Government funders represent a significant source of revenue for the nonprofit community of health and human service providers. The popular adage There is no such thing as a free lunch certainly applies here as nonprofits must meet the requirements of the government if they want to continue to receive funding. However, what is a nonprofit to do when these requirements can occasionally expose organizations to new risks and create administrative inefficiencies?
A Rocky Relationship
We consult with both human service organizations and governmental entities, so we hear both sides of the story:
- To provide the best support to their clients, the human service providers are looking for more consistency in reporting requirements, updated systems, and funders that are connected to the frontline work.
- To make the best use of public funds, the funders are looking for greater transparency, standardization, and communication.
Who is in Control of the Data?
Florida providers serving individuals living with Intellectual and Developmental Disabilities (I/DD) recently learned they must start inputting data into a mandated system facilitated by their state-run funding stream. To comply, many private organizations must switch from their chosen technology tools to embrace a new system.
In this particular case in Florida, the state agency explains the purpose of the mandate is to improve data collection. However, the system requirements do not specify how the data is protected. In fact, the requirements support the outdated Windows Operating 7 which could leave users vulnerable to malware. From a security standpoint, this does not seem like much of an improvement. Non-profits should not be afraid to ask about security measures, HIPAA compliance, and liability.
As state requirements can be out of touch with the needs of the health and human service industry, the glaring question is Who owns this data? It is only natural for providers to wonder who would be liable if a security breach were to occur. The risk an agency assumes when adopting a state-run system could be exponential. The providers have every right to understand the implications of using the mandated system.
Agencies should consider who is liable for ensuring HIPAA compliance as states require the transmission of this Private Health Information. Using a federally-certified EHR is a clear choice for many agencies faced with the challenges of meeting the requirements of state and local funding streams while ensuring that they are in compliance with federal standards.
Another Form of Free Lunch: Free Technology
Sometimes state and federal funding sources offer free systems to their providers. Health and human service organizations must consider the risk of leaving their electronic health record vendor and ask the funding source questions about data ownership and what will happen to their license should the funding relationship stop.
Providers typically enter into service agreements with their electronic health record vendors which means they can expect to maintain a degree of ownership in the configuration and use of the software. Many of the free systems are subcontracted, so they don’t offer this traditional client-vendor relationship. In many cases, the community of human service providers does not weigh in while these systems are built and the result is a system that can be disconnected from the needs of the health and human service providers.
Government entities should not reinvent the wheel. Instead, they should select a system that delivers enhanced transparency while giving agencies the flexibility to use it across all of their programs. By selecting a system that is easy to configure, that allows agencies to share forms, and has a proven track record of being a reliable tool for outcomes and compliance reporting, funders will have reliable data, uniform processes, and insight into the efficacy of the human service agencies.
Nevada nonprofit organizations have been banding together in an effort to work with their funders since the state provided a free mandated system. A community of Nevada providers started implementing AWARDS because it allowed the agencies to configure the system to meet its needs while building reports that can be sent into this state system.
“Because we own our data in AWARDS, we have control over sharing the data while still meeting state requirements.“Kay Velardo, Community Counseling Center of Southern Nevada
Kay Velardo, a system administrator at Community Counseling Center of Southern Nevada, shared that her agency discusses best practices with several other Nevada agencies and identifies ways to meet their requirements while owning their data. The Nevada group is growing and continues to meet to identify issues presented by the state system. This grassroots community has found that strength in numbers helps them to provide transparency, improves communication, and empowers them to take hold of their mission to help the community.
By taking ownership of their data, these agencies are empowered to use their outcomes to inform their own practices. Agencies owning their data can also report out to additional sources of funding, which mitigates operational risk and protects the data should the funding stream decide to terminate the relationship.
Repairing the Relationship
Indeed there is no such thing as a free lunch and here we see there is no exception to the rule. The truth is…there will always be conditions surrounding the exchange of money. The high expectations placed on nonprofits and charitable organizations to show how they spent taxpayer money is not unreasonable. Yet the presumption that human service agencies will thrive with state-mandated systems is. Just like in any relationship, when communication breaks down, difficulties arise, and pain sets in. Using data to bridge the communication gap is precisely what funders and human service agencies ought to do.
“There will always be conditions surrounding the exchange of money. The high expectations placed on nonprofits and charitable organizations to show how they spent taxpayer money is not unreasonable. Yet the presumption that human service agencies will thrive with state-mandated systems is.“
Organizations can keep up with regulatory change while ensuring a commitment to best practices through the adoption of a flexible electronic health record (EHR) that allows for easy data transmission into any external system. Agencies should look to adopt an EHR that is readily configurable to meet the changing demands of the government entities and opt for a system that understands the needs of the human service agency. Not to mention, when presented with a system that the provider will actually like using, they are more likely to be satisfied and therefore more likely to collaborate.
Health and human service organizations and the governing agencies that fund them have a symbiotic relationship. Both groups are invested in a noble cause and need one another to deliver and fund the services that affect positive social change. The issue is not whether the health and human service industry needs an electronic health record, but rather it is a matter of providing the community with a flexible EHR designed for the needs of both: the funders and the funded. By improving this relationship through the use of technology, governments and human service agencies can start to work together towards their shared goals to make an even greater impact.