HMIS collaborative called "a model"

In 2002, Congress directed HUD to work with local communities to establish a system for collecting and reporting homeless data that would better illustrate the scope of homelessness and help to evaluate the effectiveness of HUD McKinney Act programs. Based on this requirement, HUD created a specification for Homeless Management Information Systems (HMIS) and, as of 2004, required all continuum of care (CoC) communities that received McKinney Act funding to collect the required data and utilize an HMIS to communicate it to state and national officials.

Following a series of discussions, several state of New Jersey entities-the Housing and Mortgage Finance Agency (HMFA), the Department of Human Services (DHS), and the Department of Community Affairs (DCA)-decided to create an HMIS collaborative that would offer each of their departments, along with the state's 21 counties-or CoC communities-access to a shared reporting system. The system was to be developed and administered by the HMFA, through its Supportive Housing and Special Needs Division, which is based in Trenton and headed by Division Director Pamela McCrory.

Development of the HMIS collaborative program posed several challenges, she recalls: meeting HUD and HMIS requirements, bringing together diverse community agencies within each CoC community around a shared system, and providing the state of New Jersey with HMIS data sufficient to bolster its efforts to renew and increase its share of federal housing funds. “We created an advisory group with representatives from many different communities to identify the requirements needed to support a joint RFP, which was drafted by an IT consultant.” Among the key requirements for the NJHMIS software package were the ability to collect and store HUD-HMIS mandated data elements, generate HUD-HMIS mandated reports, and accommodate future growth.

Another key requirement was that the NJHMIS be web-based. This application service provider (ASP) approach to software acquisition would eliminate the burden of network management, the costs of software maintenance/upgrades, and limit the need for hardware, network, or other capital investments. Then, armed with the RFP, McCrory and the other departments entrusted the statewide HMIS implementation to a new HMIS project manager, Abram Hillson, who joined the project in May 2004.

Throughout a busy summer, Hillson led the product selection process, which was staffed primarily by a team of individuals representing NJHMIS collaborative partners. Because of hardware and bandwidth variables throughout the state, the selection team realized that they would probably make some tradeoffs, especially regarding the user interface. “There were a lot of graphical interfaces offered by the vendors that were beautiful,” says Hillson. “But we had to ask ourselves: ‘With a statewide implementation, do we really want to put out a package like this over the web?some of our community agencies-especially those in more rural areas-may still be using older hardware and dialup lines?’” He adds, “If we had specified an HMIS package that required all the latest bells and whistles to operate properly, the first thing we would have had to do would be to buy a lot of new hardware. And we weren't doing that.”

Knowing that a package that offered a “100 percent solution” could not operate on the mix of available hardware, Hillson and his team of HMIS partners decided that “any package that met 85 percent or better of our needs would probably be in the finals.” As they considered the many offerings submitted in response to the RFP, they evaluated vendors in terms of support, customization capabilities, responsiveness, and performance on similar projects.

After narrowing the finalists to three, the team then upped the ante. “We asked each of the three finalists for an on-site presentation and a ‘hands-on’ user training/demonstration session, conducted with actual end users,” he says. The group, consisting of individuals from the agency partners who planned to use the software, logged in on a range of hardware and network connections, accessing the HMIS packages through a secure (https:) web interface. “We really beat up on the systems-entering, compiling, and transmitting data. We tried to simulate the whole process and we looked at everything: How user friendly was the package? What was the system response time over the web' What were the pop-up screens like? Were the screen questions being asked in the proper sequence?”

