Montgomery County, Maryland | Department of Health and Human Services October 7, 2013

1. Integration and Interoperability in a Health and Human Services Enterprise Montgomery County, Maryland | Department of Health and Human Services October 7, 2013

2. WHO WE ARE:

3. Information about our County 3 Department of Health and Human Services 3

4. How is the Department Organized?

6. How is DHHS Organized?

7. No Wrong Door in the Future. • Seamless customer experience integrated in all 50 sites (27 program sites and 23 clinic sites) • Key to the experience will be: • Access to all DHHS Programs • Shared information and data • Customer telling their story once

8. TECHNOLOGY MODERNIZATION

9. An Aspect of Interoperability. Technology Modernization • Integrated Case Practices • Integrated Business Process • Enterprise-wide Client View • Improved Outcomes • Analytics and Individual Client Focus and Population Health Focus

10. The Process and Technology Modernization (PTM) Program lays the foundation for changing DHHS service delivery over the next few years. Drivers Goals • Changes in service delivery best practice • Changes required by the Affordable Care Act (ACA) implementation • Difficulty/cost in maintaining many one-off applications supporting programs • Inefficiencies from using multiple state systems • Improve client outcomes • Reduce overall costs of treatment • Establish single platform for most service delivery • Prepare for ACA-mandated changes • Simplify ongoing application maintenance • Realize vision of integrated DHHS

11. Service Delivery Today. The PTM Program will help HHS transform from disjointed, inefficient, program-based silos … • Clients have to “shop” for services • No consolidated view of client engagement with HHS • Integrated service delivery for only the hardest-to-serve clients

12. Service Delivery Tomorrow. … to a more integrated service delivery model that treats clients holistically and cost-effectively. • No Wrong Door for residents needing services • Consolidated view of client engagement across most programs • Integrated service delivery where appropriate Client

13. We adopted four guiding principles to serve as touchstones as we move forward.

14. The PTM Program includes 7 Interrelated Projects. IT Implementations Supporting Projects • Enterprise Integrated Case Management (EICM) • Enterprise Content Management System (ECMS) • Electronic Health Record (EHR) • US HHS Interoperability Grant • Organizational Change Management (OCM) • Project Management Office (PMO) • Quality Assurance (QA)

15. A • ADS Risk Assessment • WPA • Eligibility Determination • Application HUB (share application; eliminate dual entry) • Dependencies - • Check-in / Clearance • Registration • Program Referral • RAP • Application • Service Area Customization • Check-in / Clearance • Application • Appointment Scheduling • Registration • Appointment Scheduling • Eligibility Determination Target Phase 3 First Half • Integrations/Conversions (single view of client) • Dependencies – CIS/SAIL integration – Person Query (existing), Person Registration, Case Query (existing) Case Registration (CARES, OHEP), ECMS • Data conversion - CIS, CARES, OHEP • B • C • LotC Common/Core Functions • C Case Assignment • Service Area / Local Program Specific • D • Subsumed

16. A • ADS Risk Assessment • WPA • Service Area Customization • Provider Enrollment • Service Referrals (Manual) • Case Dispensation • Integrations/Conversions (Add new sources) • Application HUB (Add new sources) • Reporting/Analytics • RAP Target Phase 3 Second Half • B • C • LotC Common/Core Functions • C Service Plan • Provider / Serice Match • Service Strategy • Record Assessment Results • Service Area / Local Program Specific • D

17. Conversion and Batch Integration Strategy eICM State/Federal Systems of Record Iterative Conversion Process

18. Integration with Systems of Record

19. NIEM – Based Application Hub eICM

20. MONITOR PROVIDER FULFILLMENT INVOICE FOR SERVICES RENDERED Case Management Modules SERVICE TRANSACTION Current process Using System of Record CASE MANAGEMENT Automated in eICM DELIVER UNITS OF SERVICE MANAGE CASE ACTIVITY MANAGE CLIENT PARTICIPATION VERIFY CLIENT PARTICIPATION MONITOR CLIENT PROGRESS REPORT SERVICE MILESTONES MANAGE SERVICE BUDGET

21. CM/ST Interactions eICM Service Referral Case Manager Batch Process Provider Service Transaction Details State System of Record Service Transaction Details

22. Confidentiality and privacy

23. An Aspect of Interoperability. Sharing of Information • Policy and Practice • Business Process • Need to Know • Role-Based Access • Balance between Interoperability/Data-sharing and Guarding against Breaches

24. Confidentiality: Sharing Information within our Multi-Service Agency • Definition of treatment in the regulations include “related services” • In context of our department, related services include income support and social services • Addressing a client’s basic food or shelter needs greatly impacts the effectiveness of health care • Both the intent of the law and language in the rulemaking process supports this broad interpretation

26. Why Integrate Data?

27. What is our Approach? • We have a HIPAA Policy and Risk Manager leading an office of 2.5 positions • Continuously updating and staying on top of the federal and state policy environment • Continuously training and working to align policy • Our Process and Technology Modernization efforts which include the following – ECMS, eICMS, EHR, MCI, Legacy Systems and MCDHHS Portal will have policy, business process and practice alignment for HIPAA, 42CFR and other privacy statutes and regulations

28. Return on (Taxpayer) Investment/Social Return on Investment Work led by JHU Public Health Informatics School and Accenture Slides attributed to Dr. Harold Lehmann

29. Background • Application of cost-effectiveness analysis to human services • Washington State Institute for Public Policy • Evidence vs local data • Decision oriented • Klazinga, et al. Int Soc Qual Heal Care 2001 • Social return on investment • Cresswell; sroinetwork.org

30. Architectural Model Outcome Measures Costs Benefits Case vaticanus As Is To Be

31. RO(T)I Results

32. Monetizing Impact:Net Benefits by Stakeholder

33. Variables: Functional Model Costs Benefits Case • Service costs • Data costs

34. Protocol • Upper model: Trace provenance of data • Functional model: Interviews at generic level • Database model: Review database schemas • Result: • Trace data from creation to storage to outcome, along with costs: Interoperability model • Articulate benefits (as represented by the data)

35. ROTI, SROI:Based on nef, 2006 Nef=New Economics Foundation (UK) • Understand and plan • Stakeholders • Boundaries • Impact map, indicators • SROI plan Collect data Projections Analyse income, expenditure Calculate SROI Report <Cycle>

36. Questions Raised • What are the IT decisions that matter? • How far can we get with generic data? • Issue of monetizing the “upper model” outcomes • The biggest costs for the system as a whole are from NICU stays for premature babies. But those costs are not in our universe. • “Minimal modeling” (David Meltzer): Value × Durability × implementation × incidence × population.

37. What are the Markers of Success? • A seamless integrated Health and Human Services environment • Integration at the point of intake and assessment • Integration at the point of service delivery • Collaborative case practice when case acuity is severe • Improved client and patient outcomes • A more equitable service delivery system • Strong population health and program level data and analytics capabilities in addition accessible case specific data

38. Questions | Answers | More Information Uma S. Ahluwalia, Director Department of Health and Human Services | Rockville, Maryland 240.777.1266 | uma.ahluwalia@montgomerycountymd.gov