Challenges inPreparing a Network

Systemaccording to the

Detroit EMA

Don CalhounData Project Management ConsultantCalhoundon@michigan.gov

Detroit EMA - History• Detroit Health Department (DHD) & the

HIV/AIDS Service Agencies within the Detroit Eligible Metropolitan Area (EMA) saw a need to communicate and share data

• DHD established a case management (CM) network in 1999 with five CM agencies

• Providers wanted a system that; - lessen data entry

- prevented duplicate entries- allows communication/data sharing

between agencies

History cont.

• The Grantee contractually mandated the use of a data collection tool by agencies

• Resolve ownership of data – per the contract between DHD and all Aids Service Organizations (ASO) the data was deemed to be owned by the Grantee

• DHD would bear the cost of the data collection tool

Purpose of Network

• Enable CM agencies to communicate/ share data thereby enabling faster delivery of services

• Ensure CM Clients are enrolled at ‘one’ (1) CM agency only

• Grantee administered sharing information

• Automation of record keeping using the Standards of CM Care in Michigan

Round Robin vs. Hub & SpokeDHD

AgencyA

AgencyB

Agency C

DHD

AgencyC

AgencyA

AgencyB

AgencyD

Wide Area Network (WAN)Not recommended due to 24 hr. replication cycle

Wide Area Network (WAN)Recommended

Network Design

• Data not available in real-time• Non-synchronization of servers in the event of server failure

• Data is replicated in real-time• Easy synchronization of servers• Server load balancing

Network ChallengesVendor set-up & support

Individual servers at each CM site

Requires ongoing maintenance/ constant software updates

Cabling/ wiring problems in older buildings & structures

Reports could only be generated at agency site

Challenges cont.Training/ staff needs- no technical staff to support network- staff turnover

Meeting changing HRSA requirements

Three data collection tools - Paper- CAREWare- Case management system

System infrastructure and business practices were not compatible

Grantee/ User Frustration

Funding Challenges

Hardware cost and software licensing too costly

High basic operational cost

Return on Investment (ROI)

- No visible ROI after three years

- No reduction in maintenance cost

Developing a Web-based System

A solution to tracking RW Care Act Data

Single Data Repository with immediate access to data by Grantee or Agency

Latest technology & training for staff

No software to install/ upgrade at agency site

Minimal technology specifications- High speed Internet access (T1, DSL, etc)- Browser (Internet Explorer 5.x)

Vision of aHIV/AIDS Network

PRIMARY CARE LINK

PROGRAM PLANNINGPrioritization & Allocation

DEPLOYMENT STATEWIDE

HUMAN RESOURCE LINK

E-LEARNING

PREVENTIONSYSTEM LINK

INSURANCE LINK

ADAP LINK

GRANTEE BILLING SYSTEM (FSR)

SURVEILLANCE LINK

PROVIDER BILLING SYSTEM

CLIENT TRACKINGSYSTEM

Getting Agency Buy-inFeatures

– Single Data Repository– Reporting can be

automated– Access system from any

Internet-enabled computer

Advantages– Software updates made

easy– No Hardware/ Software to

maintain at agency site– Monitoring and

troubleshooting can be done remotely

Benefits– Reduce staff data entry time– Reports are completed on a

timely basis– Specialized staff monitoring– Monitor agency activity on a

daily/ monthly/ quarterly/ annual basis

– Training/ deployment can be administered remotely

– Establish a good vendor relationship

Return on Investment (ROI)– Initial investment may be high– Ongoing cost should be reduced

Web Development• Quick Place® web-based solution for creating

team workspaces for collaboration, discussions, coordination of plans, share development tasks - Team consisted of Primary Care, Case Management

& Supportive Services

- Issues are resolved immediately

- No final product surprises

• Single server with system fail-over & backup

• No hardware/ minimum software maintenance

• Reporting requirements completed via the Web

Summary• Funding

- Establish Budget - Future enhancements/ contracts

• Establish a core advisory team to make final decisions

• Establish a good vendor relationship- years of experience/ stability- state-of-the-art software

• Minimum Staffing Requirements- Project Manager - IS Trainer- Data Analyst - Network

Administrator

• Establish a ‘Vision’ for your system

Segment II

Addressing Data Security/

Administrationaccording to the

Detroit EMA

Data Security• Web-based system developed using Domino™

Lotus Notes® 5.x

• Lotus Notes used by majority of Fortune 500 companies

• Data encryption is Secure Socket Layer Protocol (SSL) – highest security level

• Password protected – multiple level sign-on capabilities

• Instant Logout allows you to remove cookies/ session data

• Domino™ Lotus Notes® 5.x has never been infiltrated (hacked)

User Rights/ Access• Hierarchical naming for certificate authentication

• System designed according to Michigan Standards of Care and HIPAA regulations

• Groups Directories maintained in a ‘role driven’ Access Control List (ACL)

Organization

OrganizationalUnit

OrganizationalUnit

CommonNames

CommonNames

CommonNames

Example format, John Doe/Case Management/Agency X/MI

User Rights/ Access

• Public Key /Private Key authentication (certificate passing/ handshaking)

• Login/ Password required

for server access• Database Access• Group level access• Document level access• Field level access

Encryption occurs at each Access Control Level

Server Encryption Features

• Data is encrypted and scrambled on the server

• Communications are encrypted and scrambled on the server

Administration• Centralized administration

• Remote administration capability

• Alternative server ‘hosting’

• Quick and easy end-user setups

• No special software required on user workstation