Report 2009-107.1 All Recommendation Responses

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 (Release Date: September 2009)

Recommendation #1 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.

Annual Follow-Up Agency Response From September 2015

BIS Status: The Training and Events module was successfully deployed out to the entire Department in December 2014. The full implementation of BIS provides the Departmental cost information to operate an institution.

SOMS Status: The Strategic Offender Management System (SOMS) provides the inmate population data to include intake, scheduling, and movements. SOMS dependent data has been available since the functional deployments of the previous two years. There is no more action for the SOMS team to take in this action plan.

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

Deployment of the Request for Personnel Action module was completed to all programs within CDCR in March 2015. This provides a paperless process for creation, review and approval of personnel actions. Functionality allows better tracking and more efficient routing of actions as well as increased accuracy of position and cost control.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Although Corrections states that the full implementation of BIS provides cost information to operate an institution, its response does not indicate whether the data system tracks specific data related to identifying custody staffing cost by inmate characteristics such as security level, age, and custody designation. Additionally, Corrections did not provide any documentation demonstrating it has fully implemented our recommendation. For example, it could provide reports generated from the new data system showing the system can provide cost information by inmate characteristics such as security level, age, and custody designation.

Annual Follow-Up Agency Response From October 2014

Updated BIS Status - The Time and Shift module has been successfully implemented at all institutions for Custody staff as of July 1, 2014. BIS is working with CCHCS to complete implementation of the SAP component at all institutions for Nursing staff by March 31, 2015. The Training and Events functionality is in Pilot Testing with the first group of 12 Headquarters' Programs scheduled to go live October 1, 2014. All rollout activities are scheduled to be complete by December 31, 2014.

In addition, BIS is working with the Office of Personnel Services to rollout Request for Personnel Action Workflow functionality which provides a paperless process for creation, review, and approval of personnel actions. Functionality allows better tracking and more efficient routing of actions, as well as increased accuracy of position and cost control.

Updated SOMS Status - In August 2014, CDCR implemented SOMS Classification and Programs modules. Inmate Classification data is now available in SOMS and being replicated to the data analytics environment. The addition of BIS data into the analytic environment is in progress.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From October 2013

Updated BIS Status - The Time & Shift module was successfully piloted at Folsom State Prison and is currently live in 14 institutions. It is being implemented in three institutions per month with all institutions live at the end of May 2014. The Training and Events functionality is undergoing revisions to the course catalog and how it will be available in the system. This functionality is scheduled for pilot to begin in April 2014.

Updated SOMS Status - SOMS Classification and Programs module is currently scheduled for deployment in March 2014. Going forward, this data combined with the BIS Time and Shift data will provide the base data necessary to perform analytics concerning staffing costs by inmate level. EIS has expanded the CDCR stakeholders they are working with to include of The Division of Rehabilitative Programming (DRP) and other business areas of CDCR. The basic infrastructure for the data analytic function to conduct correlative analysis of the data contained within seven data sources (BIS, SOMS, COMPAS, CSRA, CalParole EdCATS, ICATS), is complete and initial reports and capabilities are being tested. The priority and business value of such reports is also being assessed to ensure the highest value is worked on first. The specific ability to determine and identify custody staffing cost by inmate characteristics such as security level, age, or custody designation, is reliant on the BIS and SOMS deployments.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #2 To: Corrections and Rehabilitation, Department of

To ensure that overtime hours are accurately reported, Corrections should provide training to its personnel specialists to ensure that they properly classify retroactive overtime salary adjustments according to the Payroll Procedures Manual.

1-Year Agency Response

Corrections stated that it will provide direction to institution personnel offices via a memorandum regarding the proper procedure for coding salary adjustments. In its one-year response, Corrections stated that it had finalized the Personnel Information Bulletin related to this issue and in February 2010 sent the bulletin to its personnel officers. Corrections also stated that it discussed the bulletin with institution personnel officers in March 2010. (See 2011-406, p. 80)

California State Auditor's Assessment of 1-Year Status: Fully Implemented

Recommendation #3 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.

