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Home My WebLink AboutResolutions - 1993.09.23 - 23922MISCELLANEOUS RESOLUTION #93198 BY: FINANCE COMMITTEE, JOHN P. McCULLOCH, CHAIRPERSON IN RE: DEPARTMENT OF COMPUTER SERVICES - PURCHASE OF EQUIPE_NT FOR COMMUNITY MENTAL HEALTH TO THE OAKLAND COUNTY BOARD OF COMMISSIONER Chairperson, Ladies and Gentlemen: WHEREAS pursuant to Miscellaneous Resolution #93092, the Board of Commissioners authorized the Community Mental Health Services Board to enter into a full management agreement with the Michigan Department of Mental Health (MDMH); and WHEREAS in order to properly implement the full management agreement, and more effectively conduct its day-to-day business, Community Mental Health staff require additional computer equipment, software, training and support; and WHEREAS due to the timing of contract approval, uncommitted state funds are available through September 30, 1993 to purchase the required equipment; and WHEREAS Community Mental Health and Computer Services staff have reviewed computer needs for the division and recommend the configuration detailed on the attachment; and WHEREAS the capital cost of this configuration equals $728,065, of which the MDMH will cover 90%, leaving a County match of $72,807; and WHEREAS the County match is available in the 1993 Community Mental Health budget; and WHEREAS the Community Mental Health Services Board approved of this purchase at a special September 21, 1993 meeting; and WHEREAS the use of state funds for a capital purchase of this size is still subject to approval of the MDMH. NOW THEREFORE BE IT RESOLVED that the Board of Commissioners approves the purchase of computer equipment for Community Mental Health as detailed on the attached configuration. BE IT FURTHER RESOLVED that the 1993 Community Mental Health budget be amended, as specified below, to account for this purchase: Community Mental Health Fund 166-95-00-3042 State Institutions 166-01 -00 -9993 Computer Equip. $(728,065) 728,065 $ 0 ---------- BE IT FURTHER RESOLVED that the equipment purchased be placed in the Computer Services fund fixed assets. Chairperson, on behalf of the Finance Committee, I move the adoption of the foregoing resolution. FINANCE COMMITTEE 1:\tim\cmh\comp.mr Oakland County CMH Full Lianagement Transition Computer Hardware/Software Proposal September 21, 1993 This Computer Hardware/Software requirements study represents a collaboration of effort between staff members of Community Mental Health and the Computer Services Department. This document has been reviewed by the management teams from both Community Mental Health and Computer Services Department, and both parties are in agreement with the information as presented. It is assumed that enhancements and other revisions will be made as necessary. Richard M. Cooper, Director Community Mental Health Paul S. Funk, Director Computer Services Department TABLE OF CONTENTS INTRODUCTION . . . . . . . . . . . . . . . . ...... . . . . . ...... . ..... . . . . 1 BACKGROUND . . . . . ........ . ....... . . ..... . . ...... CURRENT ENVIRONMENT . . . . . . ............... . . . . . . 4 ESTIMATED VOLUME OF CLINICAL DOCUMENTATION ANNUALLY 7 IDENTIFIED PROBLEMS IN CURRENT ENVIRONMENT 9 PROPOSAL . . . . . . . . . ...... . .......... . ............... . . 12 BOARD OPERATED EQUIPMENT CONFIGURATION CURRENT AND PROPOSED 14 CMFI- BENEFITS . . . . . . . . . . . . . ..... . . . . . . . . . . 20 SUMMARY .................. ....... 28 INTRODUCTION A study of the computerization of Oakland County Community Mental Health (CMH) was conducted as a team effort with Computer Services staff working closely with CMH administrative, technical, clinical and support staff and receiving input and guidance from the CMH Services Board, the Full Management Transition Planning Team and the Administrative Subcommittee of the Full Management Transition Planning Team. The study sought to analyze the current configuration of computer equipment and to determine what strategy should be employed such that CMH would be positioned technologically to efficiently manage the influx in volume of clients and related data pursuant to accepting Full Management Responsibility of the citizens of Oakland County. BACKGROUND Oakland County Community Mental Health provides mental health services to adults with serious mental illness, children who are seriously emotionally impaired and people with developmental disabilities through board-operated programs, as well as contractual agencies. Services provided include outpatient care (such as therapy), psychiatric services, case management, partial day programming, inpatient hospitalization, services to ethnic-sensitive populations, prevention, and residential services. See Figures 1 and Figure 2 which outline the type of services provided. CMH provided services to nearly 8,000 people last fiscal year, and that number will increase to 10,000 this year as a result of the signing of the Full Management contract. Under Full Management, CMH is responsible for clients in state inpatient and residential facilities. This equates to serving and tracking clients served in 256 beds in Psychiatric Hospitals for Adults, 71 beds in Psychiatric Hospitals for Children, 30 beds in Centers for Persons with Developmental Disabilities,136 beds for clients in General Nursing Homes, and up to 1100 beds in state-operated residential facilities. Numerous clients could occupy the same hospital bed at different times throughout the year. As a result of Full Management, CMH's annual budget has increased from approximately $32 million to about $96 million, and will continue to increase. Integral to the concept of Full Management are "trade-off dollars"--funds redirected from the inpatient budget to the community service budget as clients are discharged and the program funds follow them from expensive inpatient facilities to more clinically appropriate community-based services. Effective administration of Full Management is dependent on comprehensive and accurate monitoring of state facility inpatient stays. Such monitoring hinges on reliable data capture and timely data reporting. Prepared September 21, 1993 Page 1 AGENCY LOCATION SERVICE PROVIDED Administration Child Adolescent Day Tx (CADT) Central Case Management North (CCM—N) Central Case Management South (CCM—S) DD Services El Centro La Familia Geriatric Services Jail Services North Oakland Child & Adolescent Clinic Screening Services Southeast CMH Clinic South Oakland Child & Adolescent Clinic Southwest CMH Clinic Mental Health Center, Pontiac 1 Water Street — Pontiac Mental Health Center, Pontiac County Jail, Pontiac BOARD OPERATED PROGRAMS Mental Health Center, Pontiac Administers CMH programs Schools in Oak Park, Pontiac, School—based treatment for children & Waterford, Hazel Park & adolescents Southfield Two locations in downtown Case Management services to adults with Pontiac, 1 Water Street, and 31 mental illness Oakland Avenue Civic Center Drive, Southfield Case Management services to adults with mental illness Counseling & Evaluation, Case Management, Day Program, Health Services and Respite services for people with Developmental Disabilities Outpatient services and case management for persons of Hispanic culture with mental illness OBRA assessments, outpatient services and case management for older adults with mental illness Psychiatric services for adults with mental illness incarcerated in county jail United Way Building, Pontiac Outpatient and case management services I for children that are emotionally impaired Clinton Valley