Return on Investment (ROI) Program Funding
Application
This template was built using the ITD ROI Submission
Intranet application. FINAL AUDIT REQUIRED: The Enterprise
Quality Assurance Office of the Information Technology Department is
required to perform post implementation outcome audits for all Pooled
Technology funded projects and may perform audits on other projects.
This is: A Pooled Technology Fund or Reengineering Fund Request. Amount
of funding requested: $25,000.00 An Agency IT Expenditure or Budget Request
(General Fund, Road Funds, Grants, etc.). Amount of funding requested:
$0.00
Section I: Proposal
Date:
8/6/02
Agency Name:
DHS - Independence
Project Name:
Health Info Assessment - All DHS Institutions
Agency Manager:
Judy Doyle
Agency Manager Phone Number / E-Mail:
(319)334-2583 / jdoyle@dhs.state.ia.us
Executive Sponsor (Agency Director or Designee):
Dave Lyon
Project Summary:
Project funds are being requested to
hire a consultant to assess work process improvement opportunities related
to the use of information technology at all DHS institutions.
Request for ROI Application Waiver:
Is this a request for a waiver? YES
Agencies are required to complete this funding
application when requesting funds for any Pooled Technology project, any
IT expenditure costing over $100,000, or any non-routine IT expenditure.
If you feel there is a compelling reason to waive this requirement,
please provide (in the box below) a brief description of the project or
expenditure, the budget amount, and a rationale for the waiver request.
Explanation:
Until a decision is made
regarding your waiver request, it is not necessary to complete any other portion
of this application. The ITD Enterprise Quality Assurance Office will convey
waiver request decisions within five working days of receipt.
A. Statutory or Other Requirements
Is this project or expenditure necessary for compliance with a Federal law,
rule, or order?
YES (If "Yes", cite the specific Federal law, rule or order.)
Explanation:
Is this project or expenditure required by state law, rule or order?
YES (If "YES",
cite the specific state law, rule or order. ) Explanation:
Does this project or expenditure meet a health, safety or security
requirement? YES
(If "YES", explain.) Explanation:
Is this project or expenditure necessary for compliance with an enterprise
technology standard? YES (If "YES", cite the specific standard.)
Explanation:
Is this project or expenditure consistent with meeting the goals and
objectives of the State's strategic plans? YES (If "YES", cite the specific
standard.) Explanation: Improved service for the
people of Iowa
[This section to be scored by
application evaluator.]
Evaluation (15 Points Maximum) If the
answer to these criteria is "no," the point value is zero (0). Depending
upon how directly a qualifying project or expenditure may relate to a
particular requirement (federal mandate, state mandate,
health-safety-security issue, or compliance with an enterprise technology
standard), or satisfies more than one requirement (e.g. it is mandated by
state and federal law and fulfills a health and safety mandate), 1-15
points awarded.
B. Customer Service Improvements
Summarize the extent to which the the
project or expenditure improves customer service to Iowa citizens or within
State government. Included would be such items as improving the quality of life,
reducing the government hassle factor, provding enhanced services, improving
work processes, etc. Response: The assessment may
provide ideas to improve work processes that may improve customer service. The
main focus of the assessment is to provide a blueprint for future work process
improvement.
[This section to be scored by
application evaluator.]
Evaluation (15 Points Maximum)
Minimally improves customer service (0-5 points).
Moderately improves customer service (6-10 points).
Significantly improves customer service (11-15 points).
C. Impact on Iowa's Citizens
Identify the main project or expenditure
stakeholders and summarize the extent to which each, especially citizens, is
impacted. Response: See B-Customer Service
Improvements above.
[This section to be scored by
application evaluator.]
Provide a pre-project or pre-expenditure
(before implementation) description of the impacted system or process.
Response: The current MHR(Mental Health Record)
computer application was written in 1982, was frequently modified in subsequent
years, and is very labor intensive. Late 80's early 90's the County Billing
System was added as a module. In FY02 the Accounts Receivable system was written
to take the data from the County Billing System and place it in a data base
(rsiding on a cntral server)so that when counties pay the state, it is
reconciled. A new admission system was created in MS-Access a few years ago,
data from the admission is transferred to the MHR system. However, if there are
changes in the MHR system data, the data is not changed in the Admission System.
