Introduction
How It Will Work
Need – Solution – Results
Questions and Answers
Securing Client Confidentiality
Contact Information

Introduction

For years, Virginia has had a vision. A vision to:

• Implement a No-Wrong-Door process, ensuring that everyone has the same access to information and resources, regardless of where he or she first enters the system.
  
  
• Develop a one-stop resource linking seniors and adults with disabilities to services.
  
  
• Help consumers have more control over decisions regarding the service they receive.
  
  
• Allow professionals to spend more time focusing on clients and less time searching for information or filling out paperwork.
  
  
• Use technology to improve the access to, and delivery of, services for seniors and adults with disabilities.
  
  
• Combine the resources, experience and energy of the public and private sectors to make a system that's right for everyone.

Virginia's partners are making it happen.

Virginia’s “No Wrong Door” system is a collaborative public/private effort between the Virginia Department for the Aging (VDA), Department of Rehabilitative Services, Department of Medical Assistance Services, Department of Social Services, Department of Mental Health, Mental Retardation and Substance Abuse Services, SeniorNavigator, a 501(c)(3) non-profit organization, pilot Area Agencies on Aging (AAAs) and their local governments and local providers.

Initial funding for this important initiative has been provided by Dominion, the U.S. Administration on Aging and the Centers for Medicare and Medicaid Services, The Commonwealth of Virginia, local governments and Virginia's community partners.

How It Will Work

Because the No Wrong Door System is still in development, there are no case studies to share. While hypothetical, "Roger" is a very real example of the type of client who will benefit from this new system.

What is Roger's situation?

• He is 84.
• His wife died last year and he suffered a stroke shortly thereafter.
• He is living alone in the home he shared with his wife for 45 years - and he doesn't want to move.
• His only child, a daughter, lives hundreds of miles away.
• While he is reluctant to seek assistance, she convinces him that a geriatric assessment would be helpful to figure out what services might make it possible for him to remain in his home.

Under the existing system, what happens next?

• The geriatric care manager interviews Roger and finds that he is on several medications, is unable to drive, requires physical therapy twice a week, is incontinent and has some short-term memory loss.
• Information collected during the interview and needs assessment is captured on paper.
• Based on her evaluation, the care manager decides what services Roger would benefit from - in this case, transportation, daycare, non-medical in-home assistance and home-delivered meals.
• The care manager looks in her personal notebook to find the numbers for an adult daycare in Roger's neighborhood that accepts clients with memory loss and incontinence.
• She places calls to each of her adult daycare contacts until she finds one that has space available and will meet Roger's needs.
• She writes a referral for the daycare and hands it to Roger and his daughter.
• Roger and his daughter meet with the case manager at the daycare.
• At the appointment, the case manager starts from the beginning with Roger and his daughter, with a new intake and interview process covering the same issues and information.

How the process will work with the No Wrong Door System:

• When Roger and his daughter first meet with the geriatric care manager, all of the interview information is entered into a HIPAA-compliant, shared client database.
• Roger's answers interface with the SeniorNavigator service provider database to find the best matches for his needs.
• It is not necessary to check on availability, special needs, waiting lists or eligibility because the search process only returns matches according to Roger's needs.
• With the match in hand, the geriatric care manager, with Roger's consent, can make an e-referral to the day services center in his area.
• When Roger arrives at the day services center, the care manager there is expecting him and has accessed his information. Roger and his daughter are relieved that they don't have to start from the beginning, telling their story all over again.
• If the day services care manager needs additional information about Roger, it is added into Roger's e-folder within the HIPAA-compliant, shared client database.
• Roger's geriatric care manager can easily check on how things are going for him.

Every time Roger seeks additional services, the streamlined process ensures that the process will be fast and efficient and that Roger will quickly get the services he needs.

Need - Solution - Results

The No Wrong Door System has been designed to stretch resources, eliminate duplication of effort and harness technology to help meet the rapidly expanding needs of the Commonwealth's older citizens and adults with disabilities.

Need:

Why does Virginia need to coordinate services?