Center, Pontiac Screening for inpatient admission and discharge planning for adults Fourteen Mile, Clawson Outpatient services for adults with mental illness Civic Center Drive, Southfield Outpatient and case management services for children that are emotionally impaired Civic Center Drive, Southfield Outpatient services for adults with mental illness Figure 1 In addition to these Board—operated programs, CMH currently contracts with various agencies to provide 24— hour emergency services; outpatient, case management, assertive community treatment, clubhouse, respite, inpatient hospitalization, and residential services for adults with mental illness; case management, day program, group home, foster home, and other residential services for clients with developmental disabilities; and residential services for children with emotional impairments. Prepared September 21, 1993 Page 2 Adults with Mental Illness Clinton Valley Center Kalamazoo Regional Psychiatric Hospital Northville Regional Psychiatric Hospital Adults with Mental Illness Walter Reuther Psychiatric Hospital Children who are Emotionally Impaired Children who are Emotionally Impaired Caro Adults with Mental Illness 81,344 386 753 6,903 19,772 491 Persons who are Developmentally Disabled Caro Mt. Pleasant Regional Center Southgate Regional Center Persons who are Developmentally Disabled Persons who are Developmentally Disabled FACILITY # DAYS IN CONTRACT POPULATION Fairlawn Center Hawthorne Center Adults with Mental Illness I Adults with Mental Illness STATE_ 1;,!. ,-.T.ENT FACILITIES Figure 2 Prepared September 21, 1993 Page 3 CURRENT ENVIRONMENT Documentation Requirements: Clinical servicing requires paperwork intensive documentation. Every case opened must have at least one assessment (three assessments are required for clients receiving Day Program Services or Assertive Community Treatment), a psychiatric evaluation, and an individualized plan of service (treatment plan). Depending upon client need and available resources, psychological testing, health assessments or vocational evaluations may also be prepared. Assessments and psychiatric evaluations are typically dictated and transcribed. If PC's are available, they are prepared in a word processing program by the clerical staff. If not, the clerical staff uses a typewriter. These assessments and evaluations are usually several pages in length and more often than not require editing and retyping. As services are delivered, progress notes must be created to document the service. Clinicians either dictate their progress notes and have them transcribed by clerical staff, or the notes are handwritten. Progress notes are usually less than a full page in length. All open cases are required to be reviewed quarterly, and require a comprehensive report of the progress made toward goals stipulated in the treatment plan. Quarterly reviews are typically handwritten, although they may occasionally be dictated and transcribed. They are normally two to three pages in length. In addition to creating notes and reports that document the service, service activity logs must be prepared. In Outpatient and Case Management agencies, clinicians prepare logs that code virtually all activities each day. These logs are prepared by hand and given to data entry staff to key into the mainframe Management Information System database. Demographic information is kept on each client, with data specific to each agency logged to aid in client tracking. In addition to demographic information such as race, age, address, income, treatment plan dates, status of quarterly reviews, clinicians assigned to the case, diagnosis, level of functioning and open and close dates for each agency are also kept. This information is captured when a case is opened and is updated at least quarterly, or as changes occur. Demographic information is captured at intake on a Screening sheet, transferred to a Face Sheet and keyed into the computer system by data entry staff. In addition, client billing information is captured by hand on a Statement of Income form and keyed into the computer system's Client Billing Profile by account clerk staff. Data captured on the Service Activity Logs directly drives the automated billing system. The computer matches up activity data, billing information and billable procedures monthly to create primary bills to all third—party payers, as well as private pay. Client ledgers are automatically produced. Primary bills to Medicaid are submitted on tape and payment is remitted on tape and posted to clients billing records automatically. Prepared September 21, 1993 Page 4 Correspondence to clients and on the behalf of clients is also processed. In addition to client—specific communications, form letters are sent. Letters, other than those in standard formats, are typically dictated by professional staff and transcribed by clerical support staff on typewriter or by PC, if one is available. Form letters are typically brief, but other correspondence can be lengthy, with many attachments. Finally Administrative support staff maintains six megabytes of files for policy and procedure and system documentation manuals. Equipment Configuration: Board—operated CMH agencies are typically assigned one or two PC's for word processing and spreadsheet applications. The number of PC's available for use is far less than the demand for access to computers. Most agencies schedule clerical staff blocks of time each week to use the PC's. PC's are stationed either on a computer table in the clerical area, or on mobile carts. While mobile carts can be pulled to the staff's work site, using a PC on a table takes the staff person away from their desk and the phone. PC's at CMH are IBM—compatible Epson 8088's, for the most part. There are about seven 80286 machines (Epson and Sperry), two 386's and a laptop. CMH owns this equipment. Multimate Advantage II, a program no longer considered state—of—the—art, is used for word processing. Lotus 123 is used for spreadsheet and database applications. Various versions of Lotus 123 are used at CMH including 2.3, 3.1 and 3.4. Since no password security is provided on the PC's, confidential client information is stored solely on floppy disks under lock and key. Working with different versions of the spreadsheet program and working with files stored on floppies is inefficient when more than one staff work conjointly on a project. These older machines use only low—density 5.25" floppies, which can't store much information. Consequently, it is difficult to locate files when so many floppies are maintained. Staff are often too busy to make backup copies of their files, which has resulted in data loss when disks have failed. Separate terminals (one or two per agency) are provided for data entry to the mainframe system. These serve to enter client demographics, insurance information and service activity data, and to perform basic queries of client tracking, billing and activity information. The terminals are leased. These terminals are typically situated on a computer table in an area of the clerical pool. The terminals also provide Electronic—Mail capabilities, allowing messages of a few lines in length to be created (without word—wrap or spell—checking) and sent to other terminals in the system. This E—mail program serves to send short messages office—to—office, but not person—to—person. Dot—matrix printers are used for printing documents prepared on the PC, and for screen— prints of data in the mainframe system. Switching between devices is done with a manual switchbox. In some cases, when PC's are