It's a one way street. So if an error where made on admission number 1, the
clerk brings up the previous data to admit the patient a second time, the same
error will occur again.
When the MHR application was written disk space
was at a premium, there were many items that the sites wanted to track, but
couldn't because of disk space. For instance, the MHR system only allows for 3
diagnois to be listed. Some patients have up to 21 different diagnois (Emotional
and physical problems). These must be kept track of in a separate data base. For
billing purposes, we do NOT have a way to automatically create a bill from the
MHR system. The system will calculate days in house, but it cannot tell you
things like what medication was given and the cost of the medication. It cannot
tell you when a consultant physician treated a patient for bronchitus. The
system can create a county bill, but billing for third party insurance is all
completed manually from paper documentation. It does not allow us to show
measures of treatment. The chart has both hand written and typed information on
a particular patient, which is fine until aggregrate data is needed, then in
order to obtain the data, each chart must be individually pulled and tallied. We
track what documents are completed and in the chart and what are documents are
outstanding. This is done in a separate data base. Another data base tracks
patients who have been placed in restraint and seclusion. The seven DHS
institutions have determined that 42 different applications (we count restaint
tracking for Clarinda and Independence as one application) have been written to
supplement what the MHR application does not do.
Cherokee and
Independence are required by Joint Accrediation of Hospitals to send data each
month to be compared against other state psychiatric facilities. Each site sends
data for six measures. This data can not be automatically taken from the MHR
system, but must manually be gathered, and then re-entered. IMHI currently
submits data on: new generation antipsychiotic use, 30 day re-admission rate,
elopement rate, seclusion hours, seclusion % of patients and restraint hours
NOTE: Eldora and Toledo do not have access to the MHR system. They are
either hand tallying information or have created a data base to give them the
information they need to do their jobs.
Provide a post-project or post-expenditure (after implementation) description
of the impacted system or process. In particular, note if the project or
expenditure makes use of information technology in reeengineering traditional
government processes. Response: The assessment will
provide an opportunity to identify and evaluate work process improvement
opportunities all DHS institution sites and at the DHS central office. With this
assessment a request may need to be written to complete a detailed anaysis of
what will meet the needs of our patients, facilities and central office staff.
The next step would be to produce an RFI, then determine what the best solution
is. Once the solution would be found and installed, training for all staff would
be needed. There is also the possibility that additional hardware would be
needed. For instance up to three PC's may have to be placed in each living area,
one at the nurses station, one for the physician, and another for social worker
or other treatment staff who would need access to the information.
[This section to be scored by
application evaluator.]
Evaluation (10 Points Maximum)
Minimal use of information technology to reengineer
government processes (0-3 points).
Moderate use of information technology to reengineer
government processes (4-6 points).
Significant use of information technology to reengineer
government processes (7-10).
E. Project Participants
List the project participants (i.e. single
agency, multiple agencies, State government enterprise, citizens, associations,
or businesses, other levels of government, etc.) and provide commentary
concerning the nature of participant involvement. Response: Tax payers, patients, families of patients and the following
facilities Cherokee MHI Clarinda MHI Eldora Training School
Glenwood Resource Center Independence MHI Mt. Pleasant MHI
Toledo Juvenile's Home Woodward Resource Center Civil Commitment
Unit for Sexual Offenders (Currently at Oakdale - soon to be at Cherokee)
DHS central office Private sector vendors
[This section to be scored by
application evaluator.]
Evaluation (10 Points Maximum)
One agency (0-3 points).
Multiple agencies or levelsof government (4-6 points).
State government enterprise (7-10 points).
F. Risk
Describe the likelihood of successful technical implementation
of the project. This is not the same as meeting the programmatic (business) goal
of the project. Response: n/a - study only.
[This section to be scored by
application evaluator.]
Evaluation (5 Points Maximum)
High Overall Risk, Low Chance of Success (0-2 points).
Moderate Overall Risk, MOderate Chance of Success (3-4
points).
