Department of Rehabilitation Electronic Records System

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1 2012 NASCIO RECOGNITION AWARD NOMINATION NASCIO Category: Improving State Operations Department of Rehabilitation Electronic Records System Project Dates: March September 2011 Nominator California Department of Rehabilitation Jennifer Hixon, Chief Information Officer

2 Executive Summary The California Department of Rehabilitation (DOR) administers the largest vocational rehabilitation (VR) program in the country, annually providing services to approximately 115,000 individuals with significant physical and mental disabilities. DOR has 750 VR counselors in over 85 offices throughout California who help consumers prepare for and obtain competitive employment in integrated work settings. Specific services include consumer assessment, counseling and guidance, purchase of individualized rehabilitation services, and job placement. The program provides services to individuals with a full range of physical and mental disabilities, pursuant to federal law. The DOR used a decades old mainframe-based case management system. This legacy system hampered the effective tracking and reporting of performance data required by the federal government, risking the loss of federal funds. Additionally, the legacy system did not allow DOR counselors to manage their cases well, requiring manual and paper processes instead of automated workflows. The system s technical architecture was obsolete, making it difficult to maintain. Lastly, it did not comply with accessibility standards, limiting access to nearly 300 DOR employees with disabilities. Updating the legacy system was a cornerstone in the DOR strategic plan to improve the accessibility, effectiveness, and efficiency of the VR Program and provide more accurate and timely information for monitoring, overseeing, planning, and reporting. The resulting project was called the Electronic Records System (ERS). The ERS project was implemented within scope, on time, and under budget, using a rolling implementation cycle to progressively bring groups of offices and branches online. Today, more than 1,500 users access the new system to manage vocational rehabilitation services to consumers with significant disabilities. The new system redesigned the case management process, eliminating duplicate data entry while improving data integrity and improving case management. As a result, staff are more effective, and tasks more visible, making counselors more accountable and enabling DOR to meet state and federal requirements and timelines. With new program efficiencies in place, counselors have more time with their consumers. With new reporting structures in place, DOR provides stakeholders with timely and accurate information in compliance with state and federal reporting requirements while developing and institutionalizing a statewide quality assurance methodology. The new system will avoid almost $2 million annually in costs while allowing DOR to move forward with modernization efforts in its other programs. 2

3 Business Problem: Antiquated System was Inefficient and Non-Compliant In Fiscal Year , DOR provided services that enabled approximately 11,000 Californians with significant disabilities to obtain jobs. However, DOR s legacy case management system created barriers to helping more consumers become employed. DOR used the Field Computing System (FCS) to support the Vocational Rehabilitation Employment and Specialized Services (Blind and Visually Impaired and Deaf and Hard of Hearing) Divisions. A legacy system created in 1990, the FCS was an outdated, inefficient, inaccessible, and cumbersome case management system. Its limitations and inefficiencies included: No access to real-time data: Information had to be organized, validated, and cleansed. Paper-based notes complicated case management and made case coordination difficult. Because FCS did not have an interface, partner organizations sent data through hard copy or disk. Inaccessibility: FCS did not fully meet Section 508 and related accessibility laws which is troubling given that DOR provides services to people with disabilities and has nearly 300 employees who require assistive technology. Inefficiency in generating required reports: Significant resources were required to develop a report and validate or correct data. Mainframe reports were hardcoded, inflexible, and expensive with each report incurring a cost to produce. Poor data integrity: FCS used 629 case service codes, 529 account codes and 36,440 procedure codes, 10 billion possible combinations. Inability to verify codes resulted in poor data and difficulty complying with federal requirements. Poor Case Flow and Manual Processes: FCS could not track cases to ensure consumers were served within federally mandated timelines and counselors could not easily monitor their workload. Vendor management and data sharing was manual, inhibiting collaboration and resulting in duplicate vendor entries. Unsupportable Technology: With FCS, hardware replacements were hard to find and it was difficult to hire technical staff able to program in the older language. In addition, mainframe transaction costs continued to escalate. To fulfill its mission, address the issues discussed above, and maintain federal funding, DOR needed a system that would meet the requirements set forth by the Rehabilitation Services Agency (RSA), a federal oversight entity. Solution After reviewing alternatives, DOR determined that a customized system would likely cost too much, take too long to implement and require IT resources that DOR did not have. DOR analysis showed that a commercial off-the-shelf system could meet its requirements with minor configuration and customization. DOR determined that the AWARE TM (Accessible Web-based Activity Reporting Environment) system could fulfill its needs while requiring less than 15% customization. The most significant improvements to business processes for the system lie in increased reporting accountability, case flow efficiencies and data integrity. The ERS solution provides: 3

