Services/Client Information Network: Health Canada Phase I Report


prepared by Oulton and Co., May 1996
Executive Summary

The AIDS Committee of Toronto's (ACT’s) needs analysis and this report have been prepared by The Oulton Group (OG) with the participation of ACT’s Project Team and other staff.

This needs analysis examines the service and operational needs of ACT and some of its partnering agencies. Phase I will develop and implement automated systems which will address these needs this year. Phase II will continue the process during the next fiscal year.

Many areas were investigated and evaluated during this needs assessment. Taken together, these areas fall into three broad categories: Information Provision, Internal Administration, and Client Case Management. ACT’s Project Team and other staff took the process very seriously and responded with high-level objectives and fine detail about how services (and automation) could be improved. Their ideas and responses show many opportunities for a more efficient use of people and information resources while at the same time improving the quality of existing services, and adding new ones.

In order for this to happen, ACT needs to invest seriously in technology and work flow automation. And it will have to make some high-level decisions as to which areas merit automation vis--vis the investment required. This should be done with an eye to maximising the service benefits to clients as well as the labour saving benefits to the organisation from the resources available for the project.

At the outset, ACT indicated that their preferred GroupWare tool for the project would be Lotus Notes, and the results of this needs analysis confirm the wisdom of their choice. Especially among not-for-profits, Lotus Notes is showing a very high rate-of-return in terms of positive effect per dollar invested.

Introduction

The purpose of this report is to sum up the work flow automation needs at ACT (while taking into account the needs of its partnering agencies), and to put forth a blueprint for action. Our goal is, through automation, to enhance and extend services to clients as well as to simplify and standardise the administrative functions of the organisations providing those services.

Methodology

To get a sense of the automation needs, issues and concerns of the key AIDS-related agencies, groups, physicians and institutions in the Metropolitan Toronto area, 159 surveys were mailed out. A community consultation meeting was also held on March 25th, 1996, which presented an overview of the project.

As well, seven key regional, provincial or national organisations were contacted for one-to-one interviews: CPHA National AIDS Clearinghouse, Community AIDS Treatment Information Exchange (CATIE), Ontario Ministry of AIDS & Health Sexual Health Infoline (AIDS Infoline), Community Information Centre of Metropolitan Toronto (CIC), Canadian AIDS Society (CAS), HIV Ontario Observational Database (HOOD), and the Pacific AIDS Resource Centre (PARC).

Internally, needs response forms were distributed to individuals and teams working in the three areas that this needs analysis investigates, and the Project Team assisted staff in working their way through the forms. The completed forms were reviewed as they came in, and if further particulars were required, the people involved were contacted.

Project team meetings, held every two weeks, monitored the progress of the needs analysis and evaluated the emerging picture.

All responses were keyed into a Notes database, which ACT now has. This report will not repeat the detail contained in that database or in the printouts from it attached to this report; instead, it will highlight the objectives that each area defined and provide implementation suggestions appropriate to each area.

The needs responses are not dead documentation, for they will serve as step-by-step guides in planning the overall work flow automation. Further consultation will, of course, be necessary during the set-up (this has been included in set-up time estimates) to get feedback on how the automation development is meeting people's needs, and it's expected that a few more requirements will inevitably crop up.

How the rest of the report is structured

We have as much as possible extended the reach of this report beyond the traditional needs analysis, to that of an action plan for some areas, and sketches of action plans which can be developed later in others.

What We Heard about Services
and Service Delivery

1) External Consultations

The Process

Seven key regional, provincial or national organisations were contacted for one-to-one interviews: CPHA National AIDS Clearinghouse, Community AIDS Treatment Information Exchange (CATIE), Ontario Ministry of AIDS & Health Sexual Health Infoline (AIDS Infoline), Community Information Centre of Metropolitan Toronto (CIC), Canadian AIDS Society (CAS), HIV Ontario Observational Database (HOOD), and the Pacific AIDS Resource Centre (PARC).

And to get a sense of the automation needs, issues and concerns of the key AIDS-related agencies, groups, physicians and institutions in the Metropolitan Toronto area, 159 surveys were mailed out. A community consultation meeting was also held on March 25th, 1996, which presented an overview of the project.

In regards to information provision, internal administration and client case management, the surveys and one-to-one interviews looked for the following information:

what work flow issues are you currently facing?
what information must you currently collect and maintain?
what areas in you organisation should be linked to information and work flow tools to ensure accuracy, proper follow-up. etc.?
what are the specific measurable objectives you would like this computer project to meet?
what opportunities and obstacles do you see this computer project creating in regards to how you provide and maintain services and organisational structures?
what are the opportunity areas for Service Providers to pool knowledge, information and services?
what is your current level of computerisation?

Surveys were returned from the following groups: Access Alliance Multicultural Community Health Centre, Etobicoke DPH (AIDS Programme); Four Villages Community Health Centre, Metropolitan Community Church (Toronto) AidsCARE programme, Music Therapy Services of Metropolitan Toronto, Teresa Group, Trinity Home Hospice, two unidentified DPH AIDS Programmes, two unidentified Aboriginal community-based groups; and one unidentified community-based group.