on mobile carts, printer cables are detached for moving to another work site and reattached for printing. While most printers are Panasonic dot matrix printers, there are two Silver Reed Daisy Wheels and a few C—Itoh dot matrix printers, which do not effectively support graphics characters. Prepared September 21, 1993 Page 5 I rting: Typewriters are assigned to each clerical staff, and some agencies have an extra typewriter or two available for use by clinical or supervisory staff. Technical support for mainframe and PC applications is provided by MIS staff. The mainframe system produces various "canned" reports based on the data entered. These include client management reports, billing reports, productivity reports and management reports. These canned reports are generated at regular pre-arranged intervals, but provisions exist for making special requests and varying reporting parameters. In addition to the "canned" reports, ad-hoc and custom reporting are produced by downloading data from the mainframe, either to the Test environment on the Mainframe at Computer Services, or to a PC on-site at CMH. The process takes 5 to 6 hours to download the demographic data to a PC. Once the download is received, the file is backed up and restored to a PC in the MIS Department. Limitations in PC disk space and processor capability prohibit activity data to be analyzed in this manner. Any custom reporting based on activity statistics must be done on the Mainframe in the Test environment. All ad-hoc reporting is generated by MIS. The current configuration does not provide for ad-hoc reporting availability to all system users. Full Management reporting involves the monitoring of inpatient utilization and reconciling county and state invoices for inpatient and residential charges. Prepared September 21, 1993 Page 6 AGENCY NAME CASES * SERVEDNR # LINES* ACTIVITY/YR # TX PLANS PER YR # PROGRESS NOTES PER YR REVIEWS # PSYCH III # ASSMTS EVALS PER YR PER YR II PER YR Administration CADT CCM—North CCM—South DD Services El Centro Geriatric Services Jail Services North OakId CAC Screening Services Southeast CMH South OakId CAC Southwest CMH n/a 179 633 612 883 131 911 172 1076 1418 539 723 539 TOTAL 7,816.00 716 2,532 2,448 3,532 524 3,644 688 4,304 n/a 2,156 2,892 2,156 31,264 179 633 612 883 131 911 172 ESTIMATED VOLUME OF CLINICAL DOCUMENTATION ANNUALLY 22992 18928 50588 30764 43918 4402 25089 2877 28708 22686 18071 31909 13599 291,539.00 179 633 612 883 • 131 911 172 1,076 nla -- 539 723 539 7,816 179 633 612 2,649 131 911 172 1,076 1,418 539 723 539 7,816 1,076 1,418 539 723 539 7,816 11852 43316 24500 38322 2433 8468 2123 17621 6069 12032 29190 9416 Figure 3 * = Actual volume as reported to MIS FY 91/92 Prepared September 21, 1993 Page 7 BILLABLE TRANS/YR 52,5092 days 5,712 services COMMENTS Inpatient/Residential Billing Reconciliation edicaid, Medicare, Other Insurance, Private Pay Nothing billable in Jail Jail Services North OakId CAC Screening Services Southeast CMH South OakId CAC Southwest CMH 7,272 services 0 included with Southwest 3,600 services 9,996 services BILLABLE SERVICES A AGENCY NAME Administration CADT CCM—North CCM—South DD Services El Centro Geriatric Services 12,516 services 7,932 services 14,208 services included with Geriatrics 3,336 services Medicaid, Medicare, Other Insurance, Private Pay Medicaid, Medicare, Other Insurance, Private Pay edicaid, Medicare, Blue Cross, Other Insurance, Private Pay billed by Geriatric's Account Clerk Medicaid, Medicare, Other Insurance, Private Pay Medicaid, Medicare, Blue Cross, Other Insurance, Private Pay Nothing billable in Institution billed by Southwest's Account Clerk Medicaid, Medicare, Other Insurance, Private Pay Medicaid, Medicare, Blue Cross, Other Insurance, Private Pay Figure 4 Prepared September 21, 1993 Page 8 IDENTIFIED PROBLEMS IN CURRENT ENVIRONMENT Through needs assessment questionnaires, surveys of the User's Groups, and informal fact- finding, CMH staff have identified several areas of concern with regard to the current environment: • PC a••••:.. is limited. "Agencies have 2 or 3 PC's to be shared amongst staff. "Staff are allotted access time -- limited to blocks on certain days of week at some agencies. 'PC's are used continuously. 'Work that could be done on PC's isn't because PC's aren't available. "Staff with special needs (wheel-chair bound, for example) have trouble writing, but don't have access to a PC. 'Since PC's aren't available to streamline support operations, clerical resources are limited, and clinical staff must hand write notes and reports. • Current hardware and software is insufficient to the n- -.s of CMH. •PC's are old 8088's and a few 286's. They are slow. 'Hard drives are small and the machines have less than 1 Meg of memory, so sophisticated number crunching and data management isn't a viable option. 'There are not enough printers to serve staff's needs adequately. Mobile PC's are carted over to printers attached to terminals or stand alone PC's to print documents. 'Software on current PC's exceeds the limitations of the hardware. 'Graphics works extremely, slow on the present PC's. •C-ITOH printers don't support graphics printing effectively. 'The volume of information kept in databases in Lotus has exceeded the existing machines' capabilities for querying and reporting--staff has had to separate the data into separate files by parts of the alphabet, which hampers integrated reporting. 'Custom demographic statistical reporting done in SPSS is preceded by the reception of a download file which takes about 5-6 hours to transfer and then must be backed up and restored to another PC. Activity data files are too large to handle on the existing PC and must be reported on the Test portion of the Mainframe, at Computer Services, taking staff away from the office. 'Mainframe response time is extremely slow. "Mainframe access is abused by staff that do data entry on terminal, but don't have access to a PC -- they create memos and notes to themselves in the E-mail screen and perform a "print-screen" and use the hard copy. • File - rity is a current con.- n. "The current PC's have no security system, so confidential client data is kept on floppies and locked up, which is inefficient. 'Backups aren't done regularly, if at all, as staff are too busy with other things to take the time to perform a backup. Prepared September 21, 1993 Page 9 • Inefficient use of staff time due to duplication of effort. 'Lists, schedules, and rolodex cards are created manually and duplicated numerous times. 'The current configuration doesn't allow CMH to centralize applications that are more efficient when centralized: 'Special application PC software programs are developed by MIS and copied to floppies for distribution to each agency. Updates to the program must be handled the same way--duplicated on numerous floppies and copied to the hard drives at each office. 'Standard report formats, assessments and forms can't be kept as masters in one file receptacle. Most are handled as hard-copy printed forms generated by the county's print shop and typewritten. .Floppies are passed back and forth to share data, to work together to complete a project and to edit documents. "Client appointment schedules are kept by hand and duplicated in several appointment books. 'With various grades of PC's, floppy format incompatibility is a problem. 'Fax can't be sent from the desktop. Documents are created, sometimes on PC, then walked over to a fax machine and faxed out. 'Documents prepared on typewriter take longer to prepare and edit than those prepared on a computer. 