Transcript HMIS 201: Intermediate HMIS Melinda Bussino, Brattleboro (VT) Area Drop In Center Barbara Ritter, Michigan HMIS Brenda Robbins, State PATH Contact, Arizona.

HMIS 201:
Intermediate HMIS
Melinda Bussino, Brattleboro (VT) Area Drop In Center
Barbara Ritter, Michigan HMIS
Brenda Robbins, State PATH Contact, Arizona
PRIVACY ISSUES
 Agency level issues
 Posters
 Releases
 Informed consent
 Data and information sharing across and
between agencies – MOU’s
 Closed vs. open systems
IMPLEMENTING HMIS
 State level issues around
 Voluntary or required participation
 Provision of appropriate hardware, software,
training
 Using HMIS software that works and can be
customized
 Adequate and ongoing training
 Balancing participant needs vs. data time
COMPELLING REASONS TO
MOVE FORWARD WITH HMIS
 Better to serve the consumer
 Provided a way to integrate case notes and
client level information
 Tracking of services
 Tracking of costs
 Use of self sufficiency measures
 Development of Individual Service Plans
 Entry directly into Point In Time
GETTING IT RIGHT THE FIRST
TIME
 Need for buy in from day one
 Correcting data quality is difficult
 Need to show benefits to all participants and players
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from state level staff to local providers to consumers
Measuring success
HEARTH issues in the coming year
Why the change is worth it
Good data equals compelling story
Data entry done by staff with some client service
experience, they see things that are inconsistent
REASONS TO MOVE AHEAD
 With a good release doors open to various
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possibilities and programs
The program participant gets more help
Remote case management/outreach/client service is
possible through the use of technology in the field
Working toward all agencies using same data sets
Multiple points of entry but single intake is a goal
BE SURE TO IMPLEMENT
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Posters in every area about the use of HMIS
Good privacy policies
Adequate releases
MOU with other agencies for shared data
With PATH Program participants & with DV
victims, have a good trauma informed policy
around issues that may cause privacy
concerns
Michigan Statewide HMIS
Using HMIS to Support Improved
Care for Homeless Persons
Participating in Path Services
December 2010
Michigan Statewide HMIS
 Capturing data on a shared platform from over
600 private organizations located across 83
Michigan counties.
 Includes the safety-net: Emergency Shelters,
Transitional Housing, emergency services
agencies (CAAs, Red Cross, VOA, Salvation
Armies) mental health and drug tx organizations,
youth programs, health care, churches and
missions, food pantries, and even a Laundromat.
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 29 Path programs reporting over 12,000 clients.
 13 S+C programs reporting over 1,200 clients.
 9 HOPWA programs reporting over 700 clients.
 Enables cross jurisdictional counting
About the Data Standards
 The data entry burden is based on:
 The
density of the service. Programs who only
see the consumer very briefly are only
responsible for the Universal Data Elements
(which is a small subset of elements).
 Programs that service clients overtime are
responsible for the Program Element.
 Funders may also require additional elements.
 The database can be “written-on” without
technical support allowing funders and
agencies to go beyond the data standards to
answer local questions of interest.
What is Unique about HMIS from most other databases?
The ability to share data creating a common
community social service record.
Logic is no different than the Single Medical Record
Fundamental Sharing Principals:
1. Only when it is in the common interest of
homeless persons.
2. Agencies determine what is shared with
whom. Different pieces of information may
be shared with different agencies.
3. Homeless persons must be fully informed
about any sharing and have a right to say
“yes” or “no” to the agencies plan.
Homeless persons must know and approve
where their data is shared.
Fundamental Sharing Principals Cont:
 Beyond PPI both agencies and persons
seeing data within an agencies must have a
“business reason” to see any particular piece
of data.
 PPI have been reduced to prevent identity
theft including:
 Name
 Year
of Birth
 Gender
 Last 4 digits of the SS#
Fundamental Sharing Principals Cont:
 What does PPI reveal:
 That person has sought services somewhere in
Michigan
 It does not reveal where that person has sought
services, and because the system is statewide, the
options are many.
 It does not reveal what sort of services someone has
sought and the options are wide from food banks to
treatment centers.
 Why are Statewide Systems more private.
 Because the data set is large and not geographically
restricted, the probability of re-identification is much
less.
 Consumers retain the right to close their data
Fundamental Sharing Principals Cont:
 Higher risk data requires a second release.