The following analysis is constructed using the information received from the 20 respondents -- 7 from interviews; 13 from survey mail-backs. And although not all respondents addressed all questions, we believe that this 13% response rate is adequate for the purposes of this needs assessment.

What we found out about other ASOs' current state of technology assets

Internal Networks

    Yes
10
    Most respondents had some form of networking. All respondents felt the need to improve their hardware. Some didn't see how they would find the money to do this, others didn't see how they could avoid the expense much longer.
    No
6
    Dumb-terminals
1
    Not addressed
3

Operating Platforms
    DOS
3
    UNIX
2
    Windows
11
    MacIntosh
1
    Not addressed
3

Dial-out Access to Internet
    Yes
4
    No
11
    Not addressed
5

Web browsing
    Yes
1
    Russell Armstrong of the Canadian AIDS Society noted that the ASOs he is in contact with don't yet see a reason to think about Web browsing, but that as soon as needed resources become available on the Web, he felt they would move to it quite quickly.
    No
13
    Not addressed
6

Internal automation needs of other organisations

Service providers that are closely tied to large institutions expressed little interest in how this overall Network (and specifically ACT's internal tools) might be of use to them. Representatives from St. Michael's hospital, for example, explained at the public meeting that they were obliged to adhere to the software tools authorised internally. Many people at that public meeting, in fact, were from such larger institutions, and so showed little interest in this aspect of the project.

It is interesting to note that this was not the case amongst those ASOs interviewed one-to-one (with the exception of HOOD, covered below). Many of those interviewed began by saying they had their own plans for an internal automated work flow system, so the interview focused first on the external, interagency aspects of the project. As the interview progressed, however, those being interviewed started to acknowledge their pressing internal automation needs and an actual strong interest in the tools ACT would be developing. Thus, the initial lack of interest in this area will not preclude at least a few ASOs borrowing some internal experience from ACT. With this in mind, a portion of the Project Team's time should be allotted to cross-training these partnering organisations.

One reason that external organisations expressed more interest in the interagency aspects of the project, rather than internal operational aspects, is because the interagency part covered “Web sites”. Even if people have never seen a Web site, they still have heard about them, and roughly grasp the concept. The internal aspect, however, covers “automating work flow”. This concept can often really only be grasped when someone explains the quantity of manual work currently involved in internal administration, and then has the picture sketched out for them as it could be with a GroupWare product in place. As they see many aspects of ACT's administration come to be automated, the concept may be clearer to them and they may indeed “want it on it”.

Of those interviewed, CAS, CATIE and the National AIDS Clearinghouse have already expressed interest in the internal work flow automation tools. Of those returning questionnaires by mail, about half expressed interest in the internal automation tools.

An overriding concern of all involved was, of course, confidentiality -- even within their own organisations. Internal automation tools that were singled out for especial interest were:

Board and volunteer management tools
Policies and procedures databases
Resource manual databases
Client usage-tracking databases
Any tools that assisted in avoiding duplication of daily effort.

Some, like Trinity Home Hospice, had tried other tracking tools that proved to too cumbersome and inflexible, and so failed to meet their needs. In order to capture their interest and confidence in ACT's internal tools, ACT should be careful to document before and after scenarios, concentrating especially on how work effort was reduced or quality of service improved. Measuring tools would allow others to judge how worthwhile the effort to implement these tools at their own organisations would be.

Among those who were very “with it” technically in terms of applications such as databases or directories (such as CATIE, HOOD or CIC), all their efforts to date have had to been concentrated on mission-critical external deliverables. These organisations have not had the resources to-date to focus inwardly on how they work as a team, so there is a great opportunity for this project to help them out internally as they have helped ACT out with the external deliverables.

Inter-Agency Automation Needs

The summary response sections that follow are multi-valued -- that is, all ideas were accepted, tracked and categorised. Note that the count indicates that some respondents provided more than one response/idea. There were still a total of 20 respondents. In the first section, for instance, there were 14 not categorised (i.e. giving no response). Subtracting 14 not categorised from 25 means that 11 “offerings” were made. Subtracting the number not categorised from 20 (20-14 = 6) means that 6 organisations gave “offerings”. Thus, 6 organisations provided 11 responses. This tells us that almost all these 6 organisations were interested enough in the question/issue to submit more than one suggestion.