'Data capture and entry is tedious. Clinical staff write out service logs and data entry staff key the data into the mainframe system. 'Form letters are labor-intensive on typewriters. •Form letters created in blank, xeroxed and filled in with specifics are unprofessional in appearance. "Quality of documents created on typewriters are inferior to that created on PC's. "Different software versions cause problems when sharing files (when more than one staff works to complete the same project) 'Standard forms must be translated manually from English to Spanish at El Centro La Familia. 'Communication isn't always timely and is • • • - -intensive. •Inter-departmental memos are typically created, xeroxed and sent through county mail, resulting in time delays, and sometimes lost memos. •A great deal of paper is used for circulating inter-office communications and rough drafts. •Mainframe E-mail is limited in its use due to the number of lines allowable in the screen; the lack of word-wrap or spell check capabilities; and the limitation that mainframe terminals aren't on every desk--E-mail gets to the agency, but not necessarily to the key person. •CMH can't electronically interface with DMH nor advocacy groups. 'Exchange of information must occur either through floppy diskettes or on paper. Prepared September 21, 1993 Page 10 •Current configuration doesn't allow for taking advantage of technological advan..:-. that can enhance clinical ad—hoc r:.• *ding or on—screen statistical data queries. •CMH's paperwork—intensive system takes time away from client servicing. 'The system doesn't allow for integrating clinical documentation with service activity data capture, or client addresses into form letters, for example. "Staff can't work simultaneously in two software programs, working with data in a spreadsheet and bringing the data into a report created in a word processing program. 'Clinicians can't utilize computerization to meet Medicaid documentation requirements -- linking progress notes to treatment goals, and tracking treatment goals. 'Clinicians can't receive on—screen prompt to remind them of documentation due for their clients. -Different pieces of equipment are required for mainframe a PO:-.• and document creation (Typewriter. PC, printer, terminal) . 'Clerical staff have typewriters at their desks, but must move away from their desk to use the PC or to access the mainframe system, making it difficult to greet clients or answer the phone. •PC's and terminals have different keyboard formats, which is sometimes confusing to staff. Prepared September 21, 1993 Page 11 PROPOSAL The proposed solution to improve the operational shortcomings associated with the current CMH operating environment and to also become positioned for the migration to full management responsibilities, is the implementation of a new hardware configuration, new software availability, and an evolution of program enhancements to fully capitalize on the processing opportunities that will be made available by the network environment. (See Figure 5 for current configuration and proposed additional equipment. Figure 6 indicates final configuration of equipment after implementation of new equipment.) The proposed hardware configuration for Community Mental Health is a personal computer network environment. (See Figure 7 for costs.) The primary characteristics of this operational environment include the following: • personal computers that will serve as network terminals will allow the personal computer to function both as a stand—alone PC as well as a terminal access device capable of accessing the County mainframe. The PC will process in a stand—alone mode for both word processing, spreadsheet processing, and "specialty" software products, providing a highly technical capability at each work station. • the network environment will bring all Oakland County computing customers together for communication. Electronic mail, appointment scheduling, and calendar software will be office products that will be accessible to all customers. The network connectivity will also provide for the passing of data from one site to another — statistics, word processing files, spread sheet data, and data files will be electronically passed between locations to eliminate the need to pass printed reports and other materials between sites. • one of the primary devices of the network environment will be the file server. The file server will be the primary data file manager for a group of "local" work stations. It will maintain the software programs and data files that will be requested by the local work stations. The primary value of this device is that data files required for daily processing can be maintained at remote locations and the inefficient requirement to process mainframe files through phone line access will be eliminated. This new processing capability will greatly enhance response to inquiries for data. Each site remote to the County Computer Center will typically have a file server when there are more than 2 terminal devices at the location. The file server concept will also provide the operating environment to allow ad hoc reporting by the end user. • the network environment to be implemented at Oakland County will also address issues that have posed problems with stand—alone PC's -- both data file security and file back—ups will be managed by OCCS. Data will be secured from unauthorized access by a series of security functions provided by the network. OCCS will bear the responsibility for the creation of customer data file back—ups to ensure that files could be recovered. CMH will be implementing the proposed network environment in two phases: Prepared September 21, 1993 Page 12 • The first phase will be the installation of the requested hardware and software. The PC's and printers will be software operational and connected to the network. The CMH Administration Building on the County campus will be the first site to be implemented. Remaining agencies will be phased-in. The successful completion of this first phase will provide word processing, spreadsheet processing, and all specially requested software processing at each of the proposed work stations. All authorized network users will be capable of communicating with any other network users including those outside of the CMH organization, through terminal communications. The Office Products, Electronic Mail, Appointment Scheduling, etc., will be available to all authorized users. In some instances, special purpose software (such as DOS Amigos Spanish/English Translation Program) will be loaded directly to the hard drive of the PC. • The second phase of this network implementation plan will be the development of new programs that will capture client and activity data at the network data base level. These new programs using the latest software technology, including "Windows" type capabilities, will pass data to the mainframe to continue to support the processing needs of the mainframe system patient billing, activity reporting, etc., while maintaining a data base on the file server that will provide for ad hoc reporting The file server will also provide data to be processed through word processing and spreadsheet applications, such as merging client addresses from the demographic data base into a form letter. It should be noted that the number of new programs to be considered for the implementation of this new file server concept will be minimal and can be implemented in increments. While the time frame for implementing the first phase of this hardware/software proposed