4 Real Time Data: ERS provides real time data, meaning information doesn t have to be validated or cleansed to be useful. Cases can be viewed in real time, enabling collaboration, reducing duplication and rework. When paired with more usable codes, DOR better serves consumers and operates more efficiently. The ERS project transfers data between departments in real-time with frequently scheduled batch interfaces. Quick and Efficient Reporting: ERS replaces costly, inefficient and non-compliant reporting processes with configurable pre-developed templates that precisely meet users needs to produce accurate, timely, useful reports. Features include: 145 report templates and 548 different report parameters, users can quickly select from nearly 80,000 distinct reports. User-specific report queues, allow staff to focus on the information important to their consumer or task. With easily customizable reports, users no longer need IT staff to develop reports, freeing IT staff to work on other priority projects. DOR now meets federal reporting requirements and has better data validation and correction. Reports no longer incur a mainframe cost to produce. Strong Data Integrity: The ERS system integrates the myriad codes of FCS into choices that users filter according to the specific case. This filtered list of fund sources and procedure codes makes selecting the correct combination intuitive and far less error prone. Conversion to 23 Service Categories and 20 fund sources allows management to easily report on categories while simplifying legislative changes. ERS centralized vendor management using a relational database making vendor information easier to maintain. The old system had nearly 55,000 vendor records, many of which were duplicates. ERS implementation cleaned up and reduced records to 40,000. Updated vendor information is now applied system wide for all records. Automated Case Flow Improves Processes: Processes are stringently controlled through workflow wizards, minimizing time spent in the tool. User choices made via the wizard direct future case options, which makes learning the system easier. ERS improves workload tracking and monitoring, notifying counselors when an activity is due. As Counselors track and complete tasks, they can use the system to communicate with colleagues and use the Reminders feature to transfer tasks to peers for completion. Comments and activities recorded throughout the system create a legally binding narrative that helps to clarify issues or disagreements if they arise. In the first six months of operation, users created more than 300,000 reminders. When a consumer needs goods or services on short notice, they may need to bear the initial financial responsibility and be reimbursed later, a severe hardship for people who are often on public support. ERS reconciles payments faster, allowing consumers to more quickly take advantage of and benefit from department approved services. Project Management Approach: DOR managed the project using a combination of California Project Management Methodology and hybrid PMBOK processes. Flexible 4

5 project management was critical to navigate the project with significant constraints, minimal funds for unanticipated tasks, and large project risks. ERS used a dedicated Project Manager, and an Independent Project Oversight, Validation and Verification team to ensure the project completed in scope, on time and under budget. Project management controls included a Change Control Board to review proposed scope or plan changes. The Board balanced project needs, deciding on 175 Change Control Requests and 58 work authorizations throughout the project. The project Support Center tracked and mitigated more than 4,000 issues throughout the project s lifecycle. Timeframes and costs: Solution customizations and interfaces to remaining legacy systems was a 15 month effort beginning in March 30, 2010 with the final production version complete and installed on June 24, Field staff training and conversion of 85 offices was completed on August 22, 2011, two days less than the original estimated completion. The total one-time cost for the purchase, design, configuration, and implementation was approximately $17 million, under budget by $3,000. Communication Management: Recognizing the importance of effective cultural change management, DOR began a change ambassador program in late 2009 to communicate with staff. A sandbox environment allowed users to test an out of the box version of the system shortly thereafter. Each office had a designated implementation coordinator who worked with the "train the trainer" team in their district. Offices spent a week in training, just before going live, to learn system navigation and new business processes. Nearly a quarter of the field staff participated as testers, trainers, change ambassadors or coordinators; serving as conduits for project information. Technology Solution and Security: AWARE is a.net application running on three dual quad-core Windows 2008 servers linked to SQL Server 2008 running on a dual quad-core for its database. Because the data is stored on Network Access, additional space can be added quickly and inexpensively, allowing DOR to keep historical cases online longer. The AWARE VR system provides robust auditing and security with adaptable user security profile changes in a real time interface. Staff access is role-based in contrast to FCS where staff access was set individually. This provides tight scrutiny over user defined roles, profiles, report creation, accessibility, cross district access, controlling the use of Social Security information and allowing for future functional changes. Accessibility: The AWARE VR technology provides web access usability to staff with a full range of disabilities. This includes integration with third party technologies to provide adaptable web accessible interfaces for staff members who are vision impaired, hearing impaired, and others. This integration provides the use of cutting edge technology with a broad range of uses to deliver VR services to the community at large. Significance DOR provides critical services to Californians with significant disabilities striving to become productive, independent members of society. ERS transformed DOR s operations, allowing the department to reduce costs, improve efficiency, and maximize rehabilitation services to consumers. Key areas of significance include: 5