Low Overall Risk, High Chance of Success (5 points).
What is the programmatic (business) risk of not achieving the project goals
to Iowa citizens and employees? What are the risks to Iowans if this project
fails? Response: n/a - study only.
[This section to be scored by
application evaluator.]
Evaluation (5 Points Maximum)
High Overall Risk, Low Chance of Success (0-2 points).
Moderate Overall Risk, MOderate Chance of Success (3-4
points).
Low Overall Risk, High Chance of Success (5 points).
G. Requestor Experience and Past Results
Provide three examples of
relevant agency IT projects, project management experience and results. List any
projects that required remediation and steps taken to resolve.
Response: LAN Project - Networking - Successful
implementation and operation of a campus area network for all DHS sites, Y2K
project - this was successfully completed at all sites. For all DHS sites, we
recently implemented the Accounts Receivable system, it is a system that
reconciles the bills produced by us, to match the county payments.
(It
is difficult to list projects, as various sites have had a number of projects -
not all projects were completed at all the sites and so I listed the common
areas.)
[This section to be scored by
application evaluator.]
Evaluation (5 Points Maximum)
Minimal success(0-2 points).
Usually successful (3-4 points).
Almost always successful (5 points).
This criteria involves
rating the extent to which previous projects have successfully achieved
their objectives e.g. on time, on budget, minimal implementation problems,
positive programmatic impact, partnering with other agencies, and impact
on other agencies.
H. Funding Requirements
On a fiscal year basis, enter the estimated
cost by funding source:
FY04
FY05
FY06
Cost($)
% Total Cost
Cost($)
% Total Cost
Cost($)
% Total Cost
State General Fund
$0
0%
$0
0%
$0
0%
Pooled Tech. Fund
$25,000
100%
$0
0%
$0
0%
Federal Funds
$0
0%
$0
0%
$0
0%
Local Gov. Funds
$0
0%
$0
0%
$0
0%
Grant or Private Funds
$0
0%
$0
0%
$0
0%
Other Funds (Specify)
$0
0%
$0
0%
$0
0%
Total Project Cost
$25,000
100%
$0
100%
$0
100%
Non-Pooled Tech. Total
$0
0%
$0
0%
$0
0%
Is this project the first part of a future, larger project? YES (If "YES", explain.)
Explanation: Once the assessment is complete, we can
identify and evaluate service delivery options.
Is this project a continuation of a previously begun project? YES (If "YES", explain.)
Explanation:
[This section to be scored by
application evaluator.]
Evaluation (10 Points Maximum)
This is the first year of a multi-year project / expenditure or
project / expenditure duration is one year (0-5 points)
The project / expenditure is of a multi-year nature and each annual
component produces a definable and stand-alone outcome, result or
product (2-8 points).
This is beyond the first year of a multi-year project / expenditure
(6-10 points)
The last part of this criteria involves rating the
extent to which a project or expenditure is at an advanced stage of
implementation and termination of the project / expenditure would waste
previously invested resources.
I. Source of Funds (Pooled Technology Funds Only)
On a fiscal year
basis, how much of the total project cost ($ amount and % ) would be
absorbed by your agency from non-Pooled Technology funds? If desired,
provide additional comment / response below. Response: FY04 - none - Please note there are no federal funds for this
project.
[This section to be scored by
application evaluator.]
Evaluation (5 Points Maximum)
0% (0 points)
1%-12% (1 point)
13%-25% (2 points)
25%-38% (3 points)
39%-50% (4 points)
Over 50% (5 points)
Section II: Financial Analysis
A. Project Budget Table
It is necessary to estimate and assign a
useful life figure to each cost identified in the project budget. Useful
life is the amount of time that project related equipment, products, or services
are utilized before they are updated or replaced. In general, the useful life of
hardware is three (3) years and the useful life of software is four (4) years.
Depending upon the nature of the expense, the useful life for other project
costs will vary between one (1) and four (4) years. On an exception basis, the
useful life of individual project elements or the project as a whole may exceed
four (4) years. Additionally, the ROI calculation must include all new
annual ongoing costs that are project related.
