Services hit home

GCN Agency Award | Pa. system tracks quality of life for Pennsylvanians who have disabilities

Project at a glance

WHO: The Pennsylvania Department of Public Welfare, Office of Mental Retardation.

MISSION: Develop an integrated system that would better track services for Pennsylvania's disabled citizens.

WHAT WAS: In 1999, Pennsylvania's auditor general's office uncovered several cases of abuse and neglect in group homes for people with mental retardation. Back then, incidents were reported to the state in paper format, and sometimes it took months to get a response. The paper-based, siloed system was delaying services and benefits to people with disabilities.

WHAT IS: The Public Welfare Department began building the Home and Community Services Information System (HCSIS), a Web-based client information management system, to better track services for the 70,000 people with mental retardation who receive services from 900 provider agencies such as group homes and day programs. HCSIS has helped to reduce the use of unnecessary restraints, provide better financial accountability and improve the quality of life for Pennsylvanians with disabilities.

USERS: About 900 provider agencies, such as group homes, day programs, facilities for the elderly, transportation services and respite care; 48 county mental retardation programs; and Pennsylvania social service agencies.

IMPACT: HCSIS has saved the state more than $54 million and saved about 13,000 hours a year for the state's central office and about 79,000 hours a year for the county programs.

COST: About $50 million since 1999.

Gary Rossman says HCSIS has made supports coordinators more effective by simplifying how they manage their work.

Rick Steele

HCSIS TEAM: In front of the state Capitol are, from left, Pennsylvania CIO Kristen Miller, project manager Gary Rossman and Public Welfare Department CIO Terry Shuchart.

Rick Steele

A Web-based client information management system run by Pennsylvania's Office of Mental Retardation is doing a lot more than just speeding claims processing and tracking services. It's actually improving the quality of life for Pennsylvanians with mental retardation.

Take, for example, the reporting of incidents that occur in group homes or treatment centers. The Office of Mental Retardation in Pennsylvania's Public Welfare Department requires 900 provider agencies in the state to report unusual incidents, such as a case of abuse, an illness or a medication error, involving any of the 70,000 people enrolled in one of 48 county mental retardation programs.

Five years ago, this was an entirely paper process, said Patty McCool, regional program manager for the office's central region.

People in the regional offices would spend hours reading the written reports, McCool said. Sometimes it would take a month for the regional managers to respond to the county.

And each of the 48 counties had its own system, said Gary Rossman, division chief of the Bureau of Information Systems in Pennsylvania's Public Welfare Department.

Sharing data

Starting in 2000, Pennsylvania began to design the Home and Community Services Information System (HCSIS), a Web-based system that provides agencies within the state's Public Welfare Department with electronic access to critical health and social-services program data.

Now, an incident is entered into the incident management module as soon as it happens, McCool said. 'We can do trend analysis of reports and make improvements,' she said.

And that's just one piece of HCSIS. The system has modules for quality management, financial management and claims processing, and incident management.

HCSIS' users include county organizations and provider agencies who offer services to people with developmental or physical disabilities, the elderly and people in the state's mental health system, said Rossman, project manager of HCSIS. This all comes out to about $2 billion a year in services, he said. The 900 providers who use HCSIS include residential group homes, community day services, therapists, in-home support agencies and even some YMCA facilities.

Each individual enrolled in HCSIS has a support plan that can be called up by authorized users. The plan identifies not only basic information about the person, but also their 'hopes and dreams and what they want to accomplish,' McCool said. Before HCSIS, if someone called the regional office with a complaint, the regional office would have to call the county, which would contact the supports coordinator, the person who works directly with the individual. If that person was on vacation, the call would have to go back to the county, adding days or weeks to the process. 'Now I can just call up HCSIS and see what notes the supports coordinator put in,' McCool said. 'Having that immediate access to information has saved a lot of time, energy and effort.'
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Ellie Myers, deputy mental retardation administrator for the Dauphin County Office of Mental Health and Mental Retardation Program, said HCSIS' incident management module has brought 'a dramatic improvement' in countY services.

'Five years ago, if there was an inquiry about an individual from a legislator's office or a family member, I would have to pick up the phone and call our support coordination unit,' Myers said. 'There were only a few things I could know'if the person was enrolled in county services, or what services they received. But with HCSIS, I can go right into the individual support plan and really get a much more vivid picture of who the person is and what their needs are.'

Myers, who has worked for the county for 30 years, calls HCSIS 'invaluable.' Before moving to the system, decisions were made based on anecdotal evidence. 'It felt subjective,' Myers said. With HCSIS, 'you can take that information and quantify it.'

Terry Shuchart, CIO of the state's Public Welfare Department, said the system has turned up some hard data supporting ideas that had been widely held but never quantified. For example, within the first year, HCSIS' quality management module showed a 13 percent increase in individuals reporting a best friend other than a staff member and a 38 percent increase in the number of individuals who went out with friends and family. 'Among people with mental retardation, the key factor in your life is social relationships,' Shuchart said. 'Something as basic as getting to pick your own roommate is pretty significant.'

HCSIS helps providers 'make sure that people are asking the right questions and focusing on what is needed for that person,' Shuchart said. Because the system offers so much data so quickly, providers are able to see right away what actions make a difference in the quality of care.

HCSIS uses the state's existing Medicaid Management Information System as its claims processing component, Rossman said. 'A number of supports coordinators have said HCSIS gave them the ability to have all their case notes in one place, and this has really simplified the management of their work,' Rossman said. 'It allowed them to better track what's going on with individuals in their case load and better understand what is going on with that individual.'

Fewer restraints

One of HCSIS' early wins was a reduction in the use of restraints, either physical or chemical, in group homes and other residential facilities for the mentally retarded.

In 1999, the Pennsylvania auditor general's office discovered evidence of substandard care in several group homes for people with mental retardation. One of the problems the investigation turned up was an excessive use of restraints'either physical or chemical'by providers.

Just by looking at the number of restraints reported in HCSIS, state officials could see which providers had the most frequent use of restraints, or which individuals had been restrained the most, McCool said. 'Then the providers could work with that individual and his team to lower that incidence of restraints.' They could look at factors such as 'the person's environment and their physical health issues,' she said. 'Sometimes people who can't verbalize their aches and pains act out in a behavioral way.'

Since 2002, the use of restraints has dropped by 74 percent.

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