6 Fulfilling our Rehabilitation Mission ERS improves case management, allowing counselors to quickly, collaboratively address consumers training needs. Better case management improves tracking of federally mandated timelines and ensures counselors are accountable for cases. Timelier services help consumers to gain employment sooner. Reduced system complexity decreases training time, allowing counselors to spend more time with consumers instead of entering data or learning the system. ERS serves DOR s employees with disabilities which is critical given DOR s mission. Better program management Additional business capabilities include timely, accurate information and better data analysis and reporting in real time for internal and external stakeholders. ERS dramatically improves data accuracy, which allows DOR to complete reports within allocated timeframes, avoiding the threat of losing federal funding. ERS improves cost management by making codes easier to use. ERS eliminates duplicate data entry and improves ease of reporting. More efficient IT ERS avoids approximately $2 million per year in mainframe expenses that can be better spent on other modernization efforts. The ERS project reduces the risk of application failure and maintenance costs by moving the system to newer technologies that are easily supported. Stakeholders: The system s primary users are DOR counselors and management who access information through the system and its reports. ERS provides a direct electronic interface with partner agencies including the Social Security Administration, California Employment Development Department, Department of Mental Health, Department of Education, RSA, service providers, and vendors. Previously DOR could not interface with these agencies on a real-time basis and had to transfer data via hard copy or disk. Data sharing allows the DOR to better track employment outcomes and to request more reimbursements from the Social Security Administration. Strategic Alignment: The ERS Project aligns with the California s 2011 IT Strategic Plan s Goal 2, Strategy 3: Coordinate and leverage state investments in data and information resources. The project also aligns with NASCIO s 2012 priorities of optimization, budget and cost control, modernization and enhancing the role of data and information management. ERS directly implements the first objective of DOR s 2004 Strategic Plan, Improve Department of Rehabilitation Infrastructure. It also enables DOR to proceed with four other modernization objectives. Benefits of the Project ERS resolves many of the problems associated with the FCS legacy system and significantly improves DOR s operations. ERS major benefits include: Fulfilling our Rehabilitation Mission: The FCS legacy system resulted in poor processes, less time with consumers, lower employee morale and risk for high turnover. 6

7 ERS eliminates redundant data entry and processes, provides an infrastructure that nurtures accurate data sharing between staff, improves case management and followup and allows the time and tools with which to build strong relationships with consumers and DOR stakeholders. Within FCS and according to a July 2005 time study, counselors with five or more years of experience completed update screens in half the time of a new employee and five times faster than a counselor relying on assistive technology. New staff members took six to nine months to feel proficient on commonly used screens in FCS. ERS uses a web enabled interface that is easier to learn, navigate, and explore. ERS and its workflow wizard allow users to quickly become proficient on the system to focus on their job, not system minutiae. DOR completes more than 500,000 authorizations annually. Finding the right vendor for authorizations was so time consuming that many staff created a new vendor record rather than search the database. AWARE reduced over 15,000 vendors in the database and finding the correct vendor takes under a minute, a considerable time savings. Entering a new consumer in FCS could take more than 15 minutes; with frequent system timeouts leading to lost data; entering a new consumer in AWARE takes about 3 minutes. FCS plans were completed on paper, requiring that case files be sent between offices, a privacy risk and a loss of time for the consumer. In AWARE plans are shared easily online with attachments of pertinent case data. DOR s 77,000 active cases are also organized consistently, providing an easier transition and more accurate information. Better Program Management: ERS provides real-time information and accurate reports allow informed decisions and fulfill federal reporting requirements. Cost tracking is greatly improved because users have filtered choices, not 10 billion code combinations from which to choose. Modernization: The ERS project was the first of five strategic system objectives for DOR. The project laid the foundation for future change by modernizing core functions including infrastructure, business processes, and support methods. Implementation of ERS demonstrated DOR's ability to replace a large-scale legacy system and has enabled the department to move forward on other modernization projects. Budget and Cost Control: The ERS project provides better functionality at a lower total cost of ownership. The new application avoids approximately $2 million per year in mainframe expenses. These savings are redirected to other priorities such as increasing bandwidth and funding AWARE upgrades and maintenance, providing a platform for future efficiencies, and services to consumers. As the largest VR program in the country, the California DOR's implementation of the new ERS provides timely and accurate information to all of its stakeholders. As DOR continues to enhance their system, the increased leading edge functionality can be incorporated into future releases of AWARE providing significant benefit to other state VR programs. 7

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