John Moore, www.govhealthit.com, writes;
When Carlo Govia first arrived at the Chicago Department of Public Health (CDPH), he found a stodgy, largely manual system with plenty of paper-clogged bottlenecks.
Govia, the department’s chief financial officer and first deputy commissioner, said the system hindered “our ability to deliver services to people in need.” Much of the organization’s cost structure, he added, was tied to administrative functions rather than service delivery.
The former Cap Gemini and Accenture consultant took a page from industry to address the situation. In the late 1990s, those global integrators focused on their customers’ supply chain management issues and introduced enterprise resource planning (ERP) software to unify financial and administrative systems. Govia now applies those concepts at CDPH.
“My background is in supply chain management and operations management,” he said. “That has certainly influenced my thinking in how we transform the health department into the 21st century.”
Three years into his CDPH hitch, Govia can point to signs of progress. The department’s hospitals and clinics are using electronic health records. Back-office operations are run on a common set of recently deployed ERP-like applications. And it is entering the final phase of a project to modernize public health services.
But there’s work still to be done, especially on the department’s citizen-facing front lines. The next step: pull together data from CDPH’s service-based organizations into a data warehouse. This will let the department mine operational data for health-related trends, bolstering the city’s population health management efforts.In Chicago, population health encompasses a number of services, including emergency preparedness, disease surveillance and food protection. The department plans to harvest the information across these disparate service areas in order to obtain better business intelligence. “Today, most of our effort is geared toward getting the transaction done,” Govia said. “This new environment will now move us from the transactional world to the analytical world.”
Reaching that goal will mark the final phase of CDPH’s Project Focus, which seeks to improve service levels for the city’s 2.8 million residents.
Project Focus initially pursued electronic health records for the department’s Personal Health arm. The city deployed a Cerner EHR system in seven city-run primary care health centers and 12 mental health service centers. The second phase, which is now concluding, revamped the department’s back-office systems.
In that, CDPH assembled a “quasi-ERP system” from multiple applications. In doing so, it tapped Microsoft Dynamics GP, a mid-market business accounting package, to manage its financial transactions. It also plans to use the enterprise reporting feature of Dynamics for budgeting.
The software stack, which runs on top of SQL Server, is hosted by an outside vendor, so the city avoids the management overhead. In another nod to software-as-a-service (SaaS), CDPH has adopted CA’s Clarity PPM to support the department’s grants management and project management initiatives.
Mark Ciampa, senior associate with Booz Allen Hamilton, said the SaaS approach, coupled with centralized back-office systems, is in line with what he sees among public health customers. The strategy provides cost savings and offloads the responsibility for IT infrastructure management.
“The goal is to free public health resources from doing infrastructure support type roles and realign them to more frontline public health activities,” Ciampa said.
Jose Mora, CA’s senior director of product marketing for CA Clarity PPM, said the SaaS model benefits agencies because the IT provider bears the responsibility for hosting the application and providing software updates.
Automating grants management is critical to CDPH, which obtains about 85 percent of its funding—an estimated $110 million—through that channel. The department hopes upgraded IT will help it cultivate new grant opportunities. According to a November 2008 presentation, CDPH seeks to close the gap on New York City’s public health grant funding, which the department reckons to be more than five times the amount Chicago receives.
With EHR and shared services largely in place, Chicago will now shift toward population health. CDPH’s population sector currently lacks a comprehensive IT infrastructure.
The patchy automation that does exist confines population health data to Word and Excel files. As a consequence, CDPH pull together the data that would provide greater insight into its programs.
“Today, we have a set of disparate, semi-automated, mostly manually driven transactions and workflows,” Govia said. “There’s no way to really aggregate data because most of our data sits in unstructured formats.”
CDPH’s current objective: deploy electronic tools to gather program data, populate a data warehouse, and tap that store for information that can help managers make decisions.
Govia said CDPH is in the process of determining “how to really leverage the information across disparate service deliverables.”
The department, he added, seeks to mine that information to obtain better business intelligence, insight that he said will help the department deliver services more efficiently.
This phase of the project is expected to kick off in the forth quarter of this year and continue through the third quarter of 2010, according to Govia.
When work begins, CDPH will be able to take advantage of the previously deployed ERP components. Forgo from Solver said those systems provide a foundation the department can exploit for population health. SQL Server, for example, will serve as the data warehouse. Forgo said data will be extracted from various population health source systems using the ProfitBase tool and pushed into the data warehouse. From there, users will consume the data as PerformancePoint Services, which provides technology for monitoring performance and the visualization of data. As for the latter, CDPH could use the software to create a geographical visualization of a flu outbreak.
Ciampa said CDPH’s data warehousing thrust is consistent with other public health organizations working to leverage data for better program insight, quality reporting and biosurveillance. As work continues, Govia pointed to one theme spanning the project’s three phases: the need for an overarching solution vs. isolated systems.
“We stepped back and really looked at the organization from a holistic perspective, end to end from demand to supply,” he said. “We have broken down the silos within the organization and really looked at the organization has a whole.”