MassCARES seeks to unite disparate state and local agencies

By Drew Robb

The Executive Office of Health and Human Services (EOHHS) is the Commonwealth of Massachusetts' largest secretariat, consisting of 15 agencies and a budget of roughly $9 billion—a massive 44% of total government expenditure. EOHHS acts as the policy and steering arm to departments covering functions as diverse as children, benefits, disabilities and public health.

Those agencies operate in close proximity, yet in terms of technology and knowledge collaboration they may as well be situated at opposite sides of the Atlantic. Some run on mainframe, some on minicomputer, others on assorted Windows, Linux, Unix and just about every other operating system known to IT managers. Although countless cases overlap, none of the systems talk to each other. Result: Double work, with some citizens receiving abundant attention from multiple departments while others in need are neglected.

Henry Swiniarski, the state’s assistant secretary for EOHHS, gives examples of some of the many agencies involved in home visiting programs—the visiting nurses association, the department of public health, the newborn home visiting program and others. With so many irons in the fire, duplication of effort became an accepted way of life.

“Most of these agencies are entirely disconnected,” says Swiniarski. “We didn’t know who was servicing whom, and multiple interviews were going on covering the same information about the same people. As a result, the knowledge of one agency was largely unavailable to others.”

The solution was MassCARES (Massachusetts Confidential Access to Resources through an Electronic Storehouse), a joint technology/KM initiative designed to centrally coordinate state health and human services information, share it among multiple agencies and use it to provide better care across the state. The project, however, faces major hurdles in terms of technology and cultural issues.

Share and share alike

Sharing information doesn’t necessarily come easily in government. A hierarchical structure and silo-like IT organization mean that each department can operate like an information fiefdom. The leader runs his or her own staff, inter-agency collaboration is typically weak, and data resides in huge repositories only accessible to one or two technical staff with the know-how to run the system. Not only does that arrangement impede the flow of data outward, it also makes it difficult to share internally.

“Even though the systems may be somewhat dated, some agencies have invested 30 years into them and it is unreasonable to try to force them to toss them away and restart from scratch,” says Barry Goffe, Microsoft (microsoft.com) .NET Enterprise Solutions manager. “Fortunately, technology is now at a point where it is possible to leverage existing assets and have them communicate in a flexible way.”

Swiniarski is of the opinion that it would have been virtually impossible to rework current agency-specific systems into one statewide platform. That’s why the state adopted an integration architecture that left departmental legacy systems strictly alone.

“MassCARES allows us to extract data from these systems, then compile and assemble a central data warehouse that is accessible over the Internet,” he says.

But someone didn’t just wake up one day, decide centralized information was a good idea, convince each agency before breakfast and then set about implementing a statewide EOHHS system. What brought about cross-agency collaboration in Massachusetts, in fact, was a surge in juvenile violence.

Things came to a head in 1993 with seven youths murdered on the streets of Boston by other juveniles. Investigation revealed that while various agencies addressed the problem, they were incapable of solving the problem individually.

“These people knew each other but didn’t normally work closely together,” says then Commissioner of Youth Services William O’Leary, a prime mover in MassCARES. “There was a commitment to collaborate. We got everyone on the same page in terms of how we could get data, how we could share information and how we could develop prevention strategies to reduce violence.”

The results were surprising and immediate. They found out something that individual agencies had no way of ever discovering—a handful of individuals were responsible for most of the city’s violence. By identifying those responsible and organizing better targeted and more closely coordinated actions, the problem was resolved. For the next two years, the city experienced no further youth shootings.

The collaborative success moved over to EOHHS when O’Leary became its head. Again, cross-agency analysis revealed the big picture that everybody missed—most high school dropouts, crimes by juveniles and teen pregnancies came from 20 or so of the city’s hundreds of zip codes. Here again, lack of cooperation stood in the way of effective action. EOHHS caseworkers relied on memory or crib sheets of contact numbers in other organizations for what little collaboration took place, mainly limited to the handful of people they knew. They ended up with localized areas of tight collaboration, but failed to take advantage of the massive array of resources potentially at their disposal. After all, Massachusetts has 26,000 state human services employees, many with distinctive qualifications and skills, 20,000 community-based organizations.

“We really needed to work out how to deploy the troops better,” says Swiniarski.