Information that those responding/contacted could offer to others:

    directories
1
    early warning alerts
1
    library catalogues
1
    news about other agencies
1
    policies and procedures
1
    reports
2
    statistics
1
    training manuals
2
    trends
1
    not categorised
14
    total responses
25

Information that those responding/contacted want access to:
    events
1
    library information
1
    news items
2
    policies and procedures
1
    referrals
1
    resource manuals
1
    speakers
1
    statistics
1
    news about what others are doing
2
    not categorised
15
    total responses
26

Issues and obstacles seen by those responding/contacted:
      autonomy issues
1
      copyright issues: need procedures
3
      lack of knowledge about what each other is doing
3
      an organisation may need to its name on material for Funders to see
3
      individuals and organisations will need access to the Internet
1
      time / cost of communicating with everyone
1
      confidentiality
2
      French and English required
2
      need to understand policies and procedures behind another’s data
1
      an organisation may have to start charging for its information
1
      pooling information may make Funders think better of you
1
      not categorised
12
      total responses
31

Opportunity areas that merit special mention

Sharing Reference Manuals

Currently every organisation compiles and maintains its own reference manuals. This represents a lot of duplicated effort. It would be ideal to have regional manuals online, from which each organisation could take what it wants. Organisations could then add to it whatever their unique needs dictate. Saving agencies this effort could do a lot to achieve buy-in on other things. Those agencies, such as the CIC, that would be needed to provide the core listings (organisation names, addresses, phone numbers) might have great incentive to provide this, because it would allow them to showcase their work to the community at large and to their own Funders.

Discussion Databases

A simple, standard Notes discussion database, password-protected for appropriate access on a Web site, would easily provide all ASOs with a central forum in which to keep each other up-to-date on news items, discuss and compare trends and issues, and communicate in a no-cost and low-time commitment environment. From what ASOs are saying, there would be very large dividends from such small effort. The Canadian AIDS Society might spearhead the efforts on this, as they are already an umbrella organisation.

Web Sites

A few organisations (such as CAS, CATIE, and PARC) are planning or are already maintaining a Web site. Others are thinking about Web sites or have started investigating them, but are not quite sure why. Of all the organisations we have contacted, ACT had the most clearly defined goals for its Web site, and at this point those goals are coming within reach. Those who are considering Web sites could be encouraged to host their initial Web site at ACT for initial pilots at least. The Notes component that would allow them to maintain their own portion of the Web site would be really attractive to them.

In an environment of pooled resources, who could pitch in what?

    Directories:
    Community Information Centre of Metro Toronto (CIC)
    Early warning alerts:
    Ontario Ministry of Health AIDS & Sexual Health Infoline
    Library catalogues:
    CPHA National AIDS clearinghouse
    News about other organisations:
    Canadian AIDS Society (CAS)
    Policies and Procedures:
    CATIE, CAS
    Reports:
    HOOD, AIDS & Sexual Health Infoline
    Statistics:
    HOOD, CAS
    Training manuals:
    CPHA National AIDS Clearinghouse, CATIE
    Trends:
    AIDS & Sexual Health Infoline

Issues that merit special mention

Information Quality

Any information provided to individual clients or to other agencies should have its source and background properly documented. The National AIDS Clearinghouse might be able to spearhead setting the standards on this.

Language

Only a few agencies require French (such as CATIE and National AIDS Clearinghouse). Perhaps the effort an ASO would have to expend to develop French services could later be shared with other ASOs.

2) Consultations within ACT

The Process

Needs response forms were distributed throughout ACT. People were given assistance both by OG and by the ACT Project Team to fill them in. In many instances, people were also interviewed.

The needs response forms looked for the following:

what information does each work area contain/track?
what other information should it link to? (i.e. what information does it currently tie into manually at present, and what information should it be tying into when the automation occurs?)
what work processes are currently involved in this component, and ideally, how could these work processes be fine tuned? How do we want to change the way people do these jobs?
who will the users be, and what will the levels of access be?
when the project actually begins, how will ACT measure success for each of these components? What will the yardsticks be?
what are the timelines and priorities for each area?

Areas submitting responses:

Information Provision Areas:
Community Referral Lists; Library Services; Living Guide; Requests for Speakers

Internal Administration Areas:
Budget Tracking; Database Management; Policies and Procedures Documentation; Relationship with Funders; Programme Staff Scheduling and Time Management; Statistical Reporting; Work Plans

Client Case Management Areas:
Advocacy; Buddy Programme; Client Record Keeping; Counselling; Hooking up Clients; Volunteer Management

Reference will be made throughout the following discussion to “conceptual paths” and “timeline paths”. The conceptual path attempts to group areas in terms of how they relate to each other (usually based on shared information or shared service goals); the timeline path reflects when areas will actually be dealt with.

A summary of objectives, and some suggestions for implementation is also included in the following discussion. Introductions to each narrative discuss the conceptual principles to be realised, rather than specific tasks to be achieved.

Information Provision Areas:

The main conceptual objectives that all areas involved in Information Provision share are standardisation, centralisation, and easier access to and sharing of information and records.

And although automating these areas will involve most of the same guiding principals as any client case management system will, the two main development principals in this area are: the information dealt with is not confidential; and clients will not need a great deal of help from workers (if any at all) in order to access the information from a workstation at ACT or via a Web browser at another agency or from home.

Developing these areas will involve getting information about the clients and services automated and organised internally first, and then making strategic and progressive decisions about what to expose to other workers within ACT and potentially to other organisations via the Web site.

