HIV/AIDS Interface Technology Systems (HITS): A Program Update

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  • Gunther
  • Introduction: Include piece on getting trust from counselors/clients to use an electronic entity within the counseling session. Financial screening (IS and R& E) Referrals (PSD) Task list (IS)
  • Challenges and deployment strategy must reflect HITS Language and focus, but mindful of the HIRS system. The HIRS system is the carrier (Microsoft) for the program/HITS (Powepoint). Formal Written Communication CBO Steering Committee Meetings Orientation Meetings with each provider Training Sustainability (Capacity building) 4 th year plan for Monograph development?
  • Challenges and deployment strategy must reflect HITS Language and focus, but mindful of the HIRS system. The HIRS system is the carrier (Microsoft) for the program/HITS (Powepoint). Formal Written Communication CBO Steering Committee Meetings Orientation Meetings with each provider Training Sustainability (Capacity building) 4 th year plan for Monograph development?
  • Success’ will follow at end (overall for presentation) Challenges Internal vs. external HIRS
  • HIV/AIDS Interface Technology Systems (HITS): A Program Update

    1. 1. HIV/AIDS Interface Technology Systems (HITS): A Program Update SPNS IT Grantees Meeting March 17, 2004 County of Los Angeles Department of Health Services Office of AIDS Programs and Policy
    2. 2. Project Staff <ul><li>Ijeoma Nwachuku, Ph.D. </li></ul><ul><li>Principal Investigator </li></ul><ul><li>Eduardo Alvarado, MPH </li></ul><ul><li>Epidemiologist, Prevention Services </li></ul><ul><li>Assefa Seyoum </li></ul><ul><li>Application Development Manager, Information Systems </li></ul><ul><li>Sophia Rumanes, MPH </li></ul><ul><li>Section Manager, Prevention Services </li></ul>
    3. 3. Estimated Persons Living with HIV/AIDS in Los Angeles County 12,000-15,000 19,000-27,000 18,000 Estimated 54,000 living with HIV/AIDS in Los Angeles County
    4. 4. CDC Funded HIV Testing CTS 2002, Los Angeles County <ul><li>Number of Tests 70,229 </li></ul><ul><li>New HIV Diagnoses 908 </li></ul><ul><li>New Positives Who Did </li></ul><ul><li>Not Return for Results 19.71% </li></ul><ul><ul><li>67% of new positives who did not return for results were anonymous testers </li></ul></ul>
    5. 5. HITS Project Objectives <ul><li>Increase Disclosure Rates for HIV-Positive Test Results </li></ul><ul><li>Decrease Time Between Disclosure and Entry Into Care </li></ul><ul><li>Improve Eligibility Screening of Enrolled Clients </li></ul>
    6. 6. HIV Information Resources System (HIRS ) <ul><li>Standardized Data and Processes </li></ul><ul><li>Integrated Data and Application Systems </li></ul><ul><li>Accurate Data Maintenance and Management </li></ul><ul><li>Highly Secured Systems </li></ul>
    7. 7. Prevention Systems, HIV Counseling and Testing (HCT) Services
    8. 8. Information Management of AIDS Cases and Services IMACS/Casewatch <ul><li>Used by OAPP-Contracted Care Providers </li></ul><ul><li>Client-Server Architecture </li></ul><ul><li>Maintains Information </li></ul><ul><ul><li>Client Registration </li></ul></ul><ul><ul><li>Demographic </li></ul></ul><ul><ul><li>Services Utilized </li></ul></ul>
    9. 9. HITS Process Flow
    10. 10. HIV Status Follow-up System Interface <ul><li>Electronic Client Tracking System </li></ul><ul><li>Prompts HCT Staff Follow-up With Confidential Testing Clients Who Do Not Return for Disclosure </li></ul><ul><li>Encourages Clients to Test Confidentially </li></ul>
