HIV/AIDS Interface Technology Systems (HITS): A Program Update

1. HIV/AIDS Interface Technology Systems (HITS): A Program Update SPNS IT Grantees Meeting March 17, 2004 County of Los Angeles Department of Health Services Office of AIDS Programs and Policy

2. Ijeoma Nwachuku, Ph.D. Principal Investigator Eduardo Alvarado, MPH Epidemiologist, Prevention Services Assefa Seyoum Application Development Manager, Information Systems Sophia Rumanes, MPH Section Manager, Prevention Services Project Staff

3. Estimated 54,000 living with HIV/AIDS in Los Angeles County Estimated Persons Living with HIV/AIDS in Los Angeles County 12,000-15,000 19,000-27,000 18,000 * Estimates from LAC HIV Epidemiology Program and CDC as of February 2004

4. CDC Funded HIV TestingCTS 2002, Los Angeles County • Number of Tests 70,229 • New HIV Diagnoses 908 • New Positives Who Did Not Return for Results 19.71% • 67% of new positives who did not return for results were anonymous testers

5. HITS Project Objectives • Increase Disclosure Rates for HIV-Positive Test Results • Decrease Time Between Disclosure and Entry Into Care • Improve Eligibility Screening of Enrolled Clients

6. HIV Information Resources System (HIRS ) • Standardized Data and Processes • Integrated Data and Application Systems • Accurate Data Maintenance and Management • Highly Secured Systems

7. Prevention Systems, HIV Counseling and Testing (HCT) Services

8. Information Management of AIDS Cases and ServicesIMACS/Casewatch • Used by OAPP-Contracted Care Providers • Client-Server Architecture • Maintains Information • Client Registration • Demographic • Services Utilized

9. HITS Process Flow

10. HIV Status Follow-up SystemInterface • Electronic Client Tracking System • Prompts HCT Staff Follow-up With Confidential Testing Clients Who Do Not Return for Disclosure • Encourages Clients to Test Confidentially

11. HIV Referral Follow-up SystemInterface • Tailored Referrals Using On-Line Resource Directory • Referred Client Information Sent to Care System • Documents Entry Into Care • Prompts HCT Staff With Various Follow-up Notifications About Referred Client

12. CARE Act Services Eligibility System Interface • Electronically-Enhanced IMACS/Casewatch Client Eligibility Screening Module • Enhances Screening for Eligibility • Screening Begins at HCT Site • Allows Client-Tailored Referrals

13. HITS Process/Interface Flow

14. HITS Implementation • Evaluate Capacity • Hardware • Software • Internet Capability • Implement Security Policy • Install, Configure and Test • Virtual Private Network (VPN) Tools • Internet Tools

15. HITS Implementation (Cont’d) • Phase I Sites (3) July 2003 • Phase II Sites (2) September 2003 • Phase III Sites (6) March 2004 • Phase IV Sites (9) by June 2004 • Phase V Sites (6) by August 2004

16. HITS Implementation (Cont’d) • Training by OAPP • Information Systems Division • Educational Services Division • Prevention Services Division • Initial Training and Follow-Up • User’s Manual

17. HITS Implementation (Cont’d) • Support • Technical Assistance Help Desk • 9½ Hours per Day • 5 Days per Week • Systems and Database Administration • Application Programming • Process, Forms Reports • Database Programming, Administration and Management • Database, Applications and Operating Systems Security

18. Implementation Plan • Staggered Implementation • Highest Volume Agencies • Outpatient Medical Providers with Casewatch • OAPP-Contracted HCT Providers 18 • Sites (>300) • Medical Outpatient Providers 23 • Sites (35) • Certified HCT Counselors  500 • Confidential HIV-Positive Tests Annually  600

19. Orientation Process • Steering Committee • Community Based Organizations • OAPP • Capacity Building for Sustainability • Assessment • Batch to Business • Training • Monograph Development

20. Lessons Learned: OAPP • Changing Service Requirements at State and Federal Levels • PEMS • ELI • Changing Data Collection Instruments • CDC CTS • HIV-6 • Policy Development

21. Lessons Learned: Providers • Technologic Issues • Varying Levels of Capacity and Capability • Changing Philosophies • Confidential vs. Anonymous Testing • Self-Referral vs. Outside-Referral • Programmatic Issues • Different Methodologies by Provider • Client-Centered Philosophies • Trust in System • Training

22. Evaluation • Baseline Data Were Analyzed • Calendar Years 2000 Through 2002 • HIV Counseling and Testing Database • Care Services Databases • Follow-up Years Include April 2004 Through March 2006 • Anticipated Improvements • Service Delivery • Quality of Care • Cost-Effectiveness

23. Service Delivery Outcomes • Decreased Time From Testing to Disclosure • Median Time to Disclosure • 2000 (13 days; n=605; P1=0 and P99=112) • 2001 (12 days; n=542; P1=0 and P99=75) • 2002 (9 days; n=566; P1=1 and P99=62) • More Clients Access Medical Care Services • Utilization and Consumption Year Clients Service Units 2000 7,667 68,761 2001 12,301 111,861 2002 15,824 120,443

24. Service Delivery (cont.) Service Units Clients

25. Quality of Care Outcomes • Improved Health Status on Entry Year HIV-Positive AIDS Unknown 2000 2,088 603 621 2001 1,485 890 0 2002 3,002 1,844 428 • Improved Referrals • Comparison of HITS and Non-HITS Clients • July 2004 Through March 2006 Survey Data

26. Quality of Care (cont’d) Status of Clients Entering Care *HIV-negative clients not depicted

27. Cost-Effectiveness Outcomes • Increased Use of Payor Sources • Identification of Non-RWCA Payor Sources Year n Proportion 2000 5,384 33% 2001 6,571 49% 2002 10,805 58% • Increased Efficiency at Provider Sites • Comparison of Baseline and Follow-up Provider Survey Data • March Through May 2004 • January Through March 2006

28. Cost-Effectiveness (cont.) Third Party Payor Sources

29. Successes • Improvement in Data Quality • Integration of Services • Increased Tracking of Linked Referrals • Cross-OAPP Collaboration • Monitoring of HCT Counselors for Compliance

30. Next Steps • Identify and Address Policy and Procedural Changes Needed to Sustain System • Assist Users Transitioning from Current Systems to HITS • Allow Resulting Data to Inform the Direction of HITS and Other Similar Endeavors