 Treatment
or referral information regarding
mental health, substance abuse, HIV/AIDs or
other health conditions, Domestic Violence.
 The system includes options for nameless
entry – The Un-named Record Interface.
 Agencies control of the right to refuse entry.
 Implied
consent for data entry.
 Informed about Business Associates
Agreements
How to make informed consent “informed”
 The Privacy Script:
 Accompanies
the Privacy Notice and
Release(s):
 Summarizes the Notices and explains the
agency plan for sharing in simple language –
bullet points.
 Created by the Agency reflecting the type of
data they collect.
 Standardizes the Privacy discussion.
 Hand Cards to leverage the privacy discussion.
Integrating with CMH Existing Privacy Practices
 A local Privacy Expert that trained in CMHs helped develop
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forms and protocols.
Adopted HIPAA as our bottom rule. The HMIS is HIPAA
compliant.
Michigan’s Sample HMIS Privacy Notice was modeled after
the existing CMH Privacy Notices and a version was
developed for integration into existing notices.
For organizations with existing Notices a version was released
that specified language that needed to be integrated into any
pre-existing release.
In addition to the Participation Agreement, those who manage
the System also sign BAAs.
We used Qualified Service Organization (42CFR) language to
support administrative and interagency sharing.
Uses of the System – Agency Perspective
Why Agencies have elected to Share.
 Sharing is managed at the local level based on the
local culture.
 Most of the direct benefits to consumers beyond
better systems planning involve sharing.
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Single Point of Entry / No Wrong Door allowing consumers
to complete admission forms once as they seek support
from a diversity of agencies. This also reduces data entry
time and improves the accuracy of information.
Local agencies may elect out based on unique privacy
needs – e.g. substance abuse agencies.
Michigan - Some examples of Single Point of Entry or No
Wrong Door
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Genessee/Flint
Kalamazoo
Lansing
Four County rural example – Region 2
Uses of the System – Better Care through Sharing
 Coordination of Care / Virtual ITC:
 Allows organizations to quickly review the service history
of the household both admissions and specific services.
 Allows organizations who are working with clients
simultaneously to build a coordinated plan.
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Multiple case managers understand the goals and
objectives active in partnering agencies.
Prevents conflicting expectations
Readily improves understanding of critical gaps in services.
Supports an understanding of the history and leverages
expensive assessment information.
NSO wrap around care for chronically homeless.
Property Manager / Service Delivery PSH
Michigan’s Pilot Coordinated Case Care for Jail re-entry.
Neighborhood Legal Services Case Management.
HPRP – Coordination of prevention funds.
Homeless Verification
Uses of the System – Automated Housing Case Management
 Home
based real-time automated housing case
management using tablets, portable printers,
scanners, and signature recognition software.
Supporting housing plan and creation of on the
spot rental agreements.
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Team Meetings occur daily and the record is always
current.
Case Notes are related to HUD’s 3 goals
Service Transactions completed for all services.
Reports / Reports / Reports to support performance.
 Outcomes:
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Intake time: 2 hours to 1 hour
Printing, copying and mailing time: 1 hr to 15 min
Case Review via virtual meeting: 5/wk to 15/wk
Benchmarking and Performance Improvement
 About ART in Michigan:
 Ability to understand performance objectives!
 Outcomes groups
 Regional and Statewide comparisons – a rural picture
of homelessness (recent increase in rural families).
 Reports as management information
Positive Housing Destination
LOS PSH
Income and Employment
Self Sufficiency Matrix
About Data Integration
 Some things to consider:
 Move
data using XML or CSV.
 Programming must be updates with any changes
on either the source or target systems. It is
relatively expensive to push data into an HMIS.
 Can easily build reports that move data out of the
HMIS for upload into financial and other systems.
 Real Time vs Periodic Integration
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Real time is very complex programmatically and often
results in moving “bad” data because data quality
checks have not been completed.
Most integration are periodic.
About Data Integration
 Should do a cost/benefit analysis asking the following
questions:
 How
much duplicate entry is really involved?
HUD’s questions are fairly specialized. If it is just
demographics, it may not be worth the cost.
 Can you budget for fairly routine upgrading of the
software?
 Do you have an IT department that can support
the exchange?
 Does your database Vender support data
exchange routinely and have tools already
available?
 Are there tools within the HMIS that you would like