Benefits of NJHMIS collaborative model

Application services provider (ASP) model:

• Delivers software via secure web interface (https:)

• Makes data accessible in virtually any location, on a range of web-capable computers or devices

• Cuts capital costs for software and database (upgrades/maintenance), servers, and network hardware

• Reduces software-, network-, and hardware-related staffing needs

Easy, secure data access:

• All data stored centrally, with high security and redundancy

• Confidentiality of personal protected information (PPI) supported via multiple levels of user access

• Collects, stores, and delivers data for multiple programs (HMIS, HPRP, PATH) using a common record, configurable forms, and a variety of program-specific report formats

• Supports upload and download of data using common, tab-delimited SQL files; routine uploads of HMIS data are made regularly by 225 of 230 NJHMIS collaborative partners

They also evaluated the configurability of the systems. “For example,” Hillson asks, “how flexible would the intake consent form be in terms of allowing additions or changes to the fields on the forms, plus new functionality to benefit the collaborative?” And, experience told Hillson and the team that the selected vendor had to be responsive-not only for the short-term configuration changes needed to adapt the software to meet HUD and NJHMIS requirements, but also for long-term training, upgrades, and technical support. After a nationwide search, Hillson and his partners recommended AWARDS, an enterprise package developed for human services agencies by application services provider Foothold Technology of New York, N.Y.

Beta testing of the new NJHMIS started in October 2004 with a 90-day system trial at 15 agency sites throughout the state. “Our statewide rollout began in January 2005. Each quarter, for the next two and a half years, we would bring up a given number of sites,” Hillson explains, noting that the site-launch process involved deployment of the software, training of two principal users, and a post-deployment visit by a HMFA technical assistant from Hillson's deployment team. Each site's users would have multiple levels of support. First, they would be trained by one of the site's two “principal” users, who received NJHMIS training from Hillson's team and who would act as first-level support. Next level support was provided by technical associates and a “help desk” in Trenton, while any vendor support was provided through a Foothold Technology systems integration manager.

Completed in mid-2006, the NJHMIS collaborative “provides licensing, access, training, and technical assistance for 230 provider agencies, 20 of 21 CoC communities, and state partners who support efforts to renovate housing, provide rent support, and related services,” says McCrory. The flexibility of the system has enabled it to grow, she says, noting that the collaborative now supports over $30 million in federal funding, not only from the HUD McKinney Vento program, but also from two other programs. First, there's the community-based, federally-funded PATH (Project to Aid Transitional Housing) program, which provides statewide outreach to individuals living with mental illness and helps them to obtain transitional and supported housing. More recently, the system has also been adapted to support Homeless Prevention and Rapid Re-Housing Program (HPRP) funds provided by Congress through the American Reinvestment and Recovery Act (ARRA).

The mechanism is relatively simple, Hillson explains. “There's one basic type of client record in the system. Based on the program being accessed (HMIS, PATH, HPRP, etc.), the system offers the appropriate variation of the form to the user, who provides the form data that is needed.” Adding support for the New Jersey Department of Human Services' PATH program, for example, involved modification/addition of forms and questions used for data input, then “some back-end customization” to support differing PATH agency data reporting requirements.

Today, HUD officials consider NJHMIS as a “model” HMIS system, while SAMHSA officials have held it up as a model for PATH program reporting, which will become mandatory in 2011. New Jersey officials say that its capability to deliver comprehensive outcomes data has helped the state not only to renew HUD funding for current programs, but to win federal funding for other, related programs.

Perhaps just as important, NJHMIS has won the respect of its user community, where it displaced locally developed work processes and procedures at over 200 locations. At one agency, where a manager once rejected the system, the team later got a second chance. Now, 40 users at the site use not only the HMIS features, but also the enterprise features of the AWARDS software to do everything from staffing, transportation, and janitorial schedules to site administration and case management. “They put everything into it,” says Hillson. “It's a tremendous tool for case management-it's a great way to track individual needs, treatment plans, and other details.”

At another site, “despite efforts to involve many people, we did find that there was a community that said they weren't going to get involved with the system because it ‘wasn't how we do business.’ Locally, they had developed an Access database system, but it did not offer a complete service plan, updates, reminders, or quality checks. We didn't push them at the time,” says Hillson, “but when they were ready to try, we supported them. Once they started using the system, they quickly appreciated what we were doing and have since become great supporters. They said that the versatility of the system ‘broke down silos between programs and showed a much broader scope of information.’”

Behavioral Healthcare 2010 June;30(6):37-38