This is the sixth in an article series based on the paper "Gaining Ground: A Guide to Facilitating Technology Innovation in Human Services."
In Montgomery County, officials at the county Department of Health and Human Services (DHHS) recognized a need to improve the county’s service delivery. Both department caseworkers and the county’s large and diverse clientele – including many individuals seeking multiple benefits – had been frustrated in the past by a service model that required repeated visits and redundant data entry.
In response, county officials have been developing an integrated case management system to improve service delivery to Montgomery County residents. The technology component of the service redesign is the Enterprise Integrated Case Management (EICM) system, which County personnel are currently building in consultation with external consultants.
Using Data to Identify Opportunities
Bordering Washington, D.C., Montgomery County is home to approximately one million residents and is one of the wealthiest counties in the country as measured by median household income. The County's Department of Health and Human Services covers five service areas that deliver benefits and services to families: Aging and Disability Services; Behavioral Health and Crisis Services; Children, Youth, and Family Services; Public Health Services; and Special Needs Housing.
The Montgomery County Department of Health and Human Services was established in 1997 following the merger of four formerly separate departments. In creating a unified health and human services agency, County leaders had hoped to integrate the delivery of services and benefits to families. Yet the County lacked basic tools to support this vision. “For the most part, our service areas operated in silos. Referrals were made to other service areas and there was some info sharing, but we had our own paper charts that we never shared,” observed one official in the Department.
In 2009, DHHS leaders pulled information from the 136 information systems in use and found that approximately one third of the agency’s clients were accessing three or more of the agency’s services. Recognizing the need to streamline delivery to these and other individuals, administrators decided to build an integrated case management model. “We worked from the practice end first, and came to the technology solutions after,” noted a senior DHHS official. After reforming business processes, County leaders moved to the development and implementation of the technology tool.
Leveraging Department Resources to Guide Development
As an agency incorporating four different program areas, DHHS has sought to ensure that the final EICM will be a useful tool across all Department components. To support active involvement from each program area in the design of the EICM, the County has mandated that each service area designate an e-SAR, or ‘EICM Service Area Representative.’ The e-SARs work alongside the vendor to provide crucial programmatic guidance as contracted technologists design the system. The representatives were chosen carefully. The Chief Operating Officer of DHHS “went to all the service area chiefs and asked them for people to help with EICM and technology modernization projects. They didn’t want somebody who wouldn’t be missed—they wanted somebody who could do the work that was needed,” noted one e-SAR.
In addition to existing personnel resources, Montgomery County used its current contracts to facilitate the project’s development. By leveraging existing contracts and projects to facilitate the development of the EICM, the Department has reduced the project’s duration by avoiding the need to begin a new, lengthy procurement process. Contacts with the state’s Chief Information Officer provided guidance to Montgomery County officials on using existing contract templates and pricing structure to streamline procurement. “We haven’t had to go through the whole RFP [Request for Proposal] cycle, which would’ve added a couple of years to our timeline,” noted one senior DHHS official.
Working Iteratively Towards a Debut
The Department of Health and Human Services is working to address confidentiality concerns in the design of the EICM before it goes live beginning next year. Federal policies each impose different requirements for the protection of sensitive information, and the Department currently incorporates a number of program areas with differing restrictions and permissions on data sharing. Agency leaders sought to address many of these concerns in the initial process planning phase, instituting a principle of promoting data sharing and building parameters for data exchange.
The EICM, which is expected to begin its phased-in debut across the department in 2015, is one of three major undertakings occurring as part of the County’s Process Technology Modernization (PTM) project, which will also introduce electronic health records and document imaging to DHHS. Through the EICM, and the PTM project as a whole, the Department of Health and Human Services hopes to advance long-term efforts to develop a more holistic approach to human services administration and benefits access.