MONDAY, 4:30 – 4:50PM Rahul Puri, Chief Software Architect, New York City Health and Human Services Joe Fleischman, Project Manager, New York City Health.

MONDAY, 4:30 – 4:50PM

Rahul Puri, Chief Software Architect, New York City Health and Human Services

Joe Fleischman, Project Manager, New York City Health and Human Services

Transforming Worker Experience through Access and Interoperability

1

Overview of New York City

• An estimated 8.6 million people live within NYC’s five boroughs

• Its $1.2 trillion economy is the second largest municipal economy in the world (Tokyo is first) and 13th largest economy globally

• Its municipal government employs more than 250,000 individuals among 90+ agencies, offices and boards

• The government provides thousands of services for citizens including educating 1.1 million school children; collecting 12,000 tons of refuse a day; maintaining 1,700 parks; and providing a safe place for some 35,000 homeless individuals and families each day

• The City’s operating budget is approximately $57 billion

• About $1 – $1.5 billion of that budget is invested in IT Annually

HIMSS 2010 2

Overview of HHS-Connect – Vision

HIMSS 2010 3

City Employee• Holistic View of Client/Customer information

• Electronic Case Files & Automated Forms

• Inter/Intra-agency Collaboration

• Collaborative Case management

• Remote Access to Information through Mobile Devices

Client/Customer• Multiple Access Channels• Online Search & Application Tools• Client Information Record• Single, Consolidated View of Information• Ability to Manage information

External Partners• Cross-Program Data

• Resource Optimization

• Holistic View of Client information

• Electronic Case Files & Automated Forms

• Inter/Intra-agency Collaboration

Agency• Cross-Agency Data

• Resource Optimization

• Employee Retention

Worker Survey

• One of the key operational outcomes of HHS-Connect is improving the worker experience vis-à-vis helping New Yorkers

• HHS-Connect conducted a baseline survey of health and humanservices workers– Respondents were 503 client-facing workers across the nine

HHS-Connect agencies– Online survey– December 9-19, 2008– Anonymous and confidential– Margin of error is 4.5%

• The survey will be conducted annually to measure improvements in the worker experience and help set direction for the HHS-Connect program

HIMSS 2010 4

More than half of all supervisors (55%) do not believe that City agencies effectively share client information

Q13: “Do you agree or disagree with the following statement: New York City agencies effectively share client information?”

N=503

HIMSS 2010 5

Workers think their experience would be improved with better data-sharing capabilities

More than 8 in 10 workers (84%) say their jobs would be easier if they could access

client data from other City agencies

Just over a quarter of workers (29%) think City agencies

effectively share client information

Yes84%

No4%

Unsure11%

Agree29%

Disagree47%

Unsure24%

N=529

Q13: “Do you agree or disagree with the following statement: New York City agencies effectively share client information?”

Q14: “Would it be easier for your to do your job if you had access to client data from other New York City agencies?”

HIMSS 2010 6

More than 8 in 10 workers (86%) would like to access clients’ date of birth and address from other agencies

Q11: “What kind of information would make helping clients easier when they are referred to you from other agencies?”

N=529

Date of birth, 86%

Proof of identity, 79%

Household composition, 76%

Name of client’s caseworker(s), 71%

City services client receives, 71%

Address, 86%

Income information, 70%

Age and number of dependents, 69%

Medicaid eligibility/info, 65%

Social security number, 68%

Proof of employment, 64%

Immigration records/citizenship, 57%

Non-Medicaid health insurance, 52%

Criminal record, 52%

Foster care records, 47%

Medical history, 65%

Education records/certificates, 52%

HIMSS 2010 7

Worker Connect Business Case

• Conducted business use case meetings with over 25 user groups from 11 agencies

• Built over 150 business use cases across 25+ user groups

• Conducted legal and policy reviews with all 5 source data agencies (ACS, DHS, NYCHA, HRA, and DFTA)

• Developed change management and training approach

HIMSS 2010 8

New York City Children’s Services – Division of Child Protection (DCP)

DCP performs approximately 60,000 child abuse/neglect investigations each year. Allegations are reported into the State Central Register. Child Protective Specialists (CPS) must make contact within 24 hours with someone who can confirm the safety of the child at the moment, and are required to physically visit a child within 48 hours of the report to the Central Register. CPS responsibilities include assessing risk and safety based upon reported allegations, protecting children in imminent danger, and providing preventative measures for those who might be at further risk. At the outset of an investigation, having as much information as possible is critical. Caseworkers are not always provided with the information they need to start their investigation. Many times, only a limited set of information is available from the initial report to the State Central Register. Sometimes parents are unwilling or unable to provide information regarding the whereabouts of their child.

Time is of the essence for DCP. DCP is mandated to conduct a full investigation within 60 days of receiving an initial report of child abuse/neglect. The ability to access contact information for a child’s relative(s) and other leads will assist DCP in meeting the 60 day investigation mandate. The ability to find collateral contacts is central to assessing a child abuse/neglect report to determine the correct course of action. These sources of information are especially helpful when trying to locate a missing child and non-school age children. Access to multiple agency information on the worker portal, as well as to documents (e.g., landlord/lease information, pay stubs, utility bills) will facilitate identifying primary and collateral contact information. In addition, documents with photo IDs (e.g., drivers licenses, passports) are invaluable to verify the identity of individuals in an investigation.