• There are over 7,000 public and private organizations serving Virginia's seniors and adults with disabilities.
• More than 2 million Virginians are over age 65 or have at least one disability.
• The population of seniors, particularly those over age 85, is growing much more rapidly than Virginia's population as a whole.
• While there are resources available to assist these individuals, locating and accessing those services can be challenging and time-consuming.
• Coordinating services will allow faster provision of services and improved outcomes.

Solution:

Virginia is piloting a breakthrough No Wrong Door System. This system will allow the sharing of information between all of a community's agencies and organizations providing services to seniors and adults with disabilities.

This Web-based system, which is being customized for Virginia, will allow providers access to privacy-protected client information as well as details on the services available in their community. Accessible 24-hours-a-day, it will:

• Record and share information on clients' specific needs, while also safeguarding their privacy.
• Identify the best services for each client, determine eligibility and make referrals electronically.
• Track enrollment and update each client's status with every service provider.
• Measure outcomes.
• Evaluate gaps in service.
  

What are the benefits of coordinated services to consumers - seniors and adults with disabilities?

• It will save time and make it easier for them to navigate a challenging system at a particularly difficult time in their lives.
  • Individuals will provide their health, contact, financial and needs information only once - it will be available on a need-to-know basis by any other service provider they turn to.
  • They will quickly know what services they are eligible for, whether they can afford them and if there is space available.
• It will assure that there is No Wrong Door - they will be able to connect with the services that offer the best match for them regardless of where they begin seeking help.
• They will be able to get assistance faster - they'll know immediately what services they can receive and when they can begin receiving them.
• They will enjoy better health outcomes - they will be connected with care and services more quickly and any additional needs will be identified and met sooner.

What are the benefits to Service Providers?

• They will have more time for client-centered service.
  • They can have clients' complete profiles and needs analyses in-hand before the initial interview.
  • The can immediately determine which services their clients are eligible for and make instant e-referrals to connect them with care.
• They will have full access to information on every service available in the community to meet their clients' needs, via the comprehensive service database.
• They will be empowered to easily track clients' current progress:
  o They can check if a client followed-up on a referral and, if so, how that placement is succeeding.
  o They will have instant access to each client's current status and be able to track progress over time.
• They will have the satisfaction of providing faster and more comprehensive assistance to their clients and helping them achieve better outcomes.

What are the advantages to Virginia and its communities?

• It will allow agencies to serve more individuals with the same resources.
• It will provide an accurate picture of the populations being served and the services available, which will be used to meet current needs and address gaps.
• It will allow for a better allocation of resources.
• It will improve the health status of seniors and adults with disabilities in Virginia by providing better outcomes.

Questions and Answers

How will confidentiality be secured?

• The system is fully HIPAA compliant.
• Locked access prevents unauthorized use.
• Need-to-know safeguards ensure that a specific agency or service provider has access only to the information necessary to serve that client - and nothing more.
• Clients choose whether or not to have their information shared.
• Multiple security layers and protocols ensure that the entire client database is secure.
• The system has equipment redundancy, backup power and communications systems, three-tier architecture and a sophisticated password control system.

Where will it be piloted?

The Virginia pilot communities include:

• Peninsula - The cities of Newport News, Hampton, Poquoson and Williamsburg and the counties of James City and York.
• Central Shenandoah - The cities of Buena Vista, Harrisonburg, Lexington, Staunton and Waynesboro and the counties of Augusta, Bath, Highland Rockbridge and Rockingham.
• Greater Richmond - The city of Richmond, and the counties of Charles City, Chesterfield, Goochland, Hanover, Henrico, New Kent and Powhatan.
• Bay Area - Counties of Essex, Gloucester, King and Queen, King William, Lancaster, Mathews, Middlesex, Northumberland, Richmond and Westmoreland.

Who is driving it?

Virginia Department for the Aging (VDA) is coordinating the development of No Wrong Door for Virginians who need aging or disability-related information and services. This collaborative, public/private effort involves key state and local agencies, including the Department of Rehabilitative Services, Department of Medical Assistance Services and Department of Social Services as well as non-profit organizations such as SeniorNavigator, 2-1-1 Virginia, Commonwealth Council on Aging and numerous other service and advocacy organizations across the state.