Community Resource Lists (combines Community Referral Lists and the Living Guide)

Objectives:

Reduce the time and work needed to compile and maintain data
Reduce costs associated with producing paper copies
Make it easier to produce specialised/focussed reports based on the information in the system
Increase access to the information
Free up time that other service providers spend on this - they are all currently tracking it in their own way

Implementation: Putting up Community Resource Lists in a Notes database will allow ACT to meet both the internal and external aspects of these objectives. The work could be quite straightforward; basically a contact manager model with enhanced areas for narrative profile information. It will be important to ensure that the database design works equally well whether the user is accessing the information via Notes or via a Web browser. Information sources such as CATIE and the CIC have expressed interest in providing the core contact information for these databases.

Library Services

Objectives:

To integrate library functions now done in separate database
To eliminate the necessity for making new paper catalogues, and to allow for continuous, or almost continuous, updating of existing catalogues
To make information about the library's collection more widely available
To make it easier to train people on how to use the library's software

Implementation: There are already a few library templates out there floating around which could be worked from and enhanced to meet ACT's needs. Lisa Betel has already reviewed the proposed format. She will request further enhancements and modifications to meet ACT's very rigorous cataloguing standards.

Requests for Speakers

Though this area was explored, it was not deemed a priority by ACT at this time, as the nature of this service may be changing.

Internal Administration Areas:

Like information provision, the practice of Database Management is the key guiding principle at work, rather than a specific task area. The main two development principles in these areas are: information will most likely be restricted to staff / Board access (organisational confidentiality); and, the network's system administration will have to take into account a (potentially) complex system of users access levels as well as information storage and flow.

Budget Tracking

Objectives:

Decrease budget update time from accounting department
Reduce amount of time spent reporting back to accounting department on expenditures to date
Allow component areas to review the remaining budgets and report back on spending

Implementation: The best model is one in which a Notes database, acting as a container for a spreadsheet, would centralise the storage of all budget work. The spreadsheet would exchange its information to Notes and get back information from Notes. As people recorded expenditures in Notes, for instance, this information could be automatically passed back into and reflected in many different budget spreadsheets. This model could be done via Microsoft Excel, but the design would be made more straightforward using Lotus 123.

Policies and Procedures Documentation

Objective:

Provide an easy mechanism to document and distribute policies and procedures internally and externally, and to set in place the "dynamic" in which this becomes a standard part of the internal operations

Implementation: Success can be measured over time by how often end users refer to it, and by how much it decreases their current reliance on others for support. Organisationally, ACT will also be using it for other purposes, and those purposes would require their own measurement yardsticks. There is a pre-existing policies and procedures database in Notes, so this should be the first thing that goes up.

Relationship with Funders

Objective:

Preparing funding proposals is a task consisting largely of assembling three different types of information -- narrative, statistics to demonstrate need, and budget proposals -- into a coherent, persuasive whole. The editorial and thinking time around amalgamating this information cannot be reduced; however, the objective is to reduce the assembly time which is currently very manual and laborious.

Implementation: This work area involves first compiling bits of narrative, statistics and budgets and then manipulating the text to form the report standard each Funder requires. Notes should act as a document container to bring all these bits together, and should notify people automatically when updates are due. The person doing the reporting would then select and assemble the information. Ultimately, the actual assembly process cannot be automated too much, because it requires human judgement and discretion, but the collection procedure can be improved dramatically.

Programme Staff Scheduling and Time Management

Objective:

Streamline and harmonise time management processes
Co-ordinate, timeline and track all tasks: individually, interdepartmentally, inter-team, intra-agency, and interagency

Implementation: Wait until midsummer 1996 when Organiser for Notes will be released, because it will write its data directly to Notes databases. Enhancement will then be necessary to tie this into work plans, but, by waiting for the new version of Organiser for Notes, a good deal of the work automating this task will already be done and will eliminate having to reinvent the wheel.

Statistical Reporting

Objective:

Reduce the amount of time currently spent on compiling and summarising statistics for reporting to 45% of what is currently required (from 185 hours to 83 hours in Support Services alone!).

Implementation: Use Lotus Approach to pull together information from different views in different databases. Some database views may be sufficient on their own for a lot of internal reporting however, and may not even need to be printed out (but simply viewed instead).

Work Plans

Objective:

Streamline and harmonise work plan process
Co-ordinate, timeline and track all tasks: individually, interteam, interdepartmentally, intra-agency, and interagency

Implementation: Narrative-based work plan databases can likely be tied into Organiser for Notes, to be released midsummer 1996. See the graphic chart attached to this report summarising how the work flow is foreseen for work plans. Work plan automation should include links to budgets for reporting, and to a calendar/timeline/project management application.

Client Case Management Areas:

Client case management is more a principle than an actual programming area. It takes into account our relationships with individuals representing themselves as well as individuals representing communities and/or organisations. Like information provision, the main conceptual objectives that all areas involved in client case management share are standardisation, centralisation, and easier access to and sharing of information and client records.