can be estimated with some degree of accuracy, the implementation of the second phase of this proposal will be evolutionary and an estimate of its completion date and cost will be established as phase two is being suggested. Because the proposed network environment provides so many new opportunities to improve on the current methods of processing data, it should be anticipated that as funding permits, new programs and procedures will be implemented to make more effective utilization of CMH resources. Prepared September 21, 1993 Page 13 28 33 1 33 1 1 9 _ 4 _ 3 _ 9 _ 3 = 71 129 10 6 4 9 7 34 3 2 3 1 1 PRINTERS 14 1WEWR[TERS 7 PRINTERS _ 7 PC's 28 1 1 2 1 1 1 2 2 7 9 2 1 2 4 1 2 5 8 2 3 12 27 5 0 1 2 1 2 6 10 BOARD OPERATED EQUIPMENT CONFIGURATION - CURRENT AND PROPOSED AGENCY NAME Administration CADT - Oak Park CADT - Pontiac CCM-NE CCM-NW CCM-South DD Services El Centro Geriatric Services Jail Services North OakId CAC Screening Services Southeast CMH South OakId CAC Southwest CMH TOTAL CURRENT CONFIGURATION TERMINALS I PC's 28.0 I 6 I 14 4.2 I 1 I 1 3.1 (cleo) 1 15.0 I 2 I 2 9.0 I 1 I 1 19.0 I 3 I 2 58.21 3 I 3 5.0 I 1 I 0 19.5 I 2 2 2.0 I 0 I 0 I 0 23.6 I 3 I 2 I 2 21.4 I 1 I 1 I 1 10.0 1 1 I 1 I 1 21.0 1 3 1 2 I 2 12.0 I 1 I 1 251.0 # FTE PROPOSED PURCHASE Figure 5 Prepared September 21, 1993 Page 14 Administration CADT - Oak Park CADT - Pontiac CCM-NE CCM-South Geriatric Services Jail Services North OakId CAC Screening Services Southeast CMH South OakId CAC Southwest CMH DD Services El Centro Previously owned equipment reallocated to clients in programs Total Equipment reallocated to clinical staff AGENCY NAME PROPOSED CONFIGURATION TYPEWRITERS Figure 6 Proposed plan eliminates the need for 28 leased terminals, and 45 leased typewriters. Prepared September 21, 1993 Page 15 CMH FULL MANAGEMENT PROGRAM file:CMHSumm.wk3 SUMMARY OF COMPUTER HARDWARE AND SOFTWARE NEEDS SEPTEMBER 21, 1993 REQUIRED PRICE ONE-TIME MAINT/ RECURRING QUANTITY ESTIMATE ACQUISITION SUPPORT MONTHLY COSTS RATE COSTS EST*** EST*** PERSONAL COMPUTERS: PC1A 116 $1,815 $210,540 40 $4,640 PC2A 6 $2,295 $13,770 40 $240 PC3B 1 $2,995 $2,995 42 $42 NOTEBOOK PC4A 7 $2,870 $20,090 46 $322 PRINTERS: LASER 9 $1,324 $11,916 30 $270 LASER W/EX TRAYS 15 $1,777 $26,655 30 $450 PRINTER CARD 24 $495 $11,880 0 $0 DOT MATRIX 1A 10 $359 $3,590 25 $250 MISC PERIPHERALS: TAPE BACKUP 4 $198 $792 PP $88 FULL PAGE SCANNER 1 $1,100 $1,100 30 $30 MOUSE PADS 129 $5 $645 0 $0 WRIST RESTS 129 $10 $1,290 0 $0 MODEMS 3 $495 $1,485 0 " $0 NETWORK CARDS 7 $495 $3,465 0 $0 PC SOFTWARE: DOS AMIGOS 1 $200 $200 0 $0 E-MAIL (WP OFFICE) 129 $100 $12,900 0 $0 LOTUS 123 46 $274 $12,604 0 $0 SCANNER SOFTWARE 1 $1,000 $1,000 0 $0 SPSS UPGRADE 1 $400 $400 0 $0 WORDPERFECT 5.2 71 $140 $9,940 0 $0 WORDPERFECT WORKS 33 $120 $3,960 0 $0 NETWORKING COMPONENTS: FILE SERVERS 5 VARIOUS $110,000 0 $0 HUBS & ROUTERS 26 VARIOUS $104,910 0 $0 NETWORK MGMT SW 129 $37 $4,773 0 $0 POWER SUPPLIES 15 $300 $4,500 0 $0 PATCH CORDS 129 $10 $1,290 0 $0 SURGE PROTECTORS 129 $15 $1,935 0 $0 WIRE TO PC 129 $10 $1,290 0 $0 NETWORK ACCESS 154 23 $3,542 NET/MAIN ACCESS 31 35 $1,085 MODEM ACCESS 4 0 $0 BULL BOARD ACCESS 1 0 $0 CD ROM LBRY ACCESS 1 0 $0 FAX SERVICE 1 0 $0 Page 16 $32,250 $49,125 $55,875 $10,900 $72,807 !:L, $0 $0 $313 CMH FULL MANAGEMENT PROGRAM (CONTD.) SUMMARY OF COMPUTER HARDWARE AND SOFTWARE NEEDS SEPTEMBER 21, 1993 REQUIRED PRICE ONE-TIME MAINT/ RECURRING QUANTITY ESTIMATE ACQUISITION SUPPORT MONTHLY COSTS RATE COSTS PROGRAM LAUNCH EXPENSES: INSTALLATION BUILDING WIRING(ALL CMH LOCATIONS) TRAINING AT OCCS 373 $150 CONTINGENCY PROGRAM LAUNCH TOTAL: STATE OF MICHIGAN SHARE OAKLAND COUNTY SHARE MGT & BUDGET TO PROVIDE MONTHLY RECURRING This proposal will address CMH's concerns (referenced in Identified Problems in the Current Environment section above) as follows: LIMITED ACCESS: A personal computer network environment would solve the concern of limited PC access by providing a work station for all clerical staff, all administrative staff, program administrators and clinical supervisors. A pilot agency would be established to measure the efficacy of a network to streamline clinical operations. Also, an additional work station would be installed at each office for use by clinical staff without work stations in their offices. This network configuration would easily lend itself to expansion, allowing for remaining staff to receive work stations in future years, as appropriate and as resources allow. INSUFFICIENT HARDWARE/SOFTWARE: The proposed network consists of state—of—the art personal computers and user—friendly software in the Windows environment, addressing the concerns expressed with regard to the limitations of the existing hardware and software. SECURITY: Password restrictions and automated backups are standard features on the proposed network, which would address the concerns regarding system security for confidential data and security against loss of data in the event of disk failure. Both data file security and file back—ups will be managed by OCCS. Data will be secured from unauthorized access by a series of security functions provided by the network. OCCS will also bear the responsibility for the backup of customer data files to ensure that files could be recovered. DUPLICATION OF EFFORT: One of the primary devices of the network environment will be the file server. The file server will be the primary data file manager for a group of "local" terminals. It will maintain the software programs and data files that will be requested by the local network users. The primary value of this device is that data files needed for daily processing can be maintained at remote locations and the need to process mainframe files through phone line access will be eliminated. This new processing capability will greatly enhance response to inquiries for data. Each site remote to the County Computer Center will typically have a file server when there are more than 2 terminal devices at the location. The file server concept will also provide the operating environment to allow ad hoc reporting by the end user. Prepared September 21, 1993 Page 18 Office applications can be streamlined through networking, greatly reducing duplication of effort. Common files such as lists and special application files would be stored on the file server, reducing the amount of paper and floppy file copies required for day—to—day operations. Forms and reports could be stored as macros and shared. Staff could have ready access to client appointment schedules kept on the schedule database. Form letters could be easily customized with data held in the client database. All staff would be working with the same version of programs, eliminating the need for file conversion when working in tandem on projects. COMMUNICATION: The network environment will bring all Oakland County computing users together for communication. Electronic mail, appointment scheduling, and calendar software will be accessible to all users. The network connectivity will also provide for the passing of data from one site to another -- statistics, word processing files, spread sheet data, and data files will be passed between locations to eliminate the need to pass printed reports and other materials between sites. TECHNOLOGICAL ADVANCES: The network environment will position CMH for innovative solutions to the tedium of data capture can be tested. Activity documentation could be integrated with activity log data capture. Data required for mainframe processing could also be stored in the local file server and could be used as merge