HIMSS 2010 9

New York City Children’s Services – Division of Child Protection (DCP)

HIMSS 2010 10

Use Case Examples of Relevant Data Sources Data Type

Confirm child’s whereabouts Client address, child care enrollment information, child care provider information

Structured

Confirm family’s location in the shelter system

Confirm family’s location in the shelter system Structured

Find collateral contacts NYCHA tenant information, DFTA landlord information, family composition, child care provider information, employment information

Structured

Locate family members/relatives

All data with address information, DFTA tenant information, NYCHA tenant information

Structured

Verify family’s building and landlord information

DFTA landlord information, NYCHA tenant information Structured

Verify income/financial situation

DFTA household income information, NYCHA household income, HRA benefits and employment information, pay stubs, lease agreements

Unstructured, Structured

Confirm child care enrollment

ACS Child care enrollment and provider information Structured

Confirm family’s benefits status

HRA Public Assistance, Food Stamp, Medicaid case information

Structured

Verify identity of family member/perpetrator

Any document with photo identification of client - Driver’s license, US passport, Medicaid Card

Unstructured

Find child’s birth certificate Birth certificate Unstructured

User accesses Worker Portal to confirm client’s citizenship

Naturalization certificates, birth certificates, NYCHA citizenship data, US Passport, driver’s license, baptismal certificate, Green Card, SSN Card, Medicaid Card

Unstructured, Structured

Confirm family composition NYCHA household composition, DFTA household composition, HRA household composition, child care enrollment

Structured

HRA – Office of Child Support Enforcement (OCSE)

The Office of Child Support Enforcement (OCSE) is responsible for ensuring that children are financially supported by their non-custodial parent. OCSE provides services to about 400,000 families. Seventeen percent of these families receive cash assistance and 83% do not. All families may apply for child support services. Services are provided regardless of income, cash assistance, or immigration status. Families applying for cash assistance are automatically referred to OCSE for child support services as a condition of eligibility. Families not receiving cash assistance may apply for services by visiting the Family Court in their respective borough. There are five basic child support services: 1) locating noncustodial parents (the parent without the child), 2) establishing paternity (legal fatherhood), 3) establishing child support and medical support orders, 4) collecting and distributing child and medical support, and 5) enforcing child and medical support orders.

OCSE’s objective is to secure a court order for child support and to ensure that the support order is enforced. The first step in this process is locating the noncustodial parent in a timely fashion and verifying their financial situation. Upon locating a noncustodial parent, a summons may be served requiring them to attend a child support court hearing. OCSE is also responsible for enforcing support orders where an NCP may not be agreeing to the terms of the support order. In these cases, locating an NCP is the primary goal. Access to address information and scanned documents which include an address will facilitate these processes.

During child support hearings, the amount of the child support order is determined, including financial and medical support based on an NCP’s financial situation. The income level of an NCP is used to determine the level of child support an NCP is required to pay. OCSE users are required to validate that the information provided is accurate, and that the client is disclosing all income sources. Access to data in the Worker Portal will allow users to more thoroughly investigate an NCPs net worth, ensuring that all income sources are disclosed during the hearing process and, as such, ensure that children and families are receiving adequate support.

HIMSS 2010 11

HRA – Office of Child Support Enforcement (OCSE)

Use Case Examples of Relevant Data Sources Data Type

Locate Non-custodial Parents

NYCHA tenant information, DFTA household information, Any document with an address for the non-custodial parent, such as Driver’s license, US passport, Utility Bill

Structured, Unstructured

Verify income informationDFTA SCRIE household income, NYCHA household income, ACS ACCIS household income, bank statement, pay stub

Structured, Unstructured

Locate Non-custodial Parents for Enforcement

NYCHA tenant information, DFTA household information, DHS Client Tracking System, Any reliable/verifiable document with an address for the non-custodial parent, including but not limited to Driver’s license, US passport, Utility Bill

Structured, Unstructured

Lookup Public Assistance Information for non-custodial parents (NCPs) and custodial parents (CPs)– Customer Services

HRA EDW PA benefits information Structured

HIMSS 2010 12

High Level Architecture

HIMSS 2010 13

Information Exchange Deliverables

HIMSS 2010 14

Infrastructure Protection

Infrastructure Protection

Emergency Management

Emergency Management

Criminal Justice

Criminal Justice

International Trade

International Trade

IntelligenceIntelligence

ImmigrationImmigration

Person Screening

Person Screening

HHSC Canonical Exchange Schema (NIEM Conformant)

Health & Human

Services

Person

Organization

Location

Property

Metadata

Contact Info

PeoplePlaces

Activity

Events

Things

NIEM Core

Application I Application II Application III Application IV

Integration Layer

Phase I Phase II Phase n

XML Based Exchanges

Non-XML Exchanges

Legend

Data Models

Information Exchange Inventory

Canonical Exchange Data Model

• HHS-Connect Abstract Logical Data Model (Left)

• Documentation of COTS data models

• Documentation of COTS data model extensions

• Application data views – subset of COTS data model + extensions

• Data dictionaries

• Process for collecting and maintaining data modeling through project lifecycle

• Suggested data object naming standard

HHS-Connect High Level Data Model

Contents

Purpose• Document Data Architecture Layer – collect COTS

data model and custom extensions that provide service components used to support business capabilities or business processes

• Document a high level conceptual data model of information subject areas and major entities managed by HHS-Connect systems

HIMSS 2010 15

Thank You

16

The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase

does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal

Health Architecture or the Department of Health and Human Services.