However, a differing conceptual component to (especially individual) client case management is one of “hooking up”. This process differs greatly from one of simply providing a client with referral information because it involves an in-depth and confidential interaction between client and worker. An automated client case management system will need to allow workers to act as their client's advocate by first assessing the client's immediate (and possibly future) needs, then by getting the client booked directly into the services he or she needs (within ACT or at other agencies), and finally by allowing workers to “follow-up” with their client to make sure things are proceeding okay.

One staff response identified a desire for one central screen for each client that would act as jumping off point for booking or referring the client to all services. Therefore, the development of Client Record Keeping systems must first involve designing this central jump-off point from which all the modules or areas link off and “report” back to.

And like the areas in information provision, this too will involve getting information about the clients and services automated and organised internally first, and then making strategic and progressive decisions about what to expose to other workers within ACT and potentially to other organisations via the Web site.

Advocacy

Objectives:

The needs response form received needs more exploration.

Implementation: From interviewing the key workers involved with this type of work, advocacy seems to track who has contacted ACT, who ACT has contacted and the nature of the contacts. Enhancing the contact manager application may meet their needs.

Buddy Programme

We are not showing a completed needs response form. Note that as an area that promises to deliver substantial time savings to Statistical Reporting, ACT must work to develop an in-depth analysis with the workers involved in this area.

Implementation: Again, an enhanced version of a contact manager system may do the trick.

Counselling

Form handed in, but need more information. i.e. blank areas do not yet permit project planning.

Volunteer Management

Objectives:

Increased retention rate for volunteers
Better communication, support, development and utilisation of volunteers
Clients should be able to make their needs/desires known about volunteer involvement in ANY area of ACT
Faster and more accurate statistics gathering and reporting
Shorter turnaround time to fill volunteer requests, meet programme needs
More responsive client services: i.e. better matching of volunteer skills to tasks

Implementation: Enhanced version of contact manager.

Implementing Phase I

Phase I involves rolling out the applications (and the hardware to run them on) that address the organisational needs. Note that the organisational needs have been defined vis--vis technology in this needs analysis; however, Phase I will still involve actually “specking” out how these needs translate in terms of fields, forms, views, etc. in the applications put into place to address these needs.

We believe that this report has identified and presented many opportunity areas for both increasing efficient use of the funding dollars while enhancing services to your clients and communities at the same time. We believe that acting on the opportunities will involve some organisational and work flow transformation, and therefore are pointing out at the outset the need for careful management and communication during Phase I.

But above all, though we point out the structural improvement aspects that the technology can have, it should not be missed that the needs analysis has been conducted with an eye to better interaction with and better service to the individuals and communities living and dealing with HIV and AIDS. Owing to the maturity of GroupWare technology currently available, there are many opportunity areas for making a client's contact with ACT a more “holistic” one (in terms of how information on that client is tracked for instance), and which allows a “one-stop shopping” opportunity for services -- either in person, over the phone or via the Web. And we were impressed by this “knowing what we're here to do” principal that came through over and over again in the objectives ACT staff defined for themselves in each needs area.

Summary Recommendations

  • ACT has eight months in which to design and implement the new environment. In order to do this, ACT will need to bring in certified Notes consultants. As previously recommended, the Project Team should be closely involved with the consultants so that cross-training can occur (cross-training is highly desirable, because it not only allows an opportunity to deepen the experience of those who have been trained, but also allows ACT to take ownership of its technology). The goal is to develop a pool of expertise in-house in order to reduce maintenance costs later on. This is achievable in a Notes environment.
  • ACT should apply a business model to its training and technology investments. Your current approach has created an infrastructure for which support costs are high, and value returned is low. We want to reverse that equation, for it will help ensure that scarce resources can be maximised and directed to delivering the services and administrative functions needed to help keep ACT’s community-based response a progressive and flexible one.
  • As this technology will result in workplace culture changes, we recommend ongoing dialogue with staff as the technology is implemented. Notes naturally leads to a collaborative environment of information sharing, so it is important that staff invest in the process.
  • New equipment is needed. As it arrives, it should be placed in the areas being automated first, as they will need it to run the new software. And as the technology is implemented, the set-up policies and procedures for its use should be documented as a part of the implementation process.

Project Milestones

We propose the following foundation for the Project's long-term plan. There are three main milestones.

1. The establishment of the Web site (to deliver the information provision areas).
2. A satisfactory level of automation for internal organisation functions.
3. The umbrella of client case management automation all woven together.

In each milestone's separate "umbrella", there may be items which deserve priority over those in previous "umbrellas". We recommend that they be moved ahead in the timeline path even though conceptually they are part of a different phase.

The Project will need to manage both the timeline path and the conceptual path to ensure proper execution and user buy-in. And it will need to manage user expectations: the technology will not all happen overnight, and it will not make what they do easier (initially). It will, however, fundamentally change what they do and how they do it.