fields in form letters. Improved tracking of goals and objectives could be done with a database of treatment plan goals. EQUIPMENT: Personal computers that will serve as network terminals will allow the personal computer to function both as a stand—alone PC as well as a terminal access device. The PC will process in a stand—alone mode for both word processing and spreadsheet processing. Prepared September 21, 1993 Page 19 CMH BENEFITS As Community Mental Health proceeds into "Full Management", the need for automation becomes much more important to the success of implementation. Planning, assessing performance, analyzing data, and documenting results are imperative to the operation of an efficient well-tuned organization. While the benefits presented here are not all hard savings for the County, they are, nevertheless, significant and required to manage the type of growth in activity that CMH is about to experience. There will be an element of this new technology which will allow CMH cost avoidance as employees respond to the mandate of being more productive, while controlling employee costs. The following identifies benefits within functional areas of CMH. Client Services Due to limited clerical resources, most reports and notes are handwritten by clinical staff, a time-consuming process that takes clinical staff away from direct client servicing. Since handwritten progress notes take time to write and are often illegible, and perhaps incomplete due to time constraints, it is generally accepted that dictating notes and having them transcribed by clerical staff would be a more desirable alternative. Further, legibility is a detriment to effective client servicing when files are shared. It takes longer to read and interpret hand-written notes than typewritten pages, prolonging the intake process when clients are being screened for services. The waiting period for clients added to CMH as a result of Full Management could be lessened as computerization streamlines clinical activities, and clients are served more effectively. umption #1: Clerical time saved through efficiencies gained by the computer system could be redirected to transcribing clinical progress notes and reports on the PC, reducing the time clinicians take to prepare the notes and reports, and allowing them to spend more time with clients. Assuming a conservative savings of 5 minutes per note, with 64,572 billable services documented annually, a savings of 5380 hours could be redirected to client services. Assuming a reimbursement rate of $42 (the typical reimbursement for a full session of therapy) for half of the time saved, this could mean up to $113,001 in reimbursement annually. umption #2: Utilization review would be enhanced, resulting in better client servicing, improved service evaluation and more time for client services if the Utilization Team were reviewing mainly word processed notes. Assuming that utilization review time could be cut in half with computer-generated notes in the client file, two hours per agency per month could be saved, for a total of 96 hours of clinical time each year. If this time were redirected to direct services, a potential for $4032 ($42/session) in reimbursement could be gained. As.g Prepared September 21, 1993 Page 20 • mption #3: Psychological testing could be done by computer, reducing the time needed to interpret tests, and thereby allowing the psychologist more time for direct services. Psychologists who have used automated testing estimate a savings of 2 hours per test. Tests administered last year totaled 300, assuming half that number would be done by computer in the new environment, 300 hours of psychologist time could be saved (2 hours each for 150 tests). Assuming the psychologist redirects half that time to therapy and the other half to more testing, at $42 per session of therapy, up to $6300 in revenue could be received (150 sessions at $42/session). Non-automated psychological testing took about 4 hours to complete, and billed out at $37.36 per hour ($149/test). Assuming the savings of 2 hours, 75 tests could be administered with the remaining 150 hours saved, with reimbursement at $37.36 per hour, at two hours each, about $5604 in revenue could be gained. Desktop electronic mail will greatly streamline communication. Detailed client-related messages can be sent in the password-secure environment, improving the turnaround time and content of messages from one agency to another. Assumption #4: Screening Services could use electronic mail instead of a series of three phone calls to notify an agency of the hospitalization of one of its clients, saving the cost of at least two phone calls per client. Of the 130 clients screened, half are already being served within CMH. If two calls of the three calls were replaced with electronic mail, at $ .15 per call, a savings of $19.50 would be realized monthly-4234 annually. umption #5: Routing OBRA tracking logs through Geriatric Services could be done via electronic mail rather than manually by hard copy, saving clerical staff approximately 40 hours per year. At the average cost of $15/hour, approximately $600 worth of clerical time could be saved. Installing a PC and translation software at El Centro La Familia will ensure that clients not fluent in English are as effectively served as their English-speaking peers, by allowing efficient translation of documents and forms from English to Spanish. umption #6: DOS Amigos, an Spanish/English translation software program will reduce the time spent by clerical staff manually translating documents and forms by 500 hours annually. At a rate of $15/hour, this amounts to a savings of $7500 each year. Clerical/Technical Support Clerks and typists are currently competing for shared computers for word processors and spreadsheet operations. Increased productivity could be realized by increasing the availability of personal computers, eliminating wasted time waiting for a personal computer to become available. Further efficiencies would be gained in the network configuration by eliminating the need for staff to be away from their desks and phone to perform computer operations. • Agg • Prepared September 21, 1993 Page 21 Workloads far exceed clerical resources, consequently, the time saved would be put to good use completing projects that have been "on hold"; increasing the quality of support; and creating innovations for better client servicing. umption #7: With more work stations available, time could be saved tracking client appointments and update review dates by using a master database of client dates for each agency in the network. It is thought that about 94 staff hours could be saved each month. At an average cost of $15 per hour for salaries and fringe benefits of clerical staff, about $16,920 of clerical time could be saved each year. Productivity would increase as the time taken for creating and editing documents would be decreased through PC operations based in the user-friendly "Windows" environment with a mouse. Files stored on floppy are often difficult to locate when staff other than the creator need to edit a document. In the network, with password security, confidential data could be stored on the file server, consequently, file searching would be much easier. Electronic mail would reduce the amount of paper routed through agencies for inter-departmental memos and copies of meeting minutes. umption #13: Utilizing a PC with a word processing program would save time creating and editing documents. It is estimated that five minutes per document for 2400 letters and 1392 memos created a