Annual Follow-Up Agency Response From October 2013

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.

Further, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Resolved

Although it has not provided documentation to demonstrate that it provided the Department of Personnel Administration with the cost of allowing any type of leave to be counted as time worked for the purpose of computing overtime compensation, Corrections asserts that it partnered with the Department of Personnel Administration to change the overtime provisions. The most recent bargaining unit agreement referenced continues to exclude leave credits from consideration as time worked for the purposes of determining overtime.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #4 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.

Annual Follow-Up Agency Response From October 2013

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.

Further, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Corrections asserts that it has partnered with the Department of Personnel Administration to change the overtime provisions. The most recent bargaining unit agreement referenced continues to exclude leave credits from consideration as time worked for the purposes of determining overtime.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #5 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.

Annual Follow-Up Agency Response From September 2015

The California Department of Human Resources has reached an understanding on voluntary overtime that will go into effect if a full agreement is made on the successor MOU for BU 6. In addition, the following should reduce the possibility of Correctional Officers (COs) exceeding the 80 hours of overtime in the control period: (a) the amount of CO vacancies has greatly diminished since 2009, therefore, the amount of overtime (voluntary and involuntary) has significantly diminished, (b) on July 27, 2015, CDCR reduced the CO Academy from 16 weeks to 12 weeks, increasing its ability to fill vacancies more quickly, (c) as of July 2015, CDCR had 1,276 CO candidates available to begin future CO Academies. The current vacancy rate for COs, statewide is at 4 percent. Institutions with a higher percentage of vacancies continue to receive COs from the Academy each month. By February 2016, CDCR anticipates the average statewide vacancy rate should be less than 1 percent.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Corrections states that it has reached an understanding on voluntary overtime that will go into effect if a full agreement is made on the next MOU. However, Corrections does not specify what that understanding is and did not provide documentation to demonstrate its claim that it reached an understanding with the California Department of Human Resources.

Annual Follow-Up Agency Response From October 2014

As stated previously, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Corrections response does not address the efforts it took to encourage a reduction to voluntary overtime allowed in future bargaining unit agreements. The bargaining unit agreement referenced still allows voluntary overtime up to 80 hours and involuntary overtime is still allowed. Therefore, it is unclear how these changes impacted correctional officers working more than 80 hours overtime in a month and whether there was an improvement as a result of the changes.

Annual Follow-Up Agency Response From October 2013

As stated previously, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Corrections response does not address the efforts it took to encourage a reduction to voluntary overtime allowed in future bargaining unit agreements. The bargaining unit agreement referenced still allows voluntary overtime up to 80 hours and involuntary overtime is still allowed. Therefore, it is unclear how these changes impacted correctional officers working more than 80 hours overtime in a month and whether there was an improvement as a result of the changes.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

Recommendation #6 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.

Annual Follow-Up Agency Response From September 2015

As stated in recommendation five, the California Department of Human Resources has reached an understanding on voluntary overtime that will go into effect if a full agreement is made on the successor MOU for BU 6. In addition, the following should reduce the possibility of Correctional Officers (COs) exceeding the 80 hours of overtime in the control period: (a) the amount of CO vacancies has greatly diminished since 2009, therefore, the amount of overtime (voluntary and involuntary) has significantly diminished, (b) on July 27, 2015, CDCR reduced the CO Academy from 16 weeks to 12 weeks, increasing its ability to fill vacancies more quickly, (c) as of July 2015, CDCR had 1,276 CO candidates available to begin future CO Academies. The current vacancy rate for COs, statewide is at 4 percent. Institutions with a higher percentage of vacancies continue to receive COs from the Academy each month. By February 2016, CDCR anticipates the average statewide vacancy rate should be less than 1 percent.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Corrections states that a reduction in vacancies and overtime since 2009 and its shorter training academy should reduce the possibility of correctional officers exceeding 80 hours of overtime. However, Corrections did not provide documentation to demonstrate its efforts better ensure that it prevents the instances in which correctional officers work beyond the voluntary overtime limit in a pay period. For example, has Corrections established a process to track and monitor instances when staff are working more than 80 hours during a month, is it tracking the instances and have the number of instances decreased, when instances occur what steps has the department taken to ensure that it minimizes the instances.

