant codes –The RWPC Office of Support also has this capability, with some limitations

30. Training and Support HIV Services provides hands-on training in the Health Department’s computer training room Training includes instruction on data entry, security, client confidentiality, policies, procedures, reports, forms and client consents On-site technical assistance and help desk support is provided as needed

31. Current Status 24 Ryan White-funded agencies are online and using the CPCDMS to register clients, verify client eligibility for services and document client service encounter and medical lab data –4 additional Title II-funded agencies are scheduled to come online this spring Since June 2000 over 9,800 clients have been registered

32. Version 2 CPCDMS Version 2 was implemented in March 2001. Added features included the ability to: –Batch import service encounter and medical lab data –Link every service encounter with a grant and contract –Edit and delete service encounter data –Export CPCDMS data into the TDH COMPIS system

33. Version 3 Version 3 was implemented in August 2002. Added features included the following: –A browser-based user interface that was the precursor to the current internet-based application –The elimination of servers at agencies that did not perform client registration –Reduced training and support time –The automation of survey administration and data entry

34. Version 4 Version 4 moves the system from ISDN linking to internet connectivity –A private network connection between agencies and HIV Services is no longer necessary –Providers access the system from any workstation that has internet connectivity at www.cpcdms.comwww.cpcdms.com –Servers are no longer needed at agency sites, resulting in significant resource savings

35. Oversight An RWPC standing committee meets bi-monthly to discuss CPCDMS issues and concerns –Members include consumers, service providers and representatives from other Ryan White Titles –HIV Services provides a status report at each meeting –Significant process changes are approved by the committee and the full RWPC Example – CPCDMS Version 4

36. Achievements From conception to production, the CPCDMS was implemented in less than two years The system has buy-in from all stakeholders –Service providers, consumers, RWPC, grantees Three significant system upgrades have been completed in three years The CPCDMS is HIPAA-compliant

37. Achievements Administrative processes have been automated –Providers can generate expense reports, utilization summaries and service histories Many previously-required reports are now unnecessary because HIV Services can run them –HIV Services can generate reports that summarize required data for HRSA WICY, CBC/MAI, CADR

38. Achievements The client eligibility process has been streamlined –Clients establish eligibility for all Title I services once a year –Service providers need only to access the CPCDMS to verify client eligibility

39. Achievements The unduplicated client-level data enhances planning –The RWPC incorporates CPCDMS data into their various planning activities: Setting service definitions Priorities and allocations Needs assessments Comprehensive planning

40. Achievements The CPCDMS enabled the Houston EMA to rapidly develop and implement QM activities –Outcomes evaluation –Clinical chart review –Client satisfaction measurement

41. Lessons Learned Include stakeholders in all planning and development activities Keep stakeholders informed and involved on an ongoing basis Overestimate project costs and staff time Minimize the “pain” of data entry when possible

42. Resources The Houston EMA has spent less than 3% of its combined FY98-03 grant award on developing, implementing, upgrading and maintaining the CPCDMS –45% for application development, enhancement and support –30% for equipment and software licenses –25% for grantee staff support

43. Resources HIV Services has three FTE staff members supporting the CPCDMS project –Project Coordinator –Systems Administrator –Trainer A consultant is also utilized –Significant application changes –Advanced reports development

44. For more information… Elizabeth G. Love, MPH Project Coordinator – Evaluation and QM Harris County Public Health Department HIV Services Section (713) 439-6041 elove@harriscountyhealth.com www.harriscountyhealth.com/hivservices