The Total Annual Prorated Cost (State Share) will be calculated based on the
following equation:
Budget Line Items
Budget Amount (1st Year Cost)
Useful Life (Years)
% State Share
Annual Ongoing Cost (After 1st Year)
% State Share
Annual Prorated Cost
Agency Staff
$0
1
0.00%
$0
0.00%
$0
Software
$0
4
0.00%
$0
0.00%
$0
Hardware
$0
3
0.00%
$0
0.00%
$0
Training
$0
4
0.00%
$0
0.00%
$0
Facilities
$0
1
0.00%
$0
0.00%
$0
Professional Services
$25,000
1
100.00%
$0
0.00%
$25,000
ITD Services
$0
4
0.00%
$0
0.00%
$0
Supplies, Maint, etc.
$0
1
0.00%
$0
0.00%
$0
Other
$0
1
0.00%
$0
0.00%
$0
Totals
$25,000
---
---
$0
---
$25,000
B. Tangible and/or Intangible Benefits
Respond to the following and
transfer data to the ROI Financial Worksheet as necessary:
1. Annual Pre-Project Cost - This section should be completed only if
state government operations costs are expected to be reduced as a result of
project implementation. Quantify all actual state government direct and indirect
costs (personnel, support, equipment, etc.) associated with the activity, system
or process prior to project implementation. Describe Annual
Pre-Project Cost: N/A
Quantify Annual Pre-Project Cost:
State Total
FTE Cost(salary plus
benefits):
$0.00
Support Cost (i.e. office supplies,
telephone, pagers, travel, etc.):
$0.00
Other Cost (expense items other than FTEs
& support costs, i.e. indirect costs if applicable,
etc.):
$0.00
Total Annual Pre-Project
Cost:
$0.00
2. Annual Post-Project Cost - This section should be completed only if
state government operations costs are expected to be reduced as a result of
project implementation. Quantify all actual state government direct and indirect
costs (personnel, support, equipment, etc.) associated with the activity, system
or process after project implementation. Describe Annual
Post-Project Cost: N/A
Quantify Annual Post-Project Cost:
State Total
FTE Cost(salary plus
benefits):
$0.00
Support Cost (i.e. office supplies,
telephone, pagers, travel, etc.):
$0.00
Other Cost (expense items other than FTEs
& support costs, i.e. indirect costs if applicable,
etc.):
$0.00
Total Annual Post-Project
Cost:
$0.00
3. Citizen Benefit - Quantify the estimated annual value of the
project to Iowa citizens. This includes the "hard cost" value of avoiding
expenses ("hidden taxes") related to conducting business with State government.
These expenses may be of a personal or business nature. They could be related to
transportation, the time expended on or waiting for the manual processing of
governmental paperwork such as licenses or applications, taking time off work,
mailing, or other similar expenses. As a "rule of thumb," use a value of $10 per
hour for citizen time savings and $.325 per mile for travel cost savings.
Travel
Savings
Number of Trips:
$0
Miles per Trip:
0
Trips per Year:
0
Number of Citizens Affected:
0
Rate per Mile
$0.325
Total Travel Savings:
$0
Transaction Savings
Number of annual online transactions:
0
Hours saved/transaction:
0
Number of Citizens affected:
0
Value of Citizen Hour
0
Total Transaction Savings:
$0
Other Savings (Describe)
$0
Total Savings:
$0
4. Opportunity Value/Risk or Loss avoidence - Quantify the estimated
annual non-operations benefit to State government. This could include
such items as qualifying for additional matching funds, avoiding the loss of
matching funds, avoiding program penalties/sanctions or interest charges,
avoiding risks to health/security/safety, avoiding the consequences of not
complying with State or Federal laws, providing enhanced services, avoinding the
consequences of not complying with enterprise technology standards, etc.
Response: N/A
5.Benefits Not Readily Quantifiable - List and summarize the overall
non-quantifiable benefits (i.e., IT innovation, unique system application,
utilization of new technology, hidden taxes, improving the quality of life,
reducing the government hassle factor, meeting a strategic goal, etc.).
Response: The assessment will provide us with a road
map of where we need to go.
