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

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

COMPELLING REASONS TO MOVE FORWARD WITH HMIS

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

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 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

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.

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

MICHIGAN

About the Data StandardsThe 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

including the PPI.

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 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. 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 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. 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. 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: 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 Time to Up-to-Date case notes: 24hrs to 1hr

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 DestinationLOS PSH

Income and EmploymentSelf 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 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 to use to augment your services?