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Success with WITS

July 1, 2008
by Patrick J. Fleming, MPA, LSAC
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Salt Lake County (SLCo) is a large urban county with a population of about 1.1 million and, contrary to what people may think about Utah, we have about 43,000 youths and adults in SLCo who need substance abuse treatment—but the capacity to treat only about 7,000 per year. If left untreated, these individuals receive services at emergency rooms and finally in the county jail. Nobody was going to solve our capacity problem for us. It became clear that we had to decrease overhead and get more funds into direct services in order to grow capacity.

Table. Composition of workgroups

Committee/Workgroup

Chair

Members

Steering Committee

Mark Manazer (Odyssey House)

Utah Alcoholism Foundation (UAF), Project Reality, AAU, chairs from workgroups, county Division of Criminal Justice Services, county Division of Substance Abuse Services, county Division of Youth Services, Utah Department of Human Services, First Step House, Volunteers of America (VOA), Odyssey House

Clinical Workgroup

Dave Felt (The Haven)

Odyssey House, First Step House, UAF, University of Utah-College of Health, county Division of Youth Services, AAU, The Haven, Project Reality

Processes/Business Rules

Shawn McMillen (First Step House)

Odyssey House, Project Reality, VOA, county Division of Substance Abuse Services, Valley Mental Health (VMH), Youth Support Systems, First Step House, Utah Department of Human Services

Training

Cory Westergard (Asian Association of Utah [AAU])

First Step House, county Division of Substance Abuse Services, Project Reality, AAU

Billing

Debbie Osborne (county Division of Youth Services)

VMH, VOA, county Division of Substance Abuse Services, First Step House, AAU, UAF, Odyssey House, Project Reality

QA/HIPAA

Linda Moore (Project Reality)

Catholic Community Services, UAF, county Division of Substance Abuse Services, Project Reality, First Step House, Odyssey House

Agency Administrators

Sabina Zunguze UWITS Project Mgr.

All agencies represented by a techie (and backup) and an administrator.

The SLCo public substance abuse treatment system is large and comprehensive, contracted to more than 18 private and governmental providers. For many years we required only a minimum data set about clients that was based on the national Treatment Episode Data Set (TEDS). We left it up to providers to gather this information and didn't dictate a specific software application to use. As a result, our provider system had a hodgepodge of data systems that were very expensive to maintain. These maintenance and development costs decreased the amount of resources available for direct services.

In late 2003 SLCo had an opportunity to be a pilot site in the Web Infrastructure for Treatment Services (WITS) project, which we accepted after consulting with our providers. Below are some of the reasons that convinced us to move in this direction:

  • SLCo's substance abuse system was made up of 18 private and public agencies, all with different client record systems—some paper, some electronic.

  • SLCo had a very limited ability to manage data within the contracted system in order to generate reports for the county, state, and federal governments.

  • With funders' increased demands for outcomes data, performance and outcomes-based reporting, quality improvement, and contract monitoring were critical but almost impossible for us to do.

  • A contracted agency's average costs for HIPAA electronic record compliance, IT staff, hardware, software, and licensing were estimated to be around $125,000 to 150,000 per year—a system-wide cost of about $2.5 million. This translated into a net reduction of about 1,000 treatment slots or a 15% reduction in the first year and another 8% reduction for each successive year.

Based on these costs, SLCo's participation in WITS was a very easy decision. SLCo agreed to bear the costs of implementation, code modification, and help desk/hosting services. We asked our providers to work on a series of development and implementation teams. We wanted the system to be designed by its users, so we had providers chair the various committees, including the steering committee (table). Although the county could veto any actions taken by the steering and implementation committees, it never did.

After 12 months we implemented the system in mid-2005 and have been improving it since. Modifications and changes usually are driven by our providers, with the county bearing the cost. SLCo basically got a $2.5 million software package for the cost of 0.75 FTE and saw no reduction in services to its citizens. The yearly operating cost is about $300,000.

We now have a fully integrated addictions EHR with a billing payer function, innovative treatment-planning module, reporting functions, and other features that make client care more efficient and uniform. Providers shed their respective systems and put those resources into direct-client care. Our capacity has increased in direct relation to the savings, and it also has increased because we can move clients more seamlessly through our provider network.

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