Pennsylvania Department of Public Welfare: Enterprise Incident Management (EIM)

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1 NASCIO 2012 Recognition Awards Pennsylvania Department of Public Welfare: Enterprise Incident Management (EIM) NASCIO Award Category: Data, Information and Knowledge Management Project Initiation Date: May 2010 Project Completion Date: October 2011 Contact Information: Teresa Shuchart, Chief Information Officer, Departments of Aging, Insurance, and Welfare

2 Executive Summary The Commonwealth of Pennsylvania s Department of Public Welfare (DPW) administers home and community-based programs that serve more than 29,500 elderly and physically or mentally disabled individuals with long-term care needs. Although the majority of services are provided in the individual s home or community (and not in an institutional setting), and are provided by hundreds of third-party provider agencies throughout the commonwealth, DPW still retains responsibility for the oversight of these services and the protection of these individuals from abuse or neglect. The program offices within DPW began to address these concerns by implementing their own incident-tracking methodologies, ranging from paper-based processes to customdeveloped systems. This approach led to inefficiencies and lack of standardization and reporting capabilities. As a result, DPW recognized the critical need to develop an enterprise-wide solution to support its incident and complaint management processes for individuals served by multiple programs. DPW s Enterprise Incident Management (EIM) system is an application used by the Office of Long Term Living (OLTL) and Bureau of Autism Services (BAS) to record, review, investigate and analyze incidents and complaints based on an online workflow. The system streamlines DPW s business processes while providing the flexibility to adapt to the unique policies of each program. It also provides powerful reporting tools to help give DPW visibility into its business processes and drive better decision making, ensuring the department is delivering quality care to Pennsylvania s citizens. EIM accesses information from systems throughout DPW to automatically pre-populate participant and provider information on newly filed incidents. As part of DPW s guiding principles for EIM, it was critical for the system to leverage these existing systems and their information, thus preserving data integrity and reducing unnecessary data entry. 1

3 Business Problem and Solution The Pennsylvania Department of Public Welfare (DPW) relies upon hundreds of thirdparty agencies, including Service Coordinators and Provider Agencies, to provide home and community-based services to more than 29,500 elderly and physically or mentally disabled individuals with long-term care needs. Further, these services were overseen by multiple offices within DPW with different and disparate systems for tracking incidents and complaints filed by participants and providers. Not only did these systems not talk to each other, they often provided little insight into the programs being managed. DPW recognized that it needed an enterprise-wide tool to better protect the health and welfare of Pennsylvania s most vulnerable citizens. The tool would need to allow providers to report incidents to the commonwealth, and for commonwealth officials to review each incident to determine whether the appropriate actions were taken. The tool needed to have a defined structure in order to provide uniformity around the overall business process, but also be flexible enough to support the needs of each program office by gathering information required for federal reporting. It needed to be Internet-enabled so that urgent incidents and complaints could be entered from hundreds of provider sites and reviewed by DPW 24 hours a day. Finally, the tool needed to provide powerful reporting features in order to give each program office visibility into their incident and complaint metrics, ensure baseline data could be collected, help guide business decisions and implement quality controls. Previously, the Office of Long-Term Living (OLTL) within DPW depended on paperforms submitted by and fax to manage the incidents and complaints for participants under the age of 60. Reporting limitations and inefficiencies led to the underreporting of incidents and prevented OLTL from fully meeting federal reporting expectations. Furthermore, OLTL lacked a full understanding of its program due to the lack of reporting baselines and other metrics. Similarly, the Bureau of Autism Services (BAS) within the Office of Developmental Programs had utilized the Home and Community Services Information System (HCSIS) since 2008 to manage incidents and complaints. HCSIS is a Web-enabled case management system used by DPW program offices that support the Home and Community-Based Services Waivers. While BAS had a system in place to support case and incident management, it wanted to expand its tracking and overall management of incidents. The transition to EIM offered the program a more streamlined solution on an enterprise platform and enhance its ability to manage the overall program. EIM also allowed BAS to collect and track complaint information, a key piece of data into which the program office previously had no insight. 2

4 With the EIM tool, the incident management process begins when a formal report is filed. The report is formatted in a way that balances the need to provide information to DPW as quickly as possible, while recognizing that it may take additional time to gather all of the facts, interview witnesses, and implement corrective actions to prevent future recurrences. When this report is submitted, DPW officials review it to determine if the incident was properly resolved and documented. At any time during this process, an investigator may be appointed to further research allegations of abuse, neglect or exploitation. Once all of these steps have been completed, and DPW determines that the appropriate corrective actions have been taken, the incident is closed. EIM was constructed using state-of-the-art technologies including the.net 4.0 Framework, Silverlight, AppFabric Caching and the Corticon Business Rules Engine. Using this technology provides the following benefits: Maximized performance Maximized system usability Decreased maintenance costs User-modifiable configurable features EIM provides a common framework that is shared across all program offices and includes user-modifiable, configurable features that give EIM significant scalability. For example, a program office could indicate if an investigation was required, optional, or not allowed based on its review. A program office makes this determination based on its incident and complaint management policies and can configure EIM to support it. The flexibility of EIM s framework allows for this type of configurability for program offices without the need of a separate solution, one of the many benefits of an enterprise solution. EIM also provides powerful reporting tools such as the COGNOS Ad Hoc Package, which allows users to build their own reports containing any of the data elements stored within the system. Additionally, the dashboard feature within EIM allows greater visibility for provider organizations and program office staff to monitor the status of incidents and complaints, resulting in improved adherence to incident management policy timelines and service. Phase 1 of the EIM implementation was initiated in April 2011 to a pilot group of 91 direct service providers and service coordination entities (SCEs) serving participants in the 21 counties. In October 2011, EIM was implemented to an additional 363 direct service providers and SCEs in the remaining 46 counties. OLTL has 390 remaining providers and Area Agencies on Aging, which will implement EIM at a later date. 3

