Cornerstone General Information

Overview | History of Cornerstone | Benefits of the System | Outcomes | In Conclusion...

Overview

Implemented in 1997, Cornerstone is a statewide data management information system developed to facilitate the integration of community maternal and child health services provided to Illinois residents by the Illinois Department of Human Services, and to effectively measure health outcomes.

Cornerstone is installed on over 3,000 workstations owned and supported by the Illinois Primary Health Care Association in approximately 380 sites across Illinois, and is used to coordinate the delivery of integrated services to over 3,500,000 individuals. Cornerstone system users are estimated at 5,000. Funding is obtained through State General Revenue, as well as from federal sources (USDA-WIC, MCH Block Grant, Public Health Service - Immunization Grant).

This system was developed and implemented and is maintained through a collaboration effort between the Illinois Department of Human Services and IPHCA.

History of Cornerstone

The Problem. Prior to the introduction of Cornerstone, local providers of Department of Human Services' (DHS') community maternal and child health (MCH) services often considered their respective services as discrete and separate. Frequently, providers of programs such as Family Case Management (FCM), WIC, and Immunizations were unaware of one another's activities, despite the fact that these services were provided to many of the same clients/families within the same facility.

This separation of services led to numerous problems, including repetitive enrollment processes, redundant data collection and reporting, partial understanding of client's service histories, excessive paperwork, and inconsistent documentation of services. In short, each program was providing fragmented, episodic and incomplete service delivery. While DHS' maternal and child health programs were often working toward the same objectives, little was being done to encourage cross-program linkages. Therefore, providers expressed a need for a mechanism to address these issues and facilitate service integration, with the goal of improving health outcomes of underserved women and children.

The Solution. In 1992, what was then the Illinois Department of Public Health began to examine options to address this need. (The MCH services, including the Cornerstone project, was later re-organized into the Department of Human Services.) Through a partnership with the Illinois Primary Health Care Association, a team began the arduous task of designing and implementing a tool to make integration the standard in Illinois. Building upon Illinois' automated WIC system, the concept of the Cornerstone system was born.

As the management information system (MIS) was developed, numerous local public health experts and community representatives were brought in for guidance, as well as for input in the actual development of the substantive aspects of the MIS. This local community input provided many insights concerning past and current practices regarding MCH service delivery and data collection, as well as ideas for rectifying inadequacies or improving operations. Many of these suggestions were incorporated into the system design, and user input continuously initiates modifications to the system.

By 1997, the system was finalized and completely installed in agencies providing DHS MCH/WIC services across the state. Indeed, the Cornerstone system has proven itself as a mechanism to fully support the delivery, monitoring and evaluation of services to women, infants, and young children. While additional programs are continuously being evaluated for integration into the system, the Cornerstone system currently supports the following state-funded programs:

• Illinois Breast and Cervical Cancer Program (BCCP)
• Early Intervention (EI)
• Family Case Management (FCM) - Includes HealthWorks of Illinois and Title 20 participants
• Healthy Families Illinois (HFI)
• Healthy Start (HSCM)
• Illinois Diabetes Control Program (IDCP)
• Immunization Program (IMM)
• Pediatric Primary Care (PPC)
• Prenatal Care(PREN)
• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
• WiseWoman Demonstration Project

The Cornerstone system is designed to allow a single point of enrollment for multiple state-funded programs. This complex computer system builds a comprehensive file on each individual as information is entered. Comprised of approximately 150 screens with pull-down menus, the system generates over 200 pre-established administrative and outcome reports.

From a broad perspective, the Cornerstone system is a statewide network of computer workstations and servers, all centrally connected. Client data is entered into the system locally at the point of enrollment, creating a comprehensive client file. In addition, certain data is transmitted to the State's mainframe computer nightly, allowing IDHS to analyze data on its programs and their outcomes.

On the local level, Cornerstone is a case management tool that helps health care professionals provide efficient, effective, and comprehensive services to their clients. Cornerstone's design and technical architecture feature many innovative approaches to administering maternal and child health services. The most significant of these are:

• A common enrollment component that allows a client's demographic and eligibility information to be captured once and made available to all other service providers who participate in Cornerstone and care for the client. This single point of entry eliminates the duplication of data entry, as well as reduces the chances of mistakes and duplicate enrollment.
• An automated care plan that generates service goals based on a client's response to a standardized series of questions assessing prenatal or child health care, nutrition, child safety, and other human service needs. Therefore, the automated care plan identifies a comprehensive array of service activities needed to address assessed risks.
• A scheduling and referral process which matches the client's service needs with the available internal and external providers. The system uses a locally developed listing of resources, organized by service type, which allows the case manager to link the client to local service providers.
• A wide-area network that allows Cornerstone users access to service history data (for example, immunization history) when clients change their place of service.

Benefits of the System

Cornerstone is unique in the fact that it is the largest distributed health information system in the nation. Its innovative and creative approach to integrating MCH services has played a critical role in solving community problems. Undoubtedly, Cornerstone provides many obvious benefits to clients, to local service providers, and to the State of Illinois.