Rate the overall non-quantifiable benefits on a "1 - 10" basis, with "10"
being of highest importance: 10
Benefits Not Readily
Quantifiable
ROI Financial Worksheet
A. Total Annual Pre-Project cost (State Share from
Section II B1):
$0
B. Total Annual Post-Project cost (State Share from
Section II B2):
[This section to be scored by
application evaluator.]
Evaluation (10 Points Maximum)
Generates 0% annual return on investment (0 points)
Generates 1-3% annual return on investment (1 point)
Generates 4-6% annual return on investment (2 points)
Generates 7-10% annual return on investment (3 points)
Generates 11-15% annual return on investment (4 points)
Generates 16-20% annual return on investment (5 points)
Generates 21-25% annual return on investment (6 points)
Generates 26-44% annual return on investment (7 points)
Generates 45-63% annual return on investment (8 points)
Generates 64-82% annual return on investment (9 points)
Generates over 83% annual return on investment (10 points)
Note: For projects where no State Governmment Benefit,
Citizen Benefit, or Opportunity Value or Risk/Loss Avoidance Benefit is
created due to the nature of the project, the Benefit/Cost Ratio and
Return on Investment values are set to Zero.
Section III. Technology
A. Current Software Technology
1) Software (Client Side / Server Side / Mid-Range / Mainframe ) :
a) Application Software
Varies per site. Seven sites utilize the Bull Mini computer
and the MHR(Mental Health Record) application.
Toledo and Eldora do not
utilize the MHR (Mental Health Record) system.
At Independence MHI the
following are the systems we use in conjunction with the MHR system.
Admission Application - (MS-Access application resides on NT Server),
the admission data is then moved to the MHR system on the mini-computer.
MHR System - this is the core medical record demographic and census
application. It tracks a patients stay in the hospital as to which ward, what
doctor, how many days, if there were leaves etc.
County Billing - on the
mini computer takes information from the MHR system, patient name, county of
legal settlement, days etc. and prepares a bill that is sent to the county.
Receipts are then tracked in the Accounts Receivable System (SQL - located on
server in Hoover Bldg)Payment Tracking: (MS-Access - resides on NT server) This
information allows us to keep track of what we have billed and what we have
received for all patients, i.e. insurance companies, medicare, medicaid,
counties, etc. Note: Initial data is transfered from MHR system.
Patient
Banking (mini computer) takes information from the MHR system, patient name,
ward, etc. and allows us to keep track of the patients money while he/she is
hospitalized). Takes data from MHR system.
NRI (MS Access - resides on
NT server) This data does not contain the patient name, but an abbreviated
amount from the MHR system. We must hand write this information on on entry
sheet, then re-enter each patient into the application each month. This data we
send to a national data base on a monthly basis to meet a JCAHO requirement.
Medicare/Medicaid Eligibility (MS-Access - resides on server) This
tracks who is currently active for benefits, when started, how many days, when
stopped, etc.
Other Patient data: (MS-word/ MS-Access /MS-excel -
resides on NT server) Each patient that is admitted, has an admission note
(completed by admitting physician), intake note(by ward physician), initial and
comprehendsive treatment plan (completed by treatment team), social history
(completed by social worker), and dischared summary. All typed by our
transcriptionist and placed in a share on the server. There are various other
data bases throughout the hospital, for example we track restraints and
seclusions, patient and staff injury, lab results and patient education. All are
in shares on the NT server.
PC based systems - Altrabill - (Medicare
Part A - electronic billing from one PC over modem to vendor)PCAAP - (Medicare
Part A, Medicaid, Wellmark from one PC over modem to vendor)Health Financial
System (CMS reporting - federal reporting requirement) CMS is Center for
Medicare and Medicaid Services.
Dictaphone System:(stand alone server)
Our physicians, social workers and counselors utilize a dictaphone dictation
system. They dictate into the telephone and the voice is saved on computer.
Information such as the diagnois is hand coded and hand recorded to be entered
into the MHR system. The transcriptionist then finds the dictation from the
doctor, and transcribes form the system. When completed the information is
deleted from the dictation system.