Back to Top

Securing Client Confidentiality

The No Wrong Door System has been meticulously designed to ensure confidentiality of client records. Locked access prevents unauthorized use and need-to-know barriers ensure that a specific agency or service provider has access only to the information necessary to assist the client. All clients have the choice of whether or not to share their information and authorization by the client initiates inclusion into the system.

HIPAA Compliance

The No Wrong Door System provides secure, confidential and HIPAA-compliant tracking of each call, follow-up management and data collection. HIPAA compliance is ensured in the following ways:

1. The system only stores encrypted Social Security numbers.
2. Data are encrypted during data transfer and are not decoded until it is confirmed that the data has been received by the correct recipient machine.
3. Data are protected by a three-tier architecture.
4. After five errant password logins, a lockout function is activated.
5. A firewall physically limits access to the core data set.
6. SeniorNavigator has business associate agreements with all service providers, subcontractors and staff to maintain the privacy of participant data.

System Security

General System Security: Web-based services are provided through a secure service environment with redundant T-3 connections to ensure 24/7 system operation and availability. The server has co-location sites which provide a secure environment with restricted access through a sophisticated handprint identification system. Diesel back-up generators are provided for ongoing power. Back-up functions are part of the online system. Information is maintained in two parallel systems.

Disaster Protection: There are servers in secure locations on each coast and a tertiary hosting facility in Oakland, California. All data backups are stored in multiple locations. During production equipment upgrades, continuous system operations are ensured by switching between sites.

Role-Based Access Controls: The system accommodates several hundred permutations of user permissions for security purposes and enables system administrators to limit access of users at the module level. Each of the modules in the system allows users to assign the following access levels: administrative, full, read-only and none. User passwords are protected with a 64-bit encryption technology.

Platform Utilized

The operating system of the server is Linux and the tools are created in JAVA. Enterprise systems also are created and maintained in FoxPro, such as HOMCare, MSSPCare, PACECare and CADCare.

The No Wrong Door System has been designed for flexibility and existing files can be transferred into it through a variety of formats, including Excel, SQL and Access.

User Security Agreements

Every agency or organization in the No Wrong Door System must agree in writing that it will:

• Uphold federal and state confidentiality regulations and laws that protect client records and will not release confidential client records without written consent of the client, or the client's guardian, unless otherwise provided for in the regulations or laws.
• Abide specifically by federal confidentiality regulations as contained in the Code of Federal Regulations, 42 CFR Part 2, regarding disclosure of alcohol and/or drug abuse records. In general, the federal regulation prohibits the disclosure of alcohol and/or drug abuse records unless disclosure is expressly permitted by written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. (A general authorization for the release of medical or other information is not sufficient for this purpose.)
• Abide specifically with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and corresponding regulations passed by the U.S. Department of Health and Human Services. In general, the regulations provide clients with new rights to control the release of medical information, including advance consent for most disclosures of health information, the right to see a copy of health records, the right to request correction to health records, the right to obtain documentation of disclosures of their health information and the right to an explanation of their privacy rights and how information may be used or disclosed. The current regulation provides for protection for paper, oral and electronic information.

In addition, these organizations must:

• Limit access to authorized users and follow all protocols to monitor those users.
• Provide SeniorNavigator with the names of all staff members and volunteers who have access to the system and certify that such staff are competent and authorized to have access to this information.
• Agree that SeniorNavigator may deny access to the system for the purpose of investigating any suspicion of breached confidentiality.
• Notify SeniorNavigator prior to or immediately following changes relating to authorized users.

Through these safeguards, the No Wrong Door System has been engineered to be a most secure tool for both ensuring client confidentiality and improving the delivery of services to seniors and adults with disabilities.

Back to Top

Contact Information

Private sector providers, please contact Katie Roeper, Executive Director, SeniorNavigator at (804) 827-1732.

Public sector providers, please contact Molly Huffstetler, No Wrong Door Coordinator, Virginia Department for the Aging at (804) 662-9153.