While not wanting to presume to know how this process should begin it seems to me that there are a LOT of programs having to look for an alternative to CORI. We cannot assume that just because they are all using CORI that their needs are all the same. In fact, (in my opinion) the greatest strength and the greatest weakness of CORI was that it was many things to many people. So while it can do a great many things, many programs did not need most of those things and as a consequence the goals of gathering and managing appropriate amounts of program data and deciding how best to monitor and evaluate program activities and outcomes often felt like a much bigger deal than it needed to be when using CORI.
It is also the case that there has been, over the past decade or so, a major shift in demands, expectations, and hardware with regards to program information management. We are not that far removed from paper files and yet most funders are increasingly expecting electronic client counts and outcome tracking. This raises two issues. The first is that programs must develop the capacity to train and supervise staff in the tasks of creating and maintaining data sets and the second is that to pay for the use of a relational database program (stand alone like Micro Soft Access or on-line like CORI) is no small ticket.
CORI positioned itself well at the start of this electrification process (my opinion) by working intensively to contact funders and to indicate that they (with their healthy subsidy) could provide what would cost LOTS more to provide if every program were to develop their own system or buy into an existing system or service contract. This also meant that the CORI model was tipped towards funders and away from grass roots program development in the area of electrification of program records (again, my opinion).
So now where are programs now that the CORI rug has been yanked?? Well what is out there in the private database consulting sector is most certainly more costly than CORI and many of the available services offer high degrees of “customization” it all comes at a cost.
It seems to me that the fact that so many programs (large AND small) are in the same place with the CORI vanishing act offers a significant opportunity for programs to take greater charge of their data management needs and to work together to find or to develop not only an immediate solution but to begin to investigate a broad range of ways to manage their program data and to engage effectively in the monitoring, evaluation, and forward planning of their programs from 2010 forward.
So what are the options? Well I think this blog can provide a forum for presenting and discussing data management options and to look for options that may well turn this challenge into a major positive opportunity for many agencies and programs.
What do we need to know? We need to know what, if any options there might be for keeping the CORI database running. What is happening to the base funding? Would there be sufficient support for going forward in a collective manner with a version of the CORI database if the necessary resources could be found? I will be looking into this question but any thoughts or comments folks have would be appreciated.
What other alternatives are there out there?
I am asking all participants in this blog-forum to let me know what they are looking at in the way of alternatives and what they think about the system(s) they are considering. Likewise I would like all programs to at least let us all know what they are looking for, what they would like to see (in the way of a data management system ... what features it could or should have ... and what might be gained by more information sharing across programs and agencies. I will start reviews of the options I find or am sent and then people who have looked at them or used them can add comments to expand the information. I will move substantive comments up into the posts so that substantive reviews are created.
As well, if folks have any new thoughts as to possible directions I invite them to add comments or to e-mail me directly (mike-boyes@shaw.ca, 403 560 9171) and I can create posts based on their ideas (fully credited of course).
I also invite finders and other (academics etc) to add their voices to this forum. I really believe this is a HUGE opportunity to establish some big new ideas in agency and program data management and to look at options that can emerge from a solid grass-roots approach to this important question.
So tell EVERYONE about the LifeAfterCORI blog (www.lifeaftercori.blogspot.com) and have them pass it along. Sign up to be notified when new blog entries appear and GET INVOLVED. I think we will be amazed with the results.
Mike Boyes
Mike-Boyes@shaw.ca
403 560 9171
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It appears to me that the first order of business would be to determine exactly why CORI is shutting down. If it is a finanical issue then it should be very straightforward to determine the economic gap between them continuing successfully or failing and then we will know exactly what we are dealing with. At this stage, we don't know what "saving CORI" actually looks like.
ReplyDeleteIt always amazed me at how little was being charged for the use of this application.
I also believe and know that the current users have invested very significantly in the training and implementation of this application. Each of these users must understand that the costs of making a change is staggering and for many users this is not a viable option. If we look at the magnitude of these costs and apply that to the possible current financial shortcomings of CORI we may be able to save CORI and continue to benefit from the investment this user community has made. I would also be happy to discuss options with a view to moving forward agressively. Kevin 250-880-1666.
Hi Mike and thanks for this blog I think it is a great idea.
ReplyDeleteI have a bit of information regarding CORI and the HOMES data base. I have been told that the Mutart Foundation is going to be retaining the rights to the HOMES database (which is the part of CORI that I believe is worth trying to save) The Mutart Foundation at one point in time had a 20 yr contract with CORI which was to provide the database to not for profit agencies at a very low rate. I do see this as the first area for discussion, would agencies be willing to band together and look at possibilities of having HOMES basically user owned? It is my assumption that this could be done at a much reduced cost to what the CORI organization required to opperate.
I appreciate the interest in CORI and in the HOMES database. I can assure you that the CORI Board of Directors recognized fully the implications of ceasing operations; it made the decision only after careful thought and analysis.
