Report 2009-107.1 Recommendations and Responses in 2012-041

Report 2009-107.1: California Department of Corrections and Rehabilitation: It Fails to Track and Use Data That Would Allow It to More Effectively Monitor and Manage Its Operations

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of Most Recent Response
California Department of Corrections and Rehabilitation 3 9 8 6
California Prison Health Care Services 3 5 5 3

Recommendation To: Correctional Health Care Services, California

To minimize costs through the use of telemedicine, Health Care Services should review the effectiveness of telemedicine consultations to better understand how to use telemedicine.

Response

Historically, CCHCS has been exploring various ways on how to review effectiveness of telemedicine consultations in comparison to specialty services provided onsite in institutions and services provided offsite in provider facilities. Quality Management and Utilization Management efforts and expertise within CCHCS have expanded markedly in the past several years and continue to mature; however, the provider quality and utilization metrics collected to date do not adequately differentiate telemedicine specialty encounters, outcomes, subsequent utilization, or other quality or effectiveness measures to assist in this review. In addition, current contract provisions for telemedicine specialty services do not include systematic deliverables that can be utilized to assess effectiveness.

With the initiation of primary care services via telemedicine supporting on-site primary care in three institutions (ISP, PVSP, and SATF), with over 6,900 patient encounters in FY 2011-12, the ability to compare performance measures (e.g., Health Care Services Dashboard Indicators) for patient-inmate populations served by telemedicine primary care providers versus those served by on-site primary care providers for the same institution is being pursued to establish an effectiveness metric. Telemedicine Services is seeking access to those data to perform those analyses. The future implementation of an enterprise electronic medical record system creates the opportunity to follow patient-inmates receiving telemedicine specialty and primary care to review health outcomes as compared with similar patient-inmates receiving specialty and primary care that is not delivered through telemedicine. Education and culture change efforts for staff and management in some institutions remain to improve utilization of telemedicine for appropriate specialty referrals.

CCHCS is considering options on future contractual requirements for metrics on specialty telemedicine providers, specialists providing services in institutions, and specialists providing services offsite to aid in comparisons of relative effectiveness. In the future, analyses of outcome measures to assist in a review of the effectiveness of telemedicine encounters shall become routine as reliable data sources and staff expertise to accomplish this is developed.. The lack of data to assess and technical analysis expertise has delayed implementing this recommendation. CCHCS is trying to address both of these deficiencies in order to improve efficacy and quality assessments for telemedicine services to inform policy decisions.

Recommendation To: Correctional Health Care Services, California

To minimize costs through the use of telemedicine, Health Care Services should perform a more comprehensive comparison between the cost of using telemedicine and the cost of traditional consultations, beyond the guarding and transportation costs, so that it can make informed decisions regarding the cost effectiveness of using telemedicine.

Response

CCHCS currently compensates specialty contractors providing services through telemedicine at the same rate as those providing specialty services in-person at providers' off-site facilities. Although some telemedicine cost center information (e.g., claims payments; equipment costs, service, and depreciation; IT connectivity costs) is available, other cost elements, such as the value of increased community safety, improved patient access to specialty care, access-to-care litigation costs avoided, and others, are difficult to estimate/quantify.

The future implementation of an enterprise electronic medical record system creates the opportunity to follow patient-inmates receiving telemedicine specialty and primary care to review health outcomes and subsequent utilization as compared with similar patient-inmates receiving specialty and primary care that is not delivered through telemedicine, to refine comparative cost analyses.

Telemedicine Services has gained access to specialties claims data and is starting analyses relating those data to telemedicine scheduling system data. Telemedicine Services is investigating cost analyses methods used by other government and non-governmental agencies that may be usable in trying to quantify some of these intangible variables to inform a cost comparison model. Systems to collect these sorts of data in a standardized way have not been identified or implemented to date. Once improved data and staff expertise to perform analyses are developed, more detailed comparisons will be done on an ongoing basis to inform policy decisions.

The insufficiency of cost center data and inadequate cost analysis methodology and technical analysis expertise have delayed implementing this recommendation. CCHCS is trying to address both of these deficiencies in order to improve efficacy and quality assessments for telemedicine services to inform policy decisions.

Recommendation To: Correctional Health Care Services, California

To increase the use of the telemedicine system, Health Care Services should continue to implement the recommendations that it has adopted from the consultant's review of telemedicine capabilities.