Why OG is recommending the Web site as the first milestone

Normally, we would stress getting internal information in order before advancing to a Web site. The arguments for waiting would be numerous:

  • it ensures proper reflection time on the business purpose, goals, and success measurements for the Web site;
  • it ensures that an internal information discipline is implemented that can handle the sudden arrival of a whole new set of information to process;
  • it ensures that the organisation has the information for the Web site organised and ready to go.

Too many Web sites go up too fast with insufficient information to represent the organisation behind the site. A Web site is a representation of your organisation to the world.

That being said, there are factors which we feel move the Web site ahead in priority. These are:

ACT's information is not yet stored electronically, but focusing on the Web site (a client service) would help ACT to focus its internal priorities, and would provide the motivation to get information organised internally in order for it to be available on the Web site;

the Web site is a core, strategic mechanism for facilitating the delivery of services and information and for querying ACT's client base on how these can be improved, fine-tuned and expanded;

a Web site would be a clear commitment by ACT to increase the level of services and information to its clients (something that ACT was asked to make a priority at the Community consultation held in March);

many of the pressing needs identified among AIDS service organisations and information providers contacted were quite basic: they want a means to inform one another about work and plans in progress so that wheels don't get reinvented, and they want to pool resources and information so as to more effectively leverage their funding dollars. ACT's Web site would give them all a place to do this until they have their own sites, and after that could serve as a very important hub in terms of the technical and service standards built together;

simply putting up a discussion database for ASOs to convene in would not justify a Web site, especially given that this discussion database would not be visible to Funders, the public or ACT's clients. However, such a discussion database, established at an early date, would be of immense value all the same to many ASOs;

the success and visibility of a Web site, especially one integrated with Notes, could provide a major impetus for other ASOs to look very closely at adapting some of ACT's internal tools for themselves. The success of a Notes Web site would help instil confidence in these internal automation tools;

other AIDS service organisations and information providers are considering putting up Web sites. An ACT Web site gives ACT the opportunity to participate in this collective move and offer peer-support.

For these reasons, we recommend that a Web site be the first milestone.

The development of a Web site will cover all of the areas involved with Information Provision with the exception of Speaker Requests. Speaker Requests, it was decided, is not a priority at this point. In meeting ACT's Information Provision needs, this milestone sees the need to have a Notes server in place and ready for further deployment soon.

Both ACT and OG feel that the first offerings on the Web site should include community resource lists and the Library's catalogue. There should also be a discussion forum for ASOs and information providers in a protected area. ACT may also wish to consider a public discussion forum.

Before any work begins, an internal Policies and Procedures database should go up. The first Policies and Procedures will be those that govern the Web site. As each area is automated, this will ensure that work flow is documented as it evolves.

Community Resource Lists:

Amalgamating the many separate referral lists that ACT currently tracks and maintains into one on-line referral service will provide external users with much easier and more up-to-date information. In the past, paper copies of these resources would run out quickly, and a costly photocopying cycle would begin. With the referral information online, anyone with access to the Internet from home, office, public library, or community will be able to get and print out precisely the information they want, when they want it. It will also serve an internal function as well, ensuring that up-to-date referral information is available to those in front line roles.

In future, the online version could permit "owners" of the profiles to submit updates to their profiles. The submission process could involve a deliberate, manual hesitation wherein someone at ACT clicks to approve the change, and then the updated data is made available. This will eliminate having various people and departments struggle to ensure that the information they have is current. The data can also be fed back to the original suppliers of the information (such as CATIE and the CIC), thereby reducing their workload as well. This will lead to uniform information standards being applied to the collection of new data. Information of this type - contact co-ordinates and profile information - is among the most costly and time-consuming to compile and maintain, so the opportunities for cost savings here are great, both for ACT and other ASOs.

Library Catalogues:

Like community referral lists, providing downloads or links to HIV/AIDS-related library collections is another service that offers a lot of bang for the buck. The National AIDS Clearinghouse is very keen on pooling/linking its catalogue with ACT's (as part of their ongoing efforts to create a national network of HIV/AIDS-related resource centres/libraries). As for ACT’s collection, on-line users would be informed that these materials are available on-site only. The catalogue would let them know, however, whether a trip on-site was worth it for the material they were seeking.

On-line catalogues will give ACT workers and clients easy access to information about the information they need. Currently, the catalogue is on only one PC in a DOS format that requires training to maneuver about in.

Information Imports:

The organisations/groups supplying this data have so-far expressed a great willingness to provide it to ACT. We need to see sample data before firmly estimating the time required to import it. We expect that the first round of imports will take a great deal of time. This is based on previous import experience and includes figuring out an import method that can be easily, efficiently, and quickly reproduced in the future. Of course, this method will be documented in the Policies and Procedures database so that ACT can perform it in future without outside help. Subsequent imports to “refresh” the data would take dramatically less time.

The first step involves negotiating with the data providers to see if they are indeed willing to contribute towards the project for the long-term. The next step is to agree to quality and format of the data to be imported. We must ensure that they see “something in it for them”, as it will entail some work and co-operation on their part.

