Client Access to Integrated Services and Information (CAISI) a tool for improved service delivery, research and evaluati

1. Client Access to Integrated Services and Information (CAISI)a tool for improved service delivery, research and evaluation Ottawa Inner City Health Nov 2006

2. Overview of the Presentation • What is CAISI? • the complexities of helping people who are chronically homeless • Why CAISI was developed • Implications of use • Next steps

3. What is CAISI? • A software system which allows you to register homeless clients once on the system and manage their care from multiple sites and programs • The system is accessible through the internet using secure systems to protect information • The system includes a function for case management, referrals to different programs and a health record system

4. Challenges of Working with the Chronically Homeless • Services are oriented for short term crisis intervention • Need for multiple services, different kinds of providers, often at different locations • Realities of a lifestyle characterized by instability, lack of planning and follow through on the part of the client,

5. As a result • Client access multiple services over a long period of time but, each service acts like it is a new event • Services are often unaware of what others are doing currently and what was done in the past • Many clients are “poor historians” and may fail to relay information which is important to the service provider

6. Who are the Chronically Homeless? • Typically constitute 10-20% of the homeless in any major city • Live in the shelters or on the streets for years with brief periods of housing • Complex profile of substance use, mental and physical illnesses and behaviors which are well adapted to street culture but not necessarily to other situations

7. The Birth of CAISI Developed in response to call for better integration of services for the chronically homeless in Toronto Developed by the City of Toronto with financial support from the Supporting Communities Partnership Initiative (SCIPI) -

8. CAISI Vision To end chronic homelessness among those with severe mental illness, addictions and disability through: • More integrated individual care • Population care and advocacy • Improved quality of care by using available technology to support provision of services

9. Development of CAISI 1) Open source IT development (free to all) 2) Front line agencies custom develop with project team 3) Rapid and frequent release of changes 4) Build on currently available systems 5) Privacy of clients part of development of the system

10. CAISI Open Development – Systems Currently being integrated through CAISI • OSCAR (electronic medical record) • UHN PRO Integration (hospital system) • EMS: e-PCR in Toronto • ??HIFIS (shelter system)

11. CAISI Target Groups / Partner Agencies • Shelters • Drop-in centres • Mobile Outreach teams • Hospitals • Primary care providers • EMS / Public Health • Advocacy groups / other

12. 2.0 CAISI Background CAISI IT Functionality: • Health intake • Referral • Queuing • Program admission and discharge • Multi-agency case management • Individual level reports • Population level reports

13. Who is Using CAISI • Toronto Seaton House • Ottawa Inner City Health • Hamilton MAP program • Street Health (limited)

14. Privacy Issues Privacy ‘the right of an individual to control his or her personal information.’ Clients must give consent to be registered on the system and for information to be shared between providers

15. CAISI Privacy: • Build on experience of similar systems • Will encompass HIC and non-HIC agencies • Parallel Privacy Processes: • City legal privacy support • Toronto CAP PIA

16. Privacy – Vulnerable Clients • Improve on existing mechanisms of client privacy and consent • Role based access to information • Mechanisms to check competence • Multiple modes of messaging • Clear decision making when consent cannot be obtained

17. Privacy • PHIPA (Provincial Health Information) • Build on UHN PRO experience • Extend circle of care • Lock box function is missing from current system • MFIPPA (Provincial Municipal Information) • City Legal support • City of Toronto Privacy Impact Assessment

18. CAISI - Sustainability • governance • Ongoing development • Resourcing • Hosting

19. CAISI as a tool for Improved Services, Evaluation and Research CAISI Outcomes • Short term • Early identification and referral • Assessment of all clients in partner agencies • Number of homeless with disability / mental illness • Medium term • Agencies providing integrated care • Increased client satisfaction • Long term • More effective use of social and health services • End of homelessness among those with mental illness / addictions / disability

20. The Possibilities in Ottawa • Currently in use at all Inner City Health locations • Will be used in Mission Primary Care Clinic and by outreach nurses next • Server and data base will be available to other organizations who wish to join in once the health care providers are fully integrated and some functional issues are resolved