HIV/AIDS Interface Technology Systems (HITS): A Program UpdateSPNS IT Grantees MeetingMarch 17, 2004
County of Los Angeles Department of Health Services
Office of AIDS Programs and Policy
2
Project Staff
Ijeoma Nwachuku, Ph.D. Principal InvestigatorEduardo Alvarado, MPH Epidemiologist, Prevention ServicesAssefa Seyoum Application Development Manager, Information SystemsSophia Rumanes, MPH Section Manager, Prevention Services
* Estimates from LAC HIV Epidemiology Program and CDC as of February 2004 3
Estimated Persons Living with HIV/AIDS in Los Angeles County
0
10,000
20,000
30,000
40,000
50,000
60,000
All HIV
Undiagnosed HIVDiagnosed HIV PLWA
Estimated 54,000 living
with HIV/AIDS in Los Angeles
County
12,000-15,000
19,000-27,000
18,000
4
CDC Funded HIV TestingCTS 2002, Los Angeles CountyNumber of Tests
70,229New HIV Diagnoses
908New Positives Who Did Not Return for Results
19.71%67% of new positives who did not return
for results were anonymous testers
5
HITS Project Objectives
Increase Disclosure Rates for HIV-Positive Test Results
Decrease Time Between Disclosure and Entry Into Care
Improve Eligibility Screening of Enrolled Clients
6
HIV Information Resources System (HIRS )
Standardized Data and Processes Integrated Data and Application
SystemsAccurate Data Maintenance and
ManagementHighly Secured Systems
7
Prevention Systems, HIV Counseling and Testing (HCT) Services
CLIENTREGISTRATION
CLIENT RISKASSESSMENT
CLIENTHIV TESTING
CLIENTDISCLOSURECOUNSELING
PREVENTION/CARE
REFERRAL
POSTDISCLOSURECOUNSELING
PCRSCOUNSELING
CLIENTPREVENTIONFOLLOW-UP
CAREREFERRAL
COUNSELING
CAREREFERRAL
FOLLOW-UP
CLIENT GETSCARE
SERVICES
PREVENTIONREFERRAL
COUNSELING
CLIENTINTERVENTION
SERVICE/S
8
Information Management of AIDS Cases and Services IMACS/Casewatch
Used by OAPP-Contracted Care Providers
Client-Server Architecture Maintains Information
Client RegistrationDemographicServices Utilized
9
HITS Process FlowHIV Information
Resources System (HIRS)
HIV Prevention System - HCT ModuleHIV/LA
ResourceDirectory
IMACS/Casewatch
AnonymousTesting Client
ConfidentialTesting Client
Enc
ount
er: H
IV T
estin
g an
d C
ouns
elin
g
Enc
ount
er: H
IV T
est R
esul
ts
Does notreturn: can't
follow up
HIV +
HIV +
Technology: HIVReferral Follow-upSystem (HRFUS)Program: C/T Follow-up
PreventionInterventions
Enc
ount
er: E
ligib
ility
Scr
eeni
ng &
Tai
lore
d R
efer
ral
Enc
ount
er: C
AR
E A
ct S
ervi
ce
Technology: CAREAct Service Eligibil-ity System (CASES)Program: Intake
UniqueIdentifier
No personalinfo: can'tfollow up
Becomesconfidential client
IntegratedSystem
Sub-systems
Interfaces(technologyadaptations)
Follow-up
Does notreturn for
test resultsDoes notaccessservices
Technology: HIVStatus Follow-upSystem (HSFUS)Program: PreventionCounselor Follow-up
HIV+ ClientReferral
HIV+ ClientFollow-Up
10
HIV Status Follow-up SystemInterface
Electronic Client Tracking SystemPrompts HCT Staff Follow-up With
Confidential Testing Clients Who Do Not Return for Disclosure
Encourages Clients to Test Confidentially
11
HIV Referral Follow-up SystemInterface
Tailored Referrals Using On-Line Resource Directory
Referred Client Information Sent to Care System
Documents Entry Into CarePrompts HCT Staff With Various
Follow-up Notifications About Referred Client
12
CARE Act Services Eligibility System Interface
Electronically-Enhanced IMACS/Casewatch Client Eligibility Screening Module
Enhances Screening for EligibilityScreening Begins at HCT Site
Allows Client-Tailored Referrals
13
HITS Process/Interface Flow
HIRS-HCTDisclosure
HIRS-HCTCARE
REFERRAL
SPNSFinancialScreening
SPNSSEARCH &
SELECTPROVIDERS
SPNS to/from
CasewatchINTERFACE
Casewatchto/fromSPNS
INTERFACE
CasewatchCARE
SERVICEDELIVERY
CareServices
(Casewatch)Intake/
Rgistration
LAC-AIDSSERVICE
DIRECTORY
HIRS-HCT
HIRS-HCT SPNS
CASEWATCH
LAC-ASD
HIRS-HCT & SPNS Task GridOUTSTANDING TASKS
HCT Disclosures
Scheduled for Disclosure But No-Show
Follow ups for Disclosures
HCT Care Referrals
HCT Care ReferralsView/Reports
Casewatch to HIRS-HCT-SPNS Care Referrals
SPNS Care Referrals
LAC-ASD SearchCare Providers
Care Referral (HIRS-SPNS)Client Reg./Intake Records
HIRS-HCT CareReferrals Transactions
Client Record Sent to Casewatch
Client No-Show for Care (Reg./Intake)
Client Reg. But No Care Service
Client Received Care ServiceHCT-SPNS Care Referrals
SPNS Financial Screening
SPNS Care ReferralsView/Reports
View/Report SPNSFinancial Screening
Select CareProviders/ Agencies
LAC-ASD SelectCare Providers
HIRS-HCT-SPNS to CareReferrals Transactions