The immediate beneficiaries of Cornerstone include over 650,000 individuals whom receive WIC and/or FCM services in Illinois. Since Cornerstone offers a truly integrated approach to service delivery, agencies offering more than one Cornerstone-supported activity can now provide all those services during one visit. Obviously, 'one-stop shopping' saves the client's time and money that was once associated with multiple visits.

Furthermore, with the scheduling and referral features of the system, there is no 'wrong' place to enter the DHS service network. Case managers now have a potent tool to ensure through careful monitoring and advocacy that clients previously at risk of being lost in the public service sector now receive a continuum of needed care. Immunization recipients, of whom there are over one million in Cornerstone, are now protected from over-immunization since client histories are available through the Cornerstone Wide Area Network (WAN).

Indirectly, Cornerstone also benefits the service provider. Multiple intake processes have been eliminated, thereby reducing the resources needed for intake services. In addition, communication between program staff is enhanced with immediate access to clients' histories, service records and schedules. Documentation is more complete and consistent, and administrative reports for the State are computed automatically and available through electronic transmission.

Outcomes

While the very existence of the Cornerstone system was a major accomplishment, the extent of its success is evident in the fact that it has grown to be the largest distributed health information system of its type in the nation. Undoubtedly, the system has been successful in achieving its goal of providing a mechanism to facilitate MCH service integration. The installation of Cornerstone has prompted many service providers to restructure their service delivery according to the integrated model underlying the system itself. While WIC and FCM programs were previously independent of each other, they no longer remain that way. In fact, the majority of health departments consider the two services as a complete package, with both program staff working together for the benefit of the client. Unsurprisingly, post-implementation survey responses revealed that Cornerstone has had a positive effect on the community health delivery model in a majority of the sites utilizing the system. Comments from users include:

• Chicago Department of Public Health:
  "Cornerstone has added structure and accountability. There is better documentation in the agency."
• DeKalb County Health Department:
  "Cornerstone was the impetus for [service] integration."
• Stephenson County Health Department:
  "Cornerstone forces a thorough service and doesn't allow short cuts..."
• JoDaviess County Health Department:
  "Our clinic flow is smoother. It used to be more fragmented and we now have more continuity of care for our clients."
• Adams County Health Department:
  "Communications between programs regarding appointments, case notes and immunizations [has improved]."
• Kankakee County Health Department:
  "[Cornerstone] will help us manage clients more efficiently and help all programs to be presenting a united and common message to the clients."

Another success of the Cornerstone system is its ability to verify health outcomes of women and children. The wealth of data available in Cornerstone has allowed for analyses that were not feasible prior to its implementation.

For example, those in the community health field have long assumed that receipt of both WIC and FCM services would result in better birth outcomes than receipt of only one of these services. Finally, through Cornerstone, this assumption was proven. Prior to the implementation of Cornerstone, a client receiving WIC, FCM, and Immunization services would have three separate files on three different databases. However, Cornerstone now provides a single client record in one database for all these services, thereby making an unduplicated count of clients across multiple programs. With this single client record, DHS was able to match MCH program service data from Cornerstone with Vital Records data (from birth and death certificates), and with data from the Medicaid Management Information System (MMIS).

The "Analysis of the Additive Effect of Family Case Management and WIC" has been conducted on data from 1996, 1997, and 1998. Results of these analyses yielded exciting and provocative findings that confirmed the critical importance of DHS-funded programs. Highlights from the 1996 and 1997 data include:

• Over 36% of the live births received either one or both FCM and WIC services. Of these, over 50% received both FCM and WIC services.
• The Very Low Birth Weight (VLBW) rate for those clients receiving both FCM and WIC services was lower that clients receiving one or no service.
• Clients receiving both FCM and WIC services experienced lower Infant Mortality (IM) rates than the general population.

Clearly, Cornerstone has allowed Illinois' community health providers to not only integrate service delivery, but has allowed them to gauge their progress toward that goal.

In Conclusion...

Cornerstone has truly proven to be a model for the management of community health service delivery - one that benefits the State, the local service provider agencies, and, most importantly, the recipients of those services. The system makes efficient use of available information so that the goal of service integration can realize its potential to improve the health outcomes of women and children.

This unique system is a product of collaboration among numerous agencies and organizations working toward the goal of improving access to the delivery of healthcare services to the underserved, and improving the health status of those individuals. Through Cornerstone, community health providers are not only encouraged and able to integrated services, but are able to prove the benefits of doing so.

The Cornerstone system has been recognized nationally as a successful model. As a result, the system is a recipient of several awards, including recognition from the U.S. Department of Health & Human Services, the Center for Disease Control, and Dan Glickman Pyramid of Excellence Award from the U.S. Department of Agriculture.

For more information regarding the Cornerstone system, please contact Stephanie Fritcher Sapetti via email at ssapetti@cquestamerica.org.