The MassCARES system

MassCARES was developed by EOHHS and Waltham, MA-based systems integrator SEI. Its purpose is to analyze and share information to enable better delivery of EOHHS resources, greater efficiency and better tracking of results. It is built on a Microsoft Windows Platform primarily (Windows 2000 Server and SQL Server), as well as IBM middleware and an Oracle database running on Unix. This backbone is accessible via browser to EOHHS agencies as well as the public. Major components are:

• Central Information Storehouse--CIS is a database that provides a central, unduplicated count of 1.2 million citizens.;

• Online analytical processing—OLAP makes it possible for state management or any agency to easily access and analyze client and service data.;

• Web-based applications—By using the Web, citizens have a simplified access point to EOHHS services. The Resource Locator lets people track down services available to them locally. An Eligibility Wizard gives consumers a single point of entry into HHS programs, determines eligibility and offers online enrollment. Specific Web applications are also available for EOHHS employees. Case Monitoring allows authorized caseworkers a cross-agency approach to the review and monitoring of client progress. A reporting tool makes it possible for agencies to better identify at-risk consumers and create reports of agency programs activities. ;

Culture of confidentiality

One of the biggest barriers to project success, however, is the confidentiality of much of the information residing in agency systems. Case workers are honor bound not to indiscriminately spread sensitive client information around. Not surprisingly, there were more than a few reservations voiced about the security aspect of MassCARES. That issue alone is often enough to thwart the efforts of those committed to interagency collaboration.

Fortunately, the weight of the state proved enough to overcome such barriers. With a solid commitment from the top, EOHHS had the clout to bring subordinate local government bodies into line.

“As we are the 10,000-pound gorilla that provides the bulk of the spending, when we come to the table and say we’re committed to integrating and sharing information, that provides enough impetus and support,” says O’Leary.

Even then, information sharing remained a labyrinth in terms of authorizations, confidential case worker-only data and accessibility issues. SEI developed a security framework that sits on top and logically arranges all information in CIS. Each agency continues as before entering data into their established legacy systems. Those then transmit virtual “cartridges” to CIS. When users logs on, their security profile determines what data and functions they can access, and how information is to be presented.

MassCARES has four security levels, from highest to lowest: authorized case workers can access personal and transactional data pertaining to clients, anonymous records where names and personal identifiers are removed, access to the database for analytical purposes by management, and report generation.

“Clarifying security and access policies between agencies is a real challenge,” says SEI President Alan Day. “While it entails technological change, it will mean far more organizational and cultural change by the time it is completed.”

That’s why the state is taking a slow, careful approach. Through a series of pilots in outlying cities like Springfield, Brockton and some remote rural regions, Massachusetts hopes to gauge progress on specific elements of MassCARES while ironing out cultural barriers as well as public acceptance. Springfield, for instance, is testing the Resource Locator. And in Brockton, a team of representatives from EOHHS, education, public safety, the mayor’s office and community groups are collaborating on the largest MassCARES pilot to date.

“These civic groups are working closely together in order to use the system to identify and measure risk factors facing children,” says Swiniarski. “They hope to develop integrated projects that offer preventive solutions.”

Long way to go

Those pilots, however, are still in the planning stages. Each is scheduled to launch by midsummer. Based on feedback from citizens and related agencies, piloting will be expanded over the course of 2003 and 2004. It won’t be until the end of fiscal year 2004 that the complete MassCARES system will finally be available across the state--if everything goes according to plan.

And that’s a big if. Swiniarski acknowledges that making services available on the Web is only the beginning. Most of the people most in need of health and human services won’t have access to the Internet to take advantage of MassCARES due to digital divide issues. But even with that limitation, at risk families will benefit through better coordination and smarter deployment of EOHHS resources.

Day has no doubts that coordinated government systems like MassCARES are the way of the future. There will soon come a point where agencies will be forced to unite, whether they want to or not.

“The bottom line is that there is an enormous waste of resources due to agency-centric information management,” says Day. “There is so much financial pressure on state government these days that the cost of duplicative efforts will become intolerable in short order.”

He believes the key to interagency harmony is to make systems flexible enough so that agencies have some freedom to continue with their information gathering and reporting efforts as before, as well as giving them a say in how the central database portion is organized. That way, cultural conflict can be minimized.

Swiniarski agrees. His philosophy is to gradually bring agencies together, moving in the direction of integrating casework to a single point of entry. Once you achieve that, you can begin reshaping the way that clients are addressed.

He believes strongly that even those who resist the initiative will soon come around. As centralized information sharing becomes known and utilized, case workers and managers will quickly buy into it as they realize the flexibility it offers and experience the benefits of having unrestricted access to state resources. Instead of working with a handful of overworked associates, they will be able to interface with the entire state team in resolving difficulties.

“At the end of the day, MassCARES means we provide more and better care, operate far more efficiently and can set better policy through achieving a greater understanding of what is really going on,” says Swiniarski. “Over time, that will add up to millions of dollars in savings and a better quality of life for our citizens.”

Drew Robb is a Los Angeles-based writer specializing in business and technology.