    11. 11. HIV Referral Follow-up System Interface <ul><li>Tailored Referrals Using On-Line Resource Directory </li></ul><ul><li>Referred Client Information Sent to Care System </li></ul><ul><li>Documents Entry Into Care </li></ul><ul><li>Prompts HCT Staff With Various Follow-up Notifications About Referred Client </li></ul>
    12. 12. CARE Act Services Eligibility System Interface <ul><li>Electronically-Enhanced IMACS/Casewatch Client Eligibility Screening Module </li></ul><ul><li>Enhances Screening for Eligibility </li></ul><ul><ul><li>Screening Begins at HCT Site </li></ul></ul><ul><li>Allows Client-Tailored Referrals </li></ul>
    13. 13. HITS Process/Interface Flow
    14. 14. HITS Implementation <ul><li>Evaluate Capacity </li></ul><ul><ul><li>Hardware </li></ul></ul><ul><ul><li>Software </li></ul></ul><ul><ul><li>Internet Capability </li></ul></ul><ul><li>Implement Security Policy </li></ul><ul><li>Install, Configure and Test </li></ul><ul><ul><li>Virtual Private Network (VPN) Tools </li></ul></ul><ul><ul><li>Internet Tools </li></ul></ul>
    15. 15. HITS Implementation (Cont’d) <ul><li>Phase I Sites (3) July 2003 </li></ul><ul><li>Phase II Sites (2) September 2003 </li></ul><ul><li>Phase III Sites (6) March 2004 </li></ul><ul><li>Phase IV Sites (9) by June 2004 </li></ul><ul><li>Phase V Sites (6) by August 2004 </li></ul>
    16. 16. HITS Implementation (Cont’d) <ul><li>Training by OAPP </li></ul><ul><ul><li>Information Systems Division </li></ul></ul><ul><ul><li>Educational Services Division </li></ul></ul><ul><ul><li>Prevention Services Division </li></ul></ul><ul><li>Initial Training and Follow-Up </li></ul><ul><li>User’s Manual </li></ul>
    17. 17. HITS Implementation (Cont’d) <ul><li>Support </li></ul><ul><ul><li>Technical Assistance Help Desk </li></ul></ul><ul><ul><ul><li>9½ Hours per Day </li></ul></ul></ul><ul><ul><ul><li>5 Days per Week </li></ul></ul></ul><ul><li>Systems and Database Administration </li></ul><ul><ul><li>Application Programming </li></ul></ul><ul><ul><ul><li>Process, Forms Reports </li></ul></ul></ul><ul><ul><li>Database Programming, Administration and Management </li></ul></ul><ul><ul><li>Database, Applications and Operating Systems Security </li></ul></ul>
    18. 18. Implementation Plan <ul><li>Staggered Implementation </li></ul><ul><ul><li>Highest Volume Agencies </li></ul></ul><ul><ul><li>Outpatient Medical Providers with Casewatch </li></ul></ul><ul><li>OAPP-Contracted HCT Providers 18 </li></ul><ul><ul><li>Sites (>300) </li></ul></ul><ul><li>Medical Outpatient Providers 23 </li></ul><ul><ul><li>Sites (35) </li></ul></ul><ul><li>Certified HCT Counselors  500 </li></ul><ul><li>Confidential HIV-Positive </li></ul><ul><li>Tests Annually  600 </li></ul>
    19. 19. Orientation Process <ul><li>Steering Committee </li></ul><ul><ul><li>Community Based Organizations </li></ul></ul><ul><ul><li>OAPP </li></ul></ul><ul><li>Capacity Building for Sustainability </li></ul><ul><li>Assessment </li></ul><ul><li>Batch to Business </li></ul><ul><li>Training </li></ul><ul><li>Monograph Development </li></ul>
    20. 20. Lessons Learned: OAPP <ul><li>Changing Service Requirements at State and Federal Levels </li></ul><ul><ul><li>PEMS </li></ul></ul><ul><ul><li>ELI </li></ul></ul><ul><li>Changing Data Collection Instruments </li></ul><ul><ul><li>CDC CTS </li></ul></ul><ul><ul><li>HIV-6 </li></ul></ul><ul><li>Policy Development </li></ul>
    21. 21. Lessons Learned: Providers <ul><li>Technologic Issues </li></ul><ul><ul><li>Varying Levels of Capacity and Capability </li></ul></ul><ul><li>Changing Philosophies </li></ul><ul><ul><li>Confidential vs. Anonymous Testing </li></ul></ul><ul><ul><li>Self-Referral vs. Outside-Referral </li></ul></ul><ul><li>Programmatic Issues </li></ul><ul><ul><li>Different Methodologies by Provider </li></ul></ul><ul><ul><li>Client-Centered Philosophies </li></ul></ul><ul><ul><li>Trust in System </li></ul></ul><ul><ul><li>Training </li></ul></ul>