Response

CCHCS has implemented thirteen of the sixteen short-term goal recommendations and six of eight long-term goal recommendations from the consultant's review. Implementation of the consultant's recommendation to initiate basic electronic medical record document management for telemedicine and develop clinical outcome analysis and cost savings benchmarks for measuring the telemedicine program awaits full implementation of the CCHCS electronic medical record procurement project currently under way. Implementation of the consultant's recommendation to develop and communicate vision/plan widely to include using telemedicine as required principal escalation for both primary care and specialty consults is a continuing effort following the June 1, 2010 Implementation of Telemedicine as Default Policy. (The policy memorandum was provided to the Bureau of State Audit for the SB 1452 requirement in previous year.) Implementation of the consultant's recommendation to institute comprehensive and timely training and appraisal review process has been slow due to limited resources for training, significant turnover in institution telemedicine staffing in early 2011, and nursing staff responsible for training/appraisal being under a separate management structure from the telemedicine program. Implementation of the consultant's recommendation to develop treatment protocols for all disease management groupings will not be implemented for specialty care contractors as CCHCS relies on those board-certified specialists expertise which exceeds the specialty expertise within CCHCS.

Recommendation To: Corrections and Rehabilitation, Department of

To more closely align its operations with state law and its own policy, make certain that inmates are provided with an adequate level of supervision, and protect the health and safety of employees and inmates, Corrections should better ensure that it prevents the instances in which correctional officers work beyond the voluntary overtime limit in a pay period.

Response

As CDCR has implemented the Standardized Staffing model which includes more relief in the areas of coverage in posted positions, there will be circumstances such as spontaneous transportation; emergency issues; and other unforeseen factors which will require CDCR to have staff on an overtime shift. CDCR makes every effort to align with the hours worked in a 28 day work period which is how the overtime for R06 is calculated.

Recommendation To: Corrections and Rehabilitation, Department of

To help it assess the effect of policy changes and manage operations in a cost-effective manner, Corrections should do the following:
• Ensure that its new data system will address its current lack of data available for statewide analysis, specifically data related to identifying the custody staffing cost by inmate characteristics such as security level, age, and custody designation.
• If implementation of its new system continues to be delayed, or if Corrections determines that the new system will not effectively replace the current assignment and scheduling systems used by the institutions, it should improve its existing data related to custody staffing levels and use the data to identify the related costs of various inmate populations.

Response

To meet the requirements of this recommendation, CDCR will need to implement the full functionality of the Business Information System (BIS), implement Phase 1a of the Strategic Offender Management System (SOMS) and implement a statistical analytical package with an external reporting component.

The full implementation of BIS will provide the departmental cost information to operate an institution.

BIS status - The BIS system modules for Budgeting, Purchasing, Accounting, Organizational Management, Workers Compensation, Training and Events, Employee Grievances, Personnel Cost Planning (PCP) and Personnel Administration have been implemented. The Time/Shift solution of TeleStaff for Shift and SAP for Time is in its final stages of development. The Shift tool is live at the pilot location of Folsom State Prison. Full implementation was delayed and is scheduled to begin November 1, 2012. The 6 wave implementation is scheduled for completion April of 2013.

SOMS Status – Implementation of Phase 1A (Intake, Movements and Counts functionality) was successfully completed in October 18, 2011. With the completion of this phase, SOMS is the system of record for all inmate movement, housing, and demographic (age, sex, etc.) information. SOMS Phase 1B is under way and will deploy functionality to capture inmate classification and program assignments in the summer of 2013.

The statistical analytical tool with business intelligence reporting will enable the Department to conduct correlative analysis of the data contained within the BIS and SOMS applications.

CDCR Enterprise Information Services (EIS) is working with CDCR business programs including the Office of Research (OR) to implement a data warehouse to conduct correlative analysis of the data contained within BIS and SOMS. The basic infrastructure for the data warehouse is being implemented as part of the SOMS project. The implementation of the basic infrastructure was delayed and is scheduled for September 2012. The SAS server for statistical analysis has been deployed for the OR. The OR currently receives data from SOMS on a daily basis. The EIS and OR have agreed to continue to work together so that as the new SOMS functionality is deployed, the new data elements can be included in data provided to OR.

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that the State is maximizing the use of funds spent on incarcerating inmates, Corrections should communicate to the Department of Personnel Administration—which is responsible for negotiating labor agreements with employee bargaining units—the cost of allowing any type of leave to be counted as time worked for the purpose of computing overtime compensation.

Response

CDCR has partnered with the Department of Personnel Administration adding GC Section 19844.1 which changed to State's overtime provisions for bargaining units RO1, RO2, RO4, RO6, RO7, RO9, R10, R11, R12, R13, R14, R15, R17, R18, R19, R20, and R21, effective with the March 2009 pay period. The new language states “for the purpose of computing the number of hours worked, time when an employee is excused from work because of holidays, sick leave, vacation, annual leave, compensating time off, or any other leave shall not be considered as time worked by the employee for the purpose of computing cash or compensating time off for overtime.” DPA issued Personnel Management Liaisons Memorandum 2009-014 advising of the change. CDCR implemented the change accordingly. GC Section 19844.1 does not include provision for bargaining units RO5, RO8, and R16; however, RO5 and RO8 are not utilized by the CDCR. R16 is utilized and CDCR shall work toward including the language of GC Section 19844.1 in their successor memorandum of understanding, as needed.