Discussion Forums

Discussion forums require minimum effort to put up, but a lot of effort to promote, facilitate and maintain. Although these forums appear in the same conceptual timeline as catalogues and referral lists, the development and delivery of these interactive features may have to be occur later on in the Project timeline.

Policies and Procedures

This can be developed from a standard Notes database already available and in use elsewhere. An internal one has already been mentioned; an online version in a protected area should be considered as well, in which ASOs and information providers can swap policies and procedures. Most organisations interviewed expressed a strong desire to be able to do this and placed high value on it: being able to do so would mean that one organisation could learn from another, instead of having to figure out an approach to something on their own.

Web Server / Notes Server Set-up

The Project Team should be involved in every step from then on so that they can understand and begin to document procedures for it. This will require training in directory set-up and maintenance, networking, backup, access control, database and file maintenance, printers, etc.. External Notes training is highly recommended as a first step.

Establishing the Online Linkage

Allow time for final pricing research, communications with the supplier, installations by the supplier, etc..

Additional Points

David will need to negotiate with the providers of the data for the online guides

Lisa will need to consider the presentation of the library catalogue and be in discussions with the National AIDS Clearinghouse

Both will need to contact external ASOs about the discussion forum and announce its availability

It will take a good deal of time to document procedures for the online guides, and especially procedures for the Web site itself

Cross-training in many technical matters and administration around these matters will be necessary, and time to document all of this so that ACT moves in the direction of an internally self-sustaining site

For all this to take place, it is important that David and Lisa are among those who first receive new PCs.

Second Milestone: Internal Administration

This milestone, which covers automatically tracking client services and organisational supports, is built on the practice of standardised database management. Database management is a principle rather than a task area, and should more properly be termed information or knowledge management, because databases are just the containers for the information, which is what one actually cares about. Helping users find the right information at the right time is the core of effective knowledge management.

ACT-wide knowledge management will come about by training users to use the help documentation and the policies and planning database, and through careful set-up of the network's front-line applications so that knowledge management is built into how users work, reducing their need to think about it.

Just as important are the people skills of the internal people on this project. We have seen instances in organisations where information (and therefore information management efforts) were needlessly duplicated owing to internal political considerations between various groups. Your people will need to exercise the skills to identify when and where needs and concerns really do justify special consideration, and which cases just require further explanation of database management and its benefits. Avoiding duplication of information will be the goal. ACT staff should be alert to necessary exceptions, should there be any, and flag special business needs early enough in the automation process for that area.

ACT staff should also search out what information - both structured and unstructured - they currently hold in electronic format. Archive databases should go up to start cataloguing unstructured information that should be preserved and shared. Structured information - such as names and addresses - should be file-copied and set aside for bringing into the proper databases. Staff will need time for this identification process, and they will need time for the archiving process - attaching the files into Notes containers.

Budget Tracking

We recommend that this be done via a spreadsheet working in combination with Lotus Notes. The budget spreadsheets, acting as the document containers and versioning managers, would be embedded within Notes, and expose their summary data to a Notes view. Proper access control would be strictly applied to all information. Some budget tracking forms may be used by several areas, and some areas will have unique requirements. Again, your internal people should be learn how to develop and maintain this process on their own.

Relationship with Funders

A contact management/central profiles database should be linked into the Case Management area, and provide a guide for defining Case Management needs. This database allows all aspects of relationships with Funders to be tracked. Training should be provided to your project leaders in the use of a contact manager; they should then cross-train other users. The original starting data would be provided by a "dump" from GiftRap, the software in use in the development department.

Scheduling

This can occur any time after midsummer 1996. At that time, Lotus will be releasing Organiser for Notes. We recommend that ACT pursue obtaining licenses from IBM/Lotus for this on a donated basis; if this is not possible, then it should be purchased at Lotus's not-for-profit rate.

The Project Team should receive training in this, and be allowed further time to practice with the application. After that, they will cross-train the rest of the staff. Remember this is not only a software skill being learnt, but also a time-management and planning tool. The team should also be trained in how to implement the software.

Work Plans

Work plans are closely tied to Scheduling. The Scheduling component will allow automatic time-based reporting back to the relevant work plans. The actual planning and tracking of work plans will require a database of some intricacy, and the work around it - how people interact with it - will need to be properly documented and explained.

Third Milestone: Case Management

Though certain aspects of case management are "on computer", this has only moved the work as it existed in manual systems to electronic ones. The areas of information and work flows remain disconnected from one another. Software tools now exist to bring them together. The benefits of this are that staff and volunteers can turn increasing amounts of their time and attention away from administration and towards direct service to clients.

Like database management, client record keeping is more a principle than an application or work area. The principles of database management - or information management - apply here too. And as discussed in the Internal Consultation section, case management involves the unique component of “hooking up” clients to the services they need (within ACT or externally). This will require access to resource guides on the Web site, the ability to make and track referrals, and the flexibility to allow clients to book their own services over the Web.

Existing client profiles in electronic format can be imported to initially populate this module. However, like statistical reporting, client case management is dependent on having service modules in place first. As part of each service module, a form for booking that service will be created.

