CRAFTING INFORMATION MANAGEMENT PROCESSES

Rapid improvements in data collection, analysis, and planning are driving wholesale changes to information management in human services organizations. As a result, leaders of these organizations are bracing to keep up with increasing internal and external requirements.

Several factors are accelerating human services organizations' IT adoption. States' increased reliance on Medicaid, particularly state-based waivers, has dramatically increased the complexity of reimbursement and service quality management. HIPAA has focused attention on client information privacy and security, while increased access to inexpensive broadband Internet connections makes information more readily available.

This sharpened focus on data and information is rapidly drawing more organizational processes into consideration for IT automation. Yet organizations are running into new technology issues as they move beyond basic tools such as word processing and e-mail.

To make the process smoother, organizations need an enterprise-wide approach. Harvard professor Andrew McAfee describes the process of moving to an enterprise-wide approach as starting with “Function IT” that assists with tasks, then moving to “Network IT” that facilitates interactions, and finally ending up at “Enterprise IT” that specifies business processes.1 McAfee notes that enterprise IT applications are “purchased and imposed…by senior management” and cannot be adopted without “new interdependencies, processes and decision rights.” The change management effort required to implement Enterprise IT requires strong CEO and board support, as well as clear, well-articulated information management processes.

The Joint Commission recognizes this need in its behavioral healthcare standards for the management of information. The standards' goal is to improve organizational client care, services, governance, management, and support processes. Information management processes must:

• Identify information needs

• Design the information management system structure

• Capture, organize, store, retrieve, process, and analyze data and information

• Transmit, report, and display data and information

• Safeguard data and information

To take all this into consideration, using enterprise resource planning (ERP) tools is an effective way to implement an enterprise-wide information management process. Yet these IT solutions are daunting for even the most profitable companies. Many organizations instead attempt to integrate several applications to approximate ERP tools' capabilities. The resulting low ERP adoption rate in healthcare organizations in general is mirrored in human services and behavioral healthcare organizations.

To be successful, organizational goals and objectives, such as performance improvement, must come first in process design. An organization might focus on improving client outcomes within financial and other resource constraints. Best practices and/or evidence-based practices provide excellent guidance for process design, as clients, families, and funding sources require more evidence to demonstrate the benefits of services.

Information to plan, deliver, document, and improve services typically is collected in paper and electronic formats. Information management process design must establish consistent information management policies and procedures to ensure underlying data quality and to manage accuracy, completeness, and timeliness of current and future data, as well as future data requirements.

Many successful human services organizations are beginning to address enterprise information management. To ensure individual component compatibility of the enterprise system, policies and procedures have to be developed. Practical considerations include the following:

Network design. As the network expands to serve more users, locations, and applications, network management overhead increases. Consider virtual private network (VPN) Internet technology (allowing users to access the network from other locations), lower maintenance Internet browser-based applications, and an internal portal to serve as a secure single point of access for all applications.

User names and passwords. Nobody likes to remember separate user names and passwords for multiple applications. Applications that integrate network user name and password management (e.g., Microsoft's Active Directory) simplify this process. Identity management software can help to address this issue.

Software compatibility. As new software applications are purchased, focus on compatibility. Integration is easier when all applications rely on common database and reporting tools (e.g., Microsoft SQL).

Organization. Traditional organizations have management structures that illustrate management responsibilities. This structure usually is embedded in human resources information systems (e.g., managers have greater security clearance than line staff). Yet accounting and clinical information systems may require more flexibility, as cross-departmental processes and service locations often don't appear in organizational charts.

Therefore, consider adopting an information management chart that defines organizational “information units.” An information unit is defined by management as a portion of the organization that must be uniquely identified when configuring all software applications so that, for example, financial, human resources, and clinical information for the information unit can be analyzed in isolation from the activities of the rest of the organization.

Role-based job descriptions. To protect patients' privacy and manage data security, HIPAA limits employee access to patients' information. To minimize the risk of violating HIPAA regulations, a list of organizational roles for employees should be created. Job descriptions should identify the appropriate role. Frontline staff might have multiple job titles but all be assigned a “frontline” role. These roles should be programmed into the information system, allowing specific levels of data access for each role. Role-based application-level security should be consistent across tasks tied to employees' assigned information units.

Through effective role definition, job descriptions, and training requirements, dashboards can be designed to address the role's need to balance privacy and security with access to information. For example, a clinician's dashboard might provide key information on each of his clients. A billing clerk's dashboard might display outstanding receivables that must be addressed.

Process ownership. Processes typically cross departmental lines. Different programs within an organization may provide the same service as part of their unique mix of services driven by local market needs. For example, to improve foster care financial and outcomes performance, foster care information units must be able to aggregate and compare relevant data. If data are collected in this manner, the “process owner” responsible for service quality in foster care will have access to meaningful data, allowing performance comparisons for performance improvement.

Data quality assurance. Enterprise-wide standards designed to manage data quality across applications are essential. To provide correct services in a timely manner, client intake must collect specific data by a specific deadline. To receive prompt payment for services and closely track productivity, an organization's frontline staff must enter accurate service data. For senior management to monitor progress, critical incidents must be reported promptly.

One such standard might be that client discharge data must be entered into the information system on the day of the discharge. If this does not occur, census data will be incorrect; the information system will not accurately reflect the number of available beds; and other performance indicators such as caseloads that rely on census data will be wrong.

Human services organizations increasingly must use information to support continuous quality and performance improvement. Processes for creating and using this information must be specified and managed. Information management will drive lower costs and enable pricing flexibility, while improving service quality, which can be communicated to the market. This is especially important because organizations face increasing competition. Therefore, a crisply managed information management structure is essential in this developing market-based environment.

Reference

1. McAfee A. Mastering the three worlds of information technology. Harvard Business Review 2006;Nov.:141.