month could be saved, and 30 minutes could be saved for 75% of the 7816 assessments and psychiatric assessments prepared annually. This total time savings of 9654 hours annually equates to $144,810 when factored with the average cost of $15 an hour for salary and fringe benefits of clerical support. umption #9: Files stored on the file server on the network would be quicker to locate for editing than files stored as they are now, on floppy disks. It is estimated that approximately 12 hours per year are spent searching for files, calculating the average cost of salary and fringe benefits ($15/hour)for clerical support, this equates to a savings of $180 annually. umption #10: Routing memos and copies of minutes through agencies using electronic mail rather than xeroxed copies would save $ .05 per copy on the photocopy machine lease. Approximately 7370 xerox copies of minutes, memos and E-mail messages delivered to the agency rather than the desktop of the recipient would be saved each month, for a savings of $4422 each year in photocopy per copy costs. Additionally, assuming 1 minute of staff time per copy could be saved, 123 hours a year could be saved at the average cost of $15/hour, or $1845 per year. • _ A_ss • Prepared September 21, 1993 Page 22 umption #11: Printing and typesetting costs would be saved by using desktop publishing software (Wordperfect) and laser printers to generate forms. Approximately $2500 is spent each year on typesetting, a 50% reduction is projected, for a savings of $1250. Nearly $18,000 is spent annually for printing, it is expected that this could be reduced by 25%, for a savings of $4500. umption #12: Since forms could be generated using Wordperfect on the network system, staff time would be saved picking up, distributing and storing the forms. It is estimated that 5 hours per month could be saved, at a savings of $900 annually, based on the average rate of $15 per hour for clerical support staff. Additionally, mileage could be saved as staff from the southern agencies wouldn't need to drive to the campus to pick up printed forms. An estimated 50 miles per month at $ .25 could be saved, at a savings of $150 annually. In many instances, an employee's work station may be comprised of a mainframe terminal, a PC, and/or a typewriter. The new network device will be a significantly upgraded PC that will generally replace all three of these devices. There should be very few situations, where the new work station has more than one device. A few typewriters will remain at the agencies for the completion of non-CMH forms. Otherwise, printing will be done mainly on shared laser printers. umption #13: Since the leases of 45 of the 71 typewriters at CMH are being terminated, 63% of the cost of typewriter supplies would be saved. Currently, $596 is spent on correcting fluid and correcting tape, and $2584 is spent annually on typewriter ribbons. $2003 would be saved (63% of $3180). Insurance Billing Medicaid, Medicare, and Blue Cross can audit a random sample of client progress notes attempting to find discrepancies between client progress notes and actual billings. If discrepancies are found, the percentage of discrepancies are extended against total billings and levied as a fine to the agency. In other instances, audits with a significant amount of deficient findings may result in a probationary billing status with the carrier. Some audit exceptions are the result of misinterpretation due to illegible handwritten notes. Others are a consequence of documentation that doesn't match the service activity code logged. Taking advantage of network technology to have direct service activity logged as a byproduct of a word-processed progress note would ensure complete documentation of billable direct services, reducing audit exceptions and potential loss of revenue. Acg Acg Prepared September 21, 1993 Page 23 umption #14: Audit exceptions would be reduced if notes and reports were not handwritten. It is estimated that 25% of the audit exceptions cited are due to illegibility. About 6% of notes reviewed are cited as exceptions. With 64,572 notes created each year, 25% of 6% is equal to 969 notes with problems due to illegibility. If notes were dictated and word processed,15 minutes of clinical time per note would easily be saved from researching the audit exception-242 hours. Assuming this time savings would be redirected to client services, client care would be increased, and a potential of $42 reimbursement per session might be realized -- a gain of $10,164. Additionally, clerical time would be saved in researching the exception — a savings of 242 hours at $15/hour, or $3632. Administration CMH administrators are required to insure that monies are being spent in a way that is most beneficial to their clients. Contracting will continue with those agencies that are producing a quality level of service of client care with successful results, based on quantitative outcome measures. The type of review required to analyze the many variables can only be accomplished through the use of personal computers and specialized statistical analysis software. Without these tools administrators are unable to accurately measure the success of programs servicing their clients, using only anecdotal information for decision-making. CMH is constantly requested to develop reports and presentations for Advocacy Groups, the State Department of Mental Health, Community Mental Health Board, and other organizations. Under the present situation, the technology is not always available to respond to these requests in a timely manner. Network personal computers would expedite these tasks. Often, staff are required to "cut and paste" and manually prepare reports and presentation materials that could otherwise be prepared quickly and look very "professional" by using a personal computer with the appropriate software. Operations at Administration would be streamlined through the PC Network to absorb Full Management expansion without a proportional increase in the number of Administrative Staff. umption #15: The scheduling program in the network system would serve to decrease the amount of time spent scheduling and confirming attendance at meetings held at the Board Conference Room. About 20 meetings are held in the conference room each month, and it is anticipated that 15 minutes of staff time could be saved for each meeting, for an annualized savings of $900, based on the average salary/fringe figure of $15/hour. Prepared September 21, 1993 Page 24 Leasing and maintenance charges would be reduced as leases on 45 typewriters and 28 terminals would be terminated. As PC forms are developed, the number of leased typewriters will decrease further. Mainframe terminals replaced by PC's will be returned to OCCS and can be reassigned to replace terminals that have been in service at other county departments much longer than the CMH devices. Typewriters will be returned to equipment inventory for possible re-assignment. umption #16: Network PC's would replace 45 typewriters leased at $28 per month and terminals at a cost of $60 per month, resulting in a savings of $15,120 annually for typewriters, and $20,160 annual for terminals. With the new network environment, the standard word processing product will be WordPerfect for Windows and all employees will be prepared for this product. A move of an employee from one location to another will not be hampered by the word processing product used at either site. CMH MIS staff will utilize and implement many of the WordPerfect features other than word processing for all sites. The