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— Robert S. Mirel, M.S.W., Systems Resource Group, Inc., Bala Cynwyd, Pennsylvania. A great deal of effort has gone into designing and implementing information systems for public-sector organizations that provide human services. This is occurring during a time of sweeping change in the delivery and evaluation of services. With the ever-shrinking pool of available resources for public-sector programs, funding authorities and other purchasers are seeking providers who can ensure cost effectiveness and high quality services, as measured by successful outcomes.
Providers are in demand who can offer strong management and the tools to identify critical issues and to implement new strategies on a timely basis. The emphasis on outcomes has placed a significant burden on service providers, who need to implement changes in their organizations to achieve the required level of outcome information. Providers are looking to modern, sophisticated automated information systems for support in this new arena. Computerized information systems are a needed tool to make these changes effectively and efficiently, to show purchasers the capabilities of the provider organization, and to maintain a program's effectiveness over time. The Shift in Demands for Data AOD organizations have been operating in an environment that emphasizes involving people in treatment services, on the assumption that treatment would provide the support needed to improve their quality of life. Now, these organizations are being asked to show very specifically the value of those services in observable and measurable ways. In fact, organizations are being asked to identify, in quantifiable terms, what treatment works with persons who present with very specific diagnoses.
To complicate this further, many organizations that serve multiple purchasers are being asked to provide different information to each. This is particularly difficult for most public-sector providers. Traditionally, publicly funded programs have had few resources to dedicate to the development of automated information systems. In addition, these programs have not focused on measuring individual client outcomes.
The current shift to a person-centered approach has forced many service providers to re-examine the way they do business. This approach requires a new means of managing complex organizations. Collaboration among departments that provide various service supports has had to be expanded and, in many cases, newly developed. Providers are growing substantially more reliant on their administrative and financial departments.
A person-centered approach requires the development of information systems that are both comprehensive and integrated. Only a comprehensive information system is capable of giving the provider what is needed — a complete view of a client's needs, of the services being provided, and the cost of those services. An information system also gives a provider the ability to utilize that information on a timely basis to ensure desired outcomes. Benefits of a Comprehensive System A comprehensive and integrated information system creates significant benefits for the organization using it. The structure that is built to support this system will hold data from many areas of the agency. Such a system:
Designing Systems for Today's Environment In today's environment, it is a challenge to design automated systems that can meet the many varied needs of the complex organizations providing behavioral health services. System development has become much easier with the advent of less expensive computer systems. In addition, many tools are now available for developing software that can respond to complex design criteria. The design of these automated systems is still quite complex and requires the cooperation of the entire organization. As organizations change and grow in this new environment, they need to be able to build clinical, administrative, and financial systems that will also grow and change. Information systems can and must be designed to meet changes as they emerge. Staff role in designing information systems Today, the outcomes to be measured are a critical component in developing an information system for an organization. The organization must clearly define what is to be measured. Defining which measures are to be used, and how these measures are best defined in terms of data to be collected, presents a difficult set of issues for the organization. Key staff from each department need to participate in this effort. Each department's staff may need to provide basic orientation to those from other departments. The issues and concerns of each can then be mutually appreciated and understood in terms of their impact on client outcomes.
The task for the provider organization staff is to define key indicators. When these indicators are analyzed and examined by professional staff, they will help identify outcomes. Program staff need to define each of the outcome indicators in terms that are relevant to the way in which they serve people. As they do this, staff must identify what data needs to be collected and/or derived throughout the process of providing service. Role of information system professionals Meanwhile, the information system professional's task is to define methodologies that will support this effort. These methodologies need to closely match the operational environment of the organization. Once staff have identified the data needed, the systems person can incorporate these elements into the data system and define the relationship between the different data elements. This data system will then support the processing of information that can produce the desired types of analyses for staff interpretation.
This systems development process means close cooperation among the agency's professional staff and the information system professionals. The agency staff needs to understand the purpose of the system and to get value-added information from it. Only then will the information system provide substantial support to professional staff in their daily work. Meeting Agency Needs First The introduction of this type of comprehensive, staff-driven information system brings about significant cultural change in an organization. To gain staff acceptance, it is critical that the information system be designed and built for that particular agency's staff. The system can provide functions that are specially designed to be useful and to meet the needs of staff from each department. When system interfaces are designed to meet specific departmental staff needs, then the system has built-in momentum toward acceptance and can be effectively integrated into the environment of the organization. When a system is developed with data collection and reporting features that closely match the needs of those who use it and the way in which they work, data will often be better and the system will be used more effectively.
Organizations need to be clear on one point. The primary focus of the information system is to serve and meet the needs of the organization that will be using it — whether that organization is a provider, a governmental jurisdiction, or a managed care organization that is purchasing services. The data being collected, as well as the method of collection, should be defined in terms that best reflect the goals of the agency. This organization alone can effectively define how that data is to be processed into information and how that information is to be portrayed to users of a system.
It is the organization's needs that should be paramount, not those of other organizations that require reporting. Reporting to outside entities can be accomplished effectively by making adaptations to automated systems. For example, reporting needs can be incorporated into an overall automated system by adding data elements or support for reports/analyses that were not otherwise defined. Often this does not require substantial modification to the system design. Meeting Needs of Outside Sources At the time an information system is being developed to meet the many and varied needs of constituencies within an organization, that system can also be designed to meet the requirements of any outside entities. Often, organizations aim to design systems that will meet specialized needs. Then, when a new need comes along, an entirely new system is developed. This piecemeal approach can lead to substantial inefficiencies and confusion on the part of staff. Importantly, a too specialized approach is not likely to provide the information that will be needed for the effective management of the organization.
An effective way to deal with this issue is to develop comprehensive and integrated information systems that are flexible and designed to grow and change. As an example, programs funded to demonstrate the effectiveness of new programmatic initiatives are often required to develop information systems. These systems are required to provide funding sources with specific feedback on the operation of the project. The Federal government often sponsors projects that require such information systems.
Local programs and jurisdictions take varied approaches to meeting these requirements. Some organizations design systems that specifically meet the need identified by the funding source. Others use this as an opportunity to meet their own agency or juris-diction's long-term goals. They develop an information system capacity that will primarily serve the goals and objectives of the jurisdiction, while also incorporating requirements of the funding source. This second approach is the more productive and promising for any organization intent on developing or upgrading their automated system.
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