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that the State is maximizing the use of funds spent on incarcerating inmates, Corrections should encourage the Department of Personnel Administration to not agree to provisions in bargaining unit agreements that permit any type of leave to be counted as time worked for the purpose of computing overtime compensation.

Response

CDCR has partnered with the Department of Personnel Administration adding GC Section 19844.1 which changed to State's overtime provisions for bargaining units RO1, RO2, RO4, RO6, RO7, RO9, R10, R11, R12, R13, R14, R15, R17, R18, R19, R20, and R21, effective with the March 2009 pay period. The new language states “for the purpose of computing the number of hours worked, time when an employee is excused from work because of holidays, sick leave, vacation, annual leave, compensating time off, or any other leave shall not be considered as time worked by the employee for the purpose of computing cash or compensating time off for overtime.” DPA issued Personnel Management Liaisons Memorandum 2009-014 advising of the change. CDCR implemented the change accordingly. GC Section 19844.1 does not include provision for bargaining units RO5, RO8, and R16; however, RO5 and RO8 are not utilized by the CDCR. R16 is utilized and CDCR shall work toward including the language of GC Section 19844.1 in their successor memorandum of understanding, as needed.

Recommendation To: Corrections and Rehabilitation, Department of

To more closely align its operations with state law and its own policy, make certain that inmates are provided with an adequate level of supervision, and protect the health and safety of employees and inmates, Corrections should encourage the Department of Personnel Administration to negotiate a reduction in the amount of voluntary overtime a correctional officer is allowed to work in future collective bargaining unit agreements, in order to reduce the likelihood that involuntary overtime will cause them to work more than 80 hours of overtime in total during a month.

Response

Correctional Officers work 168 hours in a 28 day work period. Overtime is calculated after the 168 hours. The 80 hour cap was an arbitration the department lost and as such cannot implement this recommendation in its entirety.

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that it is addressing the program needs of its inmate population in the most cost-effective manner, Corrections should develop a staffing plan that allocates teacher and instructor positions at each institution based on the program needs of its inmate population.

Response

The California Blue print provides the methodology used to calculate the offender population to be served. The attached expansion plan has been updated since the Blue Print was published to reflect the final distribution of teachers.

Recommendation To: Corrections and Rehabilitation, Department of

To ensure that it can determine whether it is in compliance with state law and can measure the efficacy of its programs in reducing recidivism, Corrections should track, maintain, and use historical program assignment and waiting list data by inmate.

Response

Implementation of the Strategic Offender Management System, Phase O, 1a and 1b; the risk assessment tool in the adult population; and a statistical analysis tool with business intelligence reporting will provide the ability to conduct the statistical historical analysis. In addition, the statistical analytical tool with business intelligence reporting will enable the Department to determine inmate needs and whether those needs were addressed, and secondly, provide individual level program data that will enable CDCR to evaluate the efficacy of programs at reducing recidivism.

BIS Status – BIS is currently working on final development of the Personnel Cost Planning (PCP) module within SAP. PCP will provide staff costing on a real time basis. Once this development has been completed the source information will be available for migration into the business intelligence warehouse for use in analytical review. PCP functionality will be fully implemented by November 1, 2012.

SOMS Status – Implementation of Phase 1A (Intake, Movements and Counts functionality) was successfully completed on October 18, 2011. With the completion of this phase, SOMS is the system of record for all inmate movement, housing, and demographic (age, sex, etc.) information. SOMS Phase 1B contains functionality to capture inmate classification and program assignments. CDCR, CTA, and HP are working to amend the schedule for delivery of the outstanding Phase 1b functionality. Consequently, the anticipated deployment date is not yet known.

The statistical analytical tool with business intelligence reporting will enable the Department to conduct correlative analysis of the data contained within the BIS and SOMS applications.

CDCR Enterprise Information Services (EIS) is working with CDCR business programs including the Office of Research (OR) to implement a data warehouse to conduct correlative analysis of the data contained within BIS and SOMS. The basic infrastructure for the data warehouse is being implemented as part of the SOMS project. The implementation of the basic infrastructure is scheduled for completion in October 2012. The SAS server for statistical analysis has been deployed for the OR. The OR currently receives data from SOMS on a daily basis. The EIS and OR have agreed to continue to work together so that as the new SOMS functionality is deployed, the new data elements can be included in data provided to OR.

Current Status of Recommendations

All Recommendations in 2012-041