Casewatch to HIRS-HCTCare Referral Follow-ups
Care (Casewatch) Follow-up toHIRS-HCT-SPNS Transactions
HIRS-HCT-SPNS to CareReferrals (Casewatch) Interface
Care Follow-ups (Casewatch)to HIRS-HCT-SPNS Interface
HIRS-HCT Care Follow-up Transactions
Care (MOP)Service Delivery
Care (MOP) ServiceDelivery View/Reports
Care Referral (HIRS-SPNS)Client Reg./Intake View/Report
Client (HIRS-SPNS) CareServices (Casewatch) Reg./
Intake Records
Client Care (MOP) Services/Delivery/Follow Up Records
HIRS-HCT DisclosureScheduled No-Shows
HIRS-HCT Disclosure ScheduledNo-Shows Follow-Ups
14
HITS Implementation
Evaluate CapacityHardwareSoftwareInternet Capability
Implement Security Policy Install, Configure and Test
Virtual Private Network (VPN) Tools
Internet Tools
15
HITS Implementation (Cont’d)
Phase I Sites (3)
July 2003
Phase II Sites (2)
September 2003
Phase III Sites (6)
March 2004
Phase IV Sites (9)
by June 2004
Phase V Sites (6)
by August 2004
16
HITS Implementation (Cont’d)
Training by OAPPInformation Systems DivisionEducational Services DivisionPrevention Services Division
Initial Training and Follow-UpUser’s Manual
17
HITS Implementation (Cont’d)
SupportTechnical Assistance Help Desk
9½ Hours per Day 5 Days per Week
Systems and Database AdministrationApplication Programming
Process, Forms ReportsDatabase Programming,
Administration and ManagementDatabase, Applications and
Operating Systems Security
18
Implementation PlanStaggered Implementation
Highest Volume AgenciesOutpatient Medical Providers with
CasewatchOAPP-Contracted HCT Providers 18
Sites (>300)
Medical Outpatient Providers 23Sites (35)
Certified HCT Counselors 500Confidential HIV-Positive Tests Annually 600
19
Orientation ProcessSteering Committee
Community Based OrganizationsOAPP
Capacity Building for SustainabilityAssessmentBatch to BusinessTrainingMonograph Development
20
Lessons Learned: OAPP
Changing Service Requirements at State and Federal LevelsPEMSELI
Changing Data Collection InstrumentsCDC CTSHIV-6
Policy Development
21
Lessons Learned: Providers Technologic Issues
Varying Levels of Capacity and Capability
Changing PhilosophiesConfidential vs. Anonymous TestingSelf-Referral vs. Outside-Referral
Programmatic IssuesDifferent Methodologies by ProviderClient-Centered PhilosophiesTrust in SystemTraining
22
EvaluationBaseline Data Were Analyzed
Calendar Years 2000 Through 2002HIV Counseling and Testing DatabaseCare Services Databases
Follow-up Years Include April 2004 Through March 2006
Anticipated ImprovementsService DeliveryQuality of CareCost-Effectiveness
23
Service Delivery OutcomesDecreased Time From Testing to
DisclosureMedian Time to Disclosure
2000 (13 days; n=605; P1=0 and P99=112)
2001 (12 days; n=542; P1=0 and P99=75)
2002 (9 days; n=566; P1=1 and P99=62)
More Clients Access Medical Care ServicesUtilization and Consumption Year Clients Service Units
2000 7,667 68,761
2001 12,301 111,861
2002 15,824 120,443
24
Service Delivery (cont.)
12,3017,66715,824
120,443111,861
68,761
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2000 2001 2002
YEAR
VA
LU
E
Utilization Consumption
Service Units
Clients
25
Quality of Care Outcomes Improved Health Status on Entry
Year HIV-Positive AIDS Unknown2000 2,088 603 6212001 1,485 890 02002 3,002 1,844 428
Improved ReferralsComparison of HITS and Non-HITS
Clients July 2004 Through March 2006 Survey
Data
*HIV-negative clients not depicted 26
Quality of Care (cont’d)
63%
18% 19%
57%
34%
0%
52%
32%
7%
2000 2001 2002
HIV AIDS Unknown
Status of Clients Entering Care
27
Cost-Effectiveness Outcomes
Increased Use of Payor SourcesIdentification of Non-RWCA Payor Sources Year n Proportion
2000 5,384 33% 2001 6,571 49% 2002 10,805 58%
Increased Efficiency at Provider SitesComparison of Baseline and Follow-up
Provider Survey Data March Through May 2004 January Through March 2006
28
Cost-Effectiveness (cont.)
0%
10%
20%
30%
40%
50%
60%
Private 6% 8% 16%
Medicare 1% 7% 3%
Medicaid 15% 28% 34%
Other Public 12% 4% 1%
Other 0% 3% 4%
No Insurance 37% 51% 42%
Unknown 29% 0% 0%
2000 2001 2002
Third Party Payor Sources
29
Successes
Improvement in Data Quality Integration of Services Increased Tracking of Linked ReferralsCross-OAPP CollaborationMonitoring of HCT Counselors for
Compliance
30
Next Steps
Identify and Address Policy and Procedural Changes Needed to Sustain System
Assist Users Transitioning from Current Systems to HITS
Allow Resulting Data to Inform the Direction of HITS and Other Similar Endeavors