    22. 22. Evaluation <ul><li>Baseline Data Were Analyzed </li></ul><ul><ul><li>Calendar Years 2000 Through 2002 </li></ul></ul><ul><ul><li>HIV Counseling and Testing Database </li></ul></ul><ul><ul><li>Care Services Databases </li></ul></ul><ul><li>Follow-up Years Include April 2004 Through March 2006 </li></ul><ul><li>Anticipated Improvements </li></ul><ul><ul><li>Service Delivery </li></ul></ul><ul><ul><li>Quality of Care </li></ul></ul><ul><ul><li>Cost-Effectiveness </li></ul></ul>
    23. 23. Service Delivery Outcomes <ul><ul><li>Decreased Time From Testing to Disclosure </li></ul></ul><ul><ul><ul><li>Median Time to Disclosure </li></ul></ul></ul><ul><ul><ul><ul><li>2000 (13 days; n=605; P 1 =0 and P 99 =112) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2001 (12 days; n=542; P 1 =0 and P 99 =75) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2002 (9 days; n=566; P 1 =1 and P 99 =62) </li></ul></ul></ul></ul><ul><ul><li>More Clients Access Medical Care Services </li></ul></ul><ul><ul><ul><li>Utilization and Consumption </li></ul></ul></ul><ul><ul><ul><li>Year Clients Service Units </li></ul></ul></ul><ul><ul><ul><li>2000 7,667 68,761 </li></ul></ul></ul><ul><ul><ul><li>2001 12,301 111,861 </li></ul></ul></ul><ul><ul><ul><li>2002 15,824 120,443 </li></ul></ul></ul>
    24. 24. Service Delivery (cont.) Service Units Clients
    25. 25. Quality of Care Outcomes <ul><ul><li> Improved Health Status on Entry </li></ul></ul><ul><ul><ul><li>Year HIV-Positive AIDS Unknown </li></ul></ul></ul><ul><ul><ul><li>2000 2,088 603 621 </li></ul></ul></ul><ul><ul><ul><li>2001 1,485 890 0 </li></ul></ul></ul><ul><ul><ul><li>2002 3,002 1,844 428 </li></ul></ul></ul><ul><ul><li>Improved Referrals </li></ul></ul><ul><ul><ul><li>C omparison of HITS and Non-HITS Clients </li></ul></ul></ul><ul><ul><ul><ul><li>July 2004 Through March 2006 Survey Data </li></ul></ul></ul></ul>
    26. 26. Quality of Care (cont’d) Status of Clients Entering Care
    27. 27. Cost-Effectiveness Outcomes <ul><ul><li>Increased Use of Payor Sources </li></ul></ul><ul><ul><ul><li>Identification of Non-RWCA Payor Sources </li></ul></ul></ul><ul><ul><ul><li>Year n Proportion </li></ul></ul></ul><ul><ul><ul><li> 2000 5,384 33% </li></ul></ul></ul><ul><ul><ul><li>2001 6,571 49% </li></ul></ul></ul><ul><ul><ul><li>2002 10,805 58% </li></ul></ul></ul><ul><ul><li>Increased Efficiency at Provider Sites </li></ul></ul><ul><ul><ul><li>Comparison of Baseline and Follow-up Provider Survey Data </li></ul></ul></ul><ul><ul><ul><ul><li>March Through May 2004 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>January Through March 2006 </li></ul></ul></ul></ul>
    28. 28. Cost-Effectiveness (cont.) Third Party Payor Sources
    29. 29. Successes <ul><li>Improvement in Data Quality </li></ul><ul><li>Integration of Services </li></ul><ul><li>Increased Tracking of Linked Referrals </li></ul><ul><li>Cross-OAPP Collaboration </li></ul><ul><li>Monitoring of HCT Counselors for Compliance </li></ul>
    30. 30. Next Steps <ul><ul><li>Identify and Address Policy and Procedural Changes Needed to Sustain System </li></ul></ul><ul><ul><li>Assist Users Transitioning from Current Systems to HITS </li></ul></ul><ul><ul><li>Allow Resulting Data to Inform the Direction of HITS and Other Similar Endeavors </li></ul></ul>

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