Advocacy

A completed needs response form has not yet been submitted.

Buddy Programme

A completed needs response form has not yet been submitted.

Counselling

Counsellors' client tracking needs might be easily added to a contact management system, mentioned above in Funder Relations. Information needs will be addressed as service components come on line. Counselling already has structured data which can be imported to initially populate the application.

Best Cases for Immediate Development:
Statistical Reporting and Volunteer Management

Virtually everyone at ACT produces statistical reports. In the needs assessment, staff were able to forecast how many hours could be saved if statistical reporting were automated. Statistics Reporting is currently taking over 180 hours a month, which is easily the equivalent of one full-time person. This shows its importance to ACT's operations, and that the current process is extremely cumbersome. Staff responsible for putting together reports told us that most of their time is spent collecting information in various formats and in various parts of the organisation. ACT is no different from other organisations in having its information in many unlinked places and formats, but other organisations can ignore statistical reporting or do it only if there is time. At ACT, it is critical.

Our target is to reduce the number of hours from 184 per month to 81 per month, a savings of 100 hours. We feel this is a conservative target, and that by the end of the project, the time will be substantially lower. At $17/hr, that 100 hours will save ACT $1,700 a month in freed-up time.

Unfortunately, automating statistical reporting is dependent upon automating each area which is the source of statistical data. Given that, we must look at which task areas will produce the greatest time savings. Buddy/PA Co-ordination says statistical reporting is taking 120 hours per month, and hopes to reduce that number to 50 hours per month. The next largest is client notes and statistical forms filled in by Counsellors. This currently takes 25 hours per month; their target is 15 hours per month, for a reduction of 10 hours.

Volunteer Management is another area where ACT can realise greater efficiency as well as cost savings.

Betty Ann Rutledge, the Co-ordinator of Volunteer Services, expressed herself with great clarity on her needs response form. She already has some structured data to start off populating this application. Set-up would probably involve adding additional functions to a contact management-like application to address her special needs. Volunteer Services was able to document the current work flow and outline preferred alternatives. This programme area is ready and eager to automate, and has looked at various software solutions.

We recommend that a Volunteer Management database be created at the same time as the Web site, not only because of these reasons, but also because of the importance of volunteer resources to ACT.

In summary, Volunteer Management should be a high-priority item and the timeline should reflect this; and any areas that can contribute to reducing time incurred in Statistical Reporting should be given priority.

Technology Recommendations

As previously stated, ACT needs to manage its users’ expectations: the technology will not all happen overnight. And it will not make what they do initially easier; instead, it will actually change what they do and how they do it.

This needs analysis was in effect also a process analysis. The implementation of Phase I will involve ACT fundamentally rethinking the way it connects to and relates to its clients and its “information and service suppliers”. Many of the recommendations are made with an eye to breaking down barriers that create wait times that add no value.

ACT needs to invest in technology in order to automate its work flow.

Software

We recommend that Lotus Notes be the core working environment. A few designer licenses should be purchased, but most users will only need lower-cost desktop licenses.

We recommend that ACT consider either MS Office or Lotus SmartSuite for their desktop applications. Both are Notes compatible, though SmartSuite is more so.

We recommend that ACT use Lotus Organiser for Notes for its scheduling software, and Lotus Approach for specialised reporting from Notes.

We recommend that the Web server be run via Notes server 4.2, which incorporates both the Web server and Notes.

All software collateral should be kept in a central, secure location.

A standard desktop configuration be in place and deviated from only where a business need is documented.

No unlicensed or unauthorised software be allowed on ACT’s machines.

Hardware

We recommend that all existing machines below a 486 processor be gradually replaced. The minimum workstation should be 486/25 with 8 meg of RAM, running Windows for Workgroups. New acquisitions should come in with a minimum of 586/100 with 16 meg of RAM. These should be running Win95.

All equipment, whether donated or new, should come with a 3 year warranty. This kind of warranty will keep support costs to a minimum.

Keeping an updated inventory should be considered crucial.

The server should be a P150 or higher with 64 meg RAM, 4 gig harddrive and a DAT backup drive. It should be running OS/2 Warp or NT server. We recommend the removal of Novell NetWare; with Windows for Workgroups/Win95 on the workstations and Warp or NT on the server, the extra maintenance and support cost of third-party networking cannot be justified.

Networking wiring should be 10-Base T. The network cards should be Ethernet. This is the industry standard and costs less than ACT's current TokenRing environment.

We recommend that a 128k/ISDN line be brought directly in-house, and that ACT register its Web site address directly to its server.

We recommend that the network operating protocol be IPX, to act as a fire wall between the Internet and internal operations.

Clearly, we are recommending that ACT invest a great deal in its hardware infrastructure. We know from experience that this produces the lowest costs overall. For the current weak structure of no-name clones in the 286 and 386 range, ACT is paying $1,000 a month for ongoing support. The environment we are proposing would eliminate that expense. We recommend that all hardware be good enough to give three to five years service in any business environment; any shorter period costs too much for support and installation.