5 The EIM communications plan addressed the key communications events, messages, vehicles and stakeholders. To promote awareness and adoption, DPW identified the following key communications considerations for EIM: The implementation of EIM will have a significant impact on DPW stakeholders, including direct service providers, service coordinators and participants as they move away from the previous paper-based process to a Web-based process. The Centers for Medicare and Medicaid Services (CMS) is an additional stakeholder that has a general interest in EIM. Incident management policies and procedures need to be firmly established before change communications begin. Significance Since going live in April 2011, the Enterprise Incident Management system has served as the incident and complaint management solution for Pennsylvania s Long-Term Care and Home and Community Based Programs. The system streamlines DPW s business processes across multiple offices while providing the flexibility to adapt to the unique policies of each program. It also provides powerful reporting tools to give DPW greater visibility into its business processes to help drive better decision making. EIM creates a common set of business processes used across each of OLTL s Medicaid Waiver and Act 150 Programs to help enforce policies described in OLTL s Critical Incident Management policy bulletin. In addition, EIM allows OLTL to meet the Centers for Medicare and Medicaid Services requirement that Pennsylvania implement a robust incident management process for participants in the Medicaid Waiver and Act 150 Programs including: Incident reporting Review or investigations of reported incidents Development of corrective action plans and remediation plans/strategies EIM has initially been rolled out to two of DPW s program offices, and over the long term, the vision is for EIM to serve as the single repository and process for incident and complaint data across the entire agency. This is a win-win situation for both DPW and Pennsylvania s citizens as EIM improves process effectiveness for the workers who report incidents with the ultimate goal of protecting the health, safety and rights of Pennsylvania s citizens. 4

6 Benefit of the Project EIM provides several benefits from a systems perspective, including Relevant System Alerts and real-time Workload Dashboard productivity tools to help program office and provider/sc users quickly identify items that require immediate action, allowing them to spend less time searching for tasks and completing them more quickly. The dashboard includes functionality that highlights all of the incidents and complaints that users need to take action on. The focus on the individual user s activities helps them complete their work more efficiently. It is also customizable to allow users to set their own preferences for the types of information they view when they log into EIM. Benefits of the Workload Dashboard include: Users spend less time searching and more time completing work Queuing to help users monitor the amount of work they have remaining so they can plan appropriately Filters to allow users to restrict the information displayed in the dashboard to maximize its relevancy to their work By providing a common framework shared across program offices, EIM represents a reduction in maintenance costs compared to having separate systems for each program office with overlapping and duplicative functionality. It also reduces maintenance costs by allowing business users to apply system changes without support from technical staff. Configuration tools accelerate the speed at which system changes can be deployed by allowing them to be applied outside standard release schedules. Additional benefits of the innovative configuration functionality include: Reduced cost and time-to-production for small scale system changes Increased flexibility for program offices to develop forms and workflows that adhere to their unique policies Version control to minimize impacts to existing incident and complaint data EIM further reduces maintenance costs by leveraging existing data within DPW such as individual, provider and case management information from other systems. This usage of existing data and technical assets helps ensure the quality of data and minimizes redundant data entry. In addition, the application provides pre-built reports that answer the department s most common business questions. Program office users can build their own ad hoc reports 5

7 using any of the data elements that are captured in EIM s Enterprise Data Warehouse (EDW), which is refreshed on a nightly basis. This gives program offices complete visibility into the system to help them monitor their incidents and complaints, make more informed policy decisions and meet CMS requirements. Further benefits of EIM s robust reporting capabilities include: Pre-built reports to efficiently answer the department s most common business questions Business users can develop their own reports, which reduces the need to create new reports as data needs evolve Accurate and up-to-date information to guide program offices towards better decisions EIM s Web-based platform provides significant enhancements to increase operational effectiveness and has given DPW program offices deeper insight into their incident and complaint management processes using a variety of reporting tools. This includes establishing baseline incident reporting metrics, providing data for open and overdue incidents and allowing visibility into provider organizations that are not reporting incidents. For the first time, OLTL has been able to establish a baseline for incidents reported per participant served by a provider in its under-60 waivers. EIM gives OLTL more transparency into the care of participants, which allows it to identify providers that appear to be underreporting, put corrective actions in place and help to ensure the health and welfare of Pennsylvania citizens. In summary, EIM s web-based platform provides significant enhancements to increase operational effectiveness and has given DPW program offices deeper insight into their incident and complaint management processes using a variety of reporting tools. This includes establishing baseline incident reporting metrics, providing data for open and overdue incidents and allowing visibility into provider organizations that are not reporting incidents. DPW has successfully implemented EIM with both OLTL and BAS and is well positioned to continue the implementation across the remaining program offices. 6