Monthly MHR data from all the sites
is transferred to DDM where it is used for Federal Reports.
b) Operating system
software For the Bull System - Unix and GCOS
c) Major interfaces
to other systems, both internal and external From the
MS-Access Admission System -> to the MHR system- COBOL,-> client
banking,COBOL-> county billing COBOL (all previous were Internal)-> to the
AR system SQL(External), ->and sent to DDM for federal reporting(External),
d) Other
2) Hardware (Client Side / Server Side / Mid-Range / Mainframe ) :
a) Platform, operating
system The seven sites that use the Bull Midrange computer,
use UNIX and GCOS
b)
Storage and physical environment Bull hard drive
c) Connectivity and
bandwidth CAT 5 and fiber
d) Logical and physical connectivity
Switches from PC to midrange
e) Major interfaces to other systems, both
internal and external The Bull Escala and the NT server --
we use FTP and SNA
f) Other none that I can think of
B. Proposed Technology
1) Software (Client Side / Server Side / Mid-Range / Mainframe ) :
a) Application Software
Server based
b) Operating system software We really won't
know until Assessment and Analysis is completed
c) Major interfaces to other systems, both
internal and external External - Accounts Receivable and
Data for federal reporting
d) General parameters if specific parameters are unknown or to be
determined We will know more after the analysis is
completed.
e) Other
Ideally we would like the information to reside at each
institution, with a possible backup at a central location. This would meet HIPAA
guidelines to keep the information as local and secure as possible. If someone
did hack into one of the sites, the others and their data would not be instantly
available. Also, we would like to preserve the data we have in some way.
Hopefully we can import some of the current data to the new system.
2) Hardware (Client Side / Server Side / Mid-Range / Mainframe ) :
a) Platform, operating
system We really won't know until Assessment and Analysis
is completed
b)
Storage and physical environment We really won't know until
Assessment and Analysis is completed
c) Connectivity and bandwidth We
really won't know until Assessment and Analysis is completed
d) Logical and
physical connectivity We really won't know until Assessment
and Analysis is completed
e) Major interfaces to other systems, both internal and external
We really won't know until Assessment and Analysis is
completed
f) General
parameters if specific parameters are unknown or to be determined N/A
g)
Other To have servers at each location, with data about
that site on the server.
C. Data Elements
We really won't know until Assessment and
Analysis is completed. However, the Health Information System would provide
electronic capability for privacy, security and coding of our health information
system to meet HIPAA standards. In addition if possible we would like to keep
the data we have collected in the MHR system. Much of it is still valuable. The
biggest problem it that there needs to be more information collected.
D. Security / Data Integrity / Data Accuracy / Information Privacy
1) List the Security
Requirements of the project It must meet all HIPAA and ITD
security guidelines
2) Describe how the security requirements will be integrated into this project
and tested. We will have to share some information with the
consultant. We would ask them to sign a confidentiality statement to make sure
they are aware of our policies and procedures.
3) Describe what measures will be taken to
insure data integrity, data accuracy and information privacy. In the assessment stage, we will not share passwords or other
information with the consultant.
E. Project Schedule
Describe general time lines, resources, tasks, checkpoints, deliverables,
responsible parties, etc. The assessment to begin July 2004
and finish by December 2004. Reports to be to the sites, and central office no
later than March of 2005.
Section IV. Auditable Outcome Measures
For each of the below categories, list the auditable metrics
for success after implementation and identify how they will be measured.
1. Improved customer
service N/A
2. Citizen impact N/A
3. Cost Savings N/A
4. Project reengineering
We must re-think how business is being done. We must look
at all sites and what tools are needed for the staff to do the job they are
assigned. What things could be automated? For instance, all medication logs on
each chart are copied weekly and sent to the business office so the medication
can be added by unit (not actual drug cost) to the patients bill by entering
into the County Billing system. This maybe something to automate and save staff
time, and save paper costs.
5. Source of funds (Budget %) No response required
6.
Tangible/Intangible benefits At this point we don't know
exactly what we will be saving. This is why we are asking for the assessment of
need. This is the first step in defining what needs are similar throughout the
institutions, and what needs are unique to a particular facility.
