Client-Level Data Collection in the Houston EMA

Elizabeth Love, MPHHarris County Public Health and Environmental

Services Department

HIV Services Section

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

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

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

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

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

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

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

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

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

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

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

Data Collection

• Client Registration

• Service Encounter Information

• Medical Updates

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

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

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

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.

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

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

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

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

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

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

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.com

– Servers are no longer needed at agency sites, resulting in significant resource savings

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

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

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

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

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

Achievements

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

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

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

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

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