Project Summary

In January 2015, the State of California Department of Health Care Services (DHCS) rolled out a new system to support the Pre-Admission Screening and Resident Review (PASRR) Program. According to Rita McCabe, DHCS Program Manager for PASRR, the Program's objective is to screen all residents in nursing facilities for potential mental illness and/or intellectual development disorders. Until recently PASRR was a paper based process supported by a backend Adabas/Natural mainframe system. DHCS was having difficulty meeting Federally mandated compliance requirements due to the delay and backlogs caused by the largely manual process. An RFP was released to acquire a new web based technology solution to replace the existing mainframe system and to fully automate many of the manual processes.

A Sacramento based prime contractor approached UBTI, Inc., to be a teaming partner responsible for the development of the new PASRR solution. The DHCS award was based on the team's ability to meet/exceed DHCS's implementation timeline while the solution was identified as the overall "best value" in the proposal review process. The solution proposed was a robust case management system developed using UBTI's .Net Trinity Framework. The Framework is being used by several large enterprises in the financial and defense industries and boasts built-in security, authentication, and mobile capabilities. Prem Daniel, Principal and Lead Technical Architect at UBTI states "It took us six years to mature the Framework and it has been well tested by large enterprises. It reduces development time by 30% to 40% and provides significant cost benefits. Because it is architected on the standard .Net framework utilizing MVC design patterns, knowledge transfer is also much easier. Our customers have the ability to support the system with minimal assistance from us. This provides an excellent opportunity for our customers to avoid significant risks commonly inherent with custom application development."

DHCS is in the process of technology knowledge transfer and implementing a few enhancements requested during roll-out. With over 100 nursing facilities using the new system fully, the plan is to complete the on-boarding process to over 3500 facilities across the state over the next several months. A large portion of the implementation process includes outreach to make the nursing facilities aware of the new process/system and to provide training to the end users responsible for the screening and assessment functions.

The benefits of the new system are overwhelmingly positive. Rita McCabe, DHCS Program Manager for PASRR commented on the benefits from a cost and quality perspective. Rita states "Once the system is fully implemented, we will eliminate 4 letters per case for an estimated savings of $20k per year and we may be able to redirect up to 5 staff members with an estimated savings of $500k per year. On the qualitative side we will be able to minimize data entry errors caused by illegible handwriting and fax quality issues, enabling us to drastically improve the turnaround time to complete the assessments from an annual average of 45 to 50 days to an annual average of 7 to 9 days".

Several clinicians were also interviewed and asked to share their perspective on the benefits to them as users of the system as well as to the patient community. A major benefit is time savings produced by the ease of completing the Level 2 evaluations. The wizard provides an intuitive interface and the determination letters are auto-generated by the system. Case notes and automated workflow processes allow for easy collaboration between the evaluators and the clinicians. Tracking a case is much easier and there is much more capability to store additional information. The clinician can now select the case from a list on the screen whereas beforehand, they received a spreadsheet where the case had to first be located, and then typed into the mainframe.

A higher quality of care was cited as a key benefit since the system now provides a structure for recording the assessment results. Prior to the new system, the assessment results were provided in handwritten form which were oftentimes illegible, compounded with degraded fax quality. Information had to be retyped and batched into the mainframe with limited field sizes and this process was prone to errors. With the increased capability of the new system to capture more information and more complete information, a higher level of focused care can be provided and this information can now be made more widely available to practitioners who are involved in the care of the patient.

Robert Baker, DHCS Project Director commented on compliance as a major benefit of the system as it is helping the state to meet federal compliance timeframes. Robert is pleased with the implementation process stating "The system was implemented ahead of schedule, within budget, and with virtually no technology issues". When asked about the benefits of working with UBTI, Robert commented "We benefited from the transparent and open nature of the partnership. The consultants at UBTI were extremely responsive during all phases of the project. We worked well together to resolve issues and define requirements to keep the project on schedule and meet the Sponsor's expectations". When asked about next steps, Robert responded "I’m excited about potentially expanding the new automated PASRR IT system to the Department of Developmental Services (DDS). DDS currently has a paper-based system that receives PASRR Level I forms similar to what DHCS receives. The new automated system can benefit DDS in meeting their timeliness requirements while eliminating all manual processes."

For more information on PASRR visit the DHCS PASRR website by clicking on the "Visit Website" link to the right on the Project menu bar above.

Latest Project News