ReplyDeleteBoth the CORI Board and the board of the Muttart Foundation continue to examine how to help CORI's clients. I hope we will be able to make some announcements before the end of this month.
I'll watch for suggestions with interest. At this point, I just want to clarify a couple of comments made by another poster.
Muttart is, in fact, a co-owner of the software that operated the HOMES database. Hull Child & Family Services is the other co-owner. I think both are open to looking at other options to continue to serve nonprofit organizations that understand the critical importance of collecting outcome information.
The suggestion of a 20-year contract between Muttart and Hull is not correct. Muttart has been a core funder of CORI (and its predecessor iteration) since the early stages of software development. Muttart has provided almost $4 million in core funding. It was this funding that helped keep licence fees low and also helped subsidize training. Other funders had, until this year, also contributed to the operating costs, through paying for training and other costs. Muttart's funding alone was not sufficient to continue CORI in its existing structure. Would other structures work? That's what we're examining.
Personally (and without having had the chance to discuss it with my Board), the idea of a co-op arrangement of some description is an interesting one. The sustainability of such a structure would, of course, be critical. And while the database was an important part of CORI's work, the training was also essential, as was the provision of IT support and a help line. All of those costs add up.
I'll continue to watch for comments and ideas.
Bob Wyatt,Executive Director, The Muttart Foundation
Critique of HOLMES Page 1
ReplyDelete• I am a general psychiatrist practicing in a publically-funded multidisciplinary mental health clinic in a small rural setting.
• From its inception just two or three years ago in our already clinically overstretched organization I have been skeptical about the adoption of the HOLMES system. I have in my professional life been subjected a number of times to these sort of systems that never live up to their claims but instead use up vast amounts of resources with scant return for the effort.
• HOLMES has conservatively used 20% of our staff time in converting existing files, inputting the mass of biographical and other clinical data into the system (although much of it cannot , in fact, be entered). To my knowledge, it never provided a single piece of valuable outcome data that influenced our clinical decision making. Such systems seldom impact outcomes in a meaningful way. They do, however detract attention, time and resources away from providing direct clinical care. This in an environment in which we are incredibly underfunded already – and there is never any resources for additional staffing – but, it seems, for computer database systems money can always be found!
• Staff that has spent hours in training are left frustrated, angry and justifiably cynical about database systems such as HOLMES when these systems are shut down. Just at the moment when the culture of an organization has began to accept and adopt a system such as this, it is shut down. It will far harder to persuade them to adopt another. So it should be.
• HOLMES never integrated with our regional database used by our local hospital just down the road from our free-standing clinic as well as by every other referral hospital in our region. So we were unable to bring up valuable clinical material from laboratories, radiology, pharmacy or review consultations from referral hospitals. Can you imagine?
• Neither did it provide any information that helped us in a recent important regional planning exercise. The database was incomplete. We ended up using pen and paper to quickly capture the most relevant statistics which ended up being perfectly adequate. But you might have thought HOLMES could, at least, have contributed value to the process.
•
Nicholas Sladen-Dew MD.,MPH (Harvard).,FRCPC
Consultant Psychiatrist
Critique of HOLMES Page 2
ReplyDelete• HOLMES was cumbersome, inefficient, and did not lend itself to the clinical recording on complex multi-problem clients. I’m not sure what population it was designed for but it wasn’t the multi-problem, chronically mentally ill population. Integration with new tablet PC technology and speech-recognition software was unavailable.
• Because a clinical chart has multiple pieces of information in various forms one had to have access to BOTH the chart and the computer in order to review a patients clinical material.
• HOLMES forces one to work at the computer when seeing patients instead of having the flexibility to see patients in multiple sites where there may or may not be computer access.
• There were multiple glitches with HOLMES when the system went down or access was denied for some reason. (Luckily the most important clinical information was handwritten on the chart.)
• Client rights to confidentiality and privacy was ignored. Clients were never asked to consent to having clinical material sent off site to “who knows where” and to what use the material was put. Was the data “mined” for financial reimbursement? Who benefitted from this spurious exercise? Recently, the Canadian Medical Protective Association has expressed increasing concern about patients rights and off-site mass storage of information.
• Above all scarce public funding was diverted from direct clinical care into HOLMES and if I were responsible for such funding I would recommend bringing an action against the HOLMES organization for recovery of costs. It was simply irresponsible of CARF to recommend an unproven system with no guarantee of longevity to be adopted as a condition of accreditation. It was equally irresponsible of to make a small organization like ours expend the effort and time that we have on a system that has yielded no benefit to our patients at all.
• Our Board and our funders should take a very close look at this wastage of time, money and effort before considering anything remotely like it again!
• Good riddance to HOLMES. Let’s refocus on patient care. Let this be a lesson well learned!
Nicholas Sladen-Dew MD.,MPH (Harvard).,FRCPC
Consultant Psychiatrist