standard spreadsheet application will be Lotus for Windows. All staff will have the same version, eliminating the time wasted in the current environment as work sheets prepared in one version required conversion to another version in some situations. Further, existing PC's relegated to client use in the clubhouse or to use by clinical staff will have a Wordperfect software product installed to ensure compatibility when files are shared. Assumption #17: Standard software installed on the network will eliminate the need to convert files, saving approximately 12 hours a year converting the Base Program Description, 24 hours a year converting the fiscal reports, 40 hours each year working with the annual report, and 40 hours a year converting or retyping policies and procedures created outside of Administration. Assuming the average salary and fringe benefit cost for clerical support at $15 an hour, a savings of $1740 could be realized. POSITIONING FOR FUTURE DEVELOPMENT The capability of CMH agency staff to perform ad hoc reporting should greatly proliferate the information that can be made available to management and professional staff. There should be no staff concerns regarding the inability to report on data that has been captured by the computer. The capability to generate ad hoc reports by CMH staff will reduce the cost and the timeliness associated with program development by OCCS staff. As work stations are provided for clinicians, clinicians will be able to complete documentation more quickly. Applications developed that automatically create activity logs, reports on progress towards client goals, and fulfill the needs of other clinical documentation will result in clinicians being free to spend more time with their clients. A.c.c Prepared September 21, 1993 Page 25 Administration and clinicians alike are concerned that clinicians are spending nearly half of their time on clinical paperwork. It is expected that automation will serve to reduce the time spent on documentation and increase the time available to be spent with clients. More direct time with clients equates to additional client servicing and potentially more revenue. Clinical reports on client progress are critical for patient care, and are required for insurance billing. Therapists are either dictating or hand writing notes for typing. Required time to follow—up for proof reading, editing, and finalizing a report can be very time consuming, taking time away from the clients. Having available lap—top computers for therapists could expedite the completion of progress reports in a more timely manner. In future development phases, clients could utilize phone access to determine the balance owing on their private pay account, or check on their next appointment date. Prepared September 21, 1993 Page 26 $113,001 $4,032 $5,604 $6,300 $10,164 $139,101 $452,004 $565,005 $16.128 $20,160 $22,416 $28,020 $25,200 $31,500 $40,656 $50,820 $556,404 $695,505 $600 $7,500 $16,920 $144,810 $180 $1,845 $900 $3,632 $900 $1,740 $179,027 $2,400 $3.000 $30,000 $37,500 $67,680 $84,600 $579,240 $724,050 $720 $900 $7,380 $9,225 $3,600 $4,500 $14,529 $18,161 $3,600 $4,500 $6.960 $8,700 $716,109 $895,136 $234 $936 $1,170 $4,422 $17,688 $22,110 $5,750 $23,000 $28,750 $150 $600 $750 $2,003 $8,012 $10,015 $15,120 $60,480 $75,600 $20,160 $80,640 $100,800 $47,839 $191,356 $239,195 $365,967 $1,463,869 $1,829,836 CMH FIVE YEAR COST B COST CAPITAL EXPENSE-ACQUISITION & INSTALLATION ANNUAL OPERATIONAL EXPENSE SOFTVVARE DEVELOPMENT SUPPORT FOR 24 MONTHS TOTAL COST BENEFIT ASSUMP. # INCREASED REVENUES NEFIT ANALYSIS YEAR YEARS ONE TWO THRU FIVE CUMULATIVE COST COST TOTAL $728,065 $728.065 $135,264 $541,056 $676,320 $82,500 $82,500 $165,000 $945,829 $623,556 -$K569,385 YEAR YEARS ONE TWO THRU FIVE CUMULATIVE BENEFIT BENEFIT TOTAL 1 CLIENT TREATMENT FROM TIME SAVED FROM HANDWRITTEN NOTES 2 CLIENT TREATMENT FROM UR REVIEW SAVINGS 3 CLIENT TESTING FROM PYSCH TESTING TIME SAVED 3 CLIENT TREATMENT FROM PSYCH TESTING SAVED 4 CLIENT TREATMENT FROM AUDIT TIME SAVED SUBTOTAL - INCREASED REVENUES PRODUCTIVITY IMPROVEMENTS TIME SAVINGS IN: 5 ROUTING OBRA TRACKING - CLERICAL TIME 6 TRANSLATING ENGLISH/SPANISH DOCS - CLERICAL TIME 7 TRACKING CLIENT APPOINTMENTS - CLERICAL TIME 8 CREATING/EDITING FILES - CLERICAL TIME 9 LOCATING FILES - CLERICAL TIME 10 XEROXING E-MAIL MESSAGES- CLERICAL TIME 12 PICKING UP & STORING FORMS - CLERICAL TIME 14 RESEARCHING AUDIT EXCEPTIONS - CLERICAL TIME 15 SCHEDULING MEETINGS - CLERICAL TIME 17 CONVERTING FILES - CLERICAL TIME SUBTOTAL - PRODUCTIVITY IMPROVEMENTS COST AVOIDANCE 4 PHONE CALLS RE: INPATIENT ADMISSIONS 10 XEROX PER/COPY COST 11 TYPESE I I I NG/PRINTING 12 MILEAGE TO PICK UP FORMS 13 TYPEWRITER SUPPLIES 16 LEASES ON RETURNED TYPEWRITERS 16 LEASES ON RETURNED TERMINALS SUBTOTAL - COST AVOIDANCE TOTAL BENEFITS NET BENaTT* SEE DETAILS REGARDING ASSUMPTIONS IN THE BENEFIT SECTION OF THE PROPOSAL. *COST BENEFIT ANALYSIS INDICATES A 3.5 YEAR PAYBACK $260,451 Prepared 21-Sep-V page 27 SUMMARY Although CMH is responding in a large part to the increased demands of administering the Full Management Contract, CMH is also answering to the mandate being made of all current County employees -- each employee, at every level must become more productive and each employee must become more creative in determining and developing new procedures that will make our operations more productive and cost effective. A PC based network environment will be the major device for implementing this new philosophy at the County. While it is very difficult to quantify the value of time saved as a result of automating operational improvements or to place a value on better service for the clients of CMH, it should be apparent that by streamlining the indirect service functions associated to delivery of service will result in a larger share of the CMH budget being spent on direct client care. The Cost Benefit Analysis shows that revenue could increase by $695,505 by the end of the fifth year, if efficiencies gained by clinicians were redirected to direct client services. After five years, a total of $239,195 could be avoided in office supplies and related costs in the network environment. The equivalent of $895,136 in clerical support could be relieved in this proposal. This clerical time would be allocated to provide additional support to clinical staff, allowing clinical staff to enhance client services. After the system is established, Administration will examine clerical staffing ratios to determine if any hard savings could be realized in this area. However, the evaluation shows that through hard and soft savings, the cost of the initial equipment purchase would be fully absorbed after three and a half years. It is the recommendation of those that have taken part in this analysis that CMH implement the initial plan and purchase the proposed equipment as itemized in the plan. Prepared September 21, 1993 Page 28 Resolution #93198 September 23, 1993 Moved by McCulloch supported by Gosling the resolution be adopted. AYES: Gosling, Jensen, Johnson, Kaczmar, Kingzett, Law, McCulloch, McPherson, Miltner, Moffitt, Oaks, Palmer, Pernick, Powers, Price, Schmid, Taub, Wolf, Aaron, Crake, Dingeldey, Douglas, Garfield. (23) NAYS: None. (0) A sufficient majority having voted therefor, the resolution was adopted. STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lynn D. Allen, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on September 23, 1993 with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 23rd.day of September, 1993 Lynn i D. Allen, County Clerk 336