Annual Follow-Up Agency Response From October 2014

As stated in Recommendation 5, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

The new bargaining unit agreement that Corrections referenced continues to include the same voluntary limit of 80 hours of overtime in a work period. Additionally, Corrections did not provide documentation to demonstrate its efforts to better ensure that it prevents the instances in which correctional officers work beyond the voluntary overtime limit in a pay period.

Annual Follow-Up Agency Response From October 2013

As stated in Recommendation 5, the new MOU ratified for BU6 on September 28, 2013, does not allow for the Department to mandate involuntary overtime if staff elects to volunteer even if the staff volunteering are over 80 hours of overtime during the work period. See BU6 MOU section 12.05 Voluntary Overtime BY Seniority. The MOU also has a new 7k process where it is now a 7-day work week and overtime begins after 41 hours, so it is no longer a "work period" but now a "pay period".

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

The new bargaining unit agreement that Corrections referenced continues to include the same voluntary limit of 80 hours of overtime in a work period. Additionally, Corrections did not provide documentation to demonstrate its efforts to better ensure that it prevents the instances in which correctional officers work beyond the voluntary overtime limit in a pay period.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

Recommendation #7 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.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Recommendation #8 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.

Annual Follow-Up Agency Response From September 2015

BIS Status: The Budget Forecasting Function module has been fully deployed which allows program areas to identify real time personnel costs along with forecast projections throughout the Fiscal Year.

SOMS Status: SOMS dependent data has begun to be available since the functional deployment of the Programs module in March 2014. There is no more action for the SOMS team to take in this action plan. Departmental use of the Programs module allows trend data to be created over time.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Corrections does not state whether the new systems include program assignment and waiting list data by inmate that it can use to track, maintain, and use. Additionally, Corrections did not provide documentation to support its claim of full implementation of this recommendation such as reports generated used to track information.

Annual Follow-Up Agency Response From October 2014

Updated BIS Status - The Personnel Cost Planning (PCP) module has been updated and is in use by all programs. In conjunction with Time and Shift implementation, BIS, Budget Management Branch and Office of Personnel Services is developing overtime cost reporting and projection tools that provide an accurate expenditure view of overtime at the program level as well as projection costs based on potential scenarios. These reports will be in Production by December 31, 2014.

Updated SOMS Status - The SOMS Classification and Programs modules were implemented in August 2014. As of the recent implementation of the SOMS Programs module, the Program data needed to accomplish this recommendation can now begin to be collected and analyzed over time for trends in effective programming and legal compliance.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From October 2013

Updated BIS Status - The Personnel Cost Planning (PCP) module was originally deployed in November 2012. Enhancements to the PCP module to improve reporting capabilities and address inaccuracies in staff costing have been identified by the Business and are in currently in the development phase. These enhancements are scheduled to be in place by June 2014.

Updated SOMS Status - SOMS Classification and Programs deployment is currently scheduled for deployment in March 2014. Going forward, this data will provide much of the information necessary to begin to perform analytics concerning rehabilitative program effects. SOMS and CDCR Enterprise Information Services (EIS) is working with CDCR business programs including the Office of Research (OR) to continue efforts to leverage data out of various data sources within the CDCR. The basic infrastructure has been implemented as part of the SOMS project. 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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #9 To: Corrections and Rehabilitation, Department of

To ensure that staff are aware of the relevant requirements related to prisoner literacy, Corrections should continue its efforts to update its adult education program policies.

Annual Follow-Up Agency Response From December 2011

In July 2011 a detailed binder of the new academic structures with operational procedures was sent to each Principal to give specific details on how to implement. (See 2011-041, p. 116)

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Recommendation #10 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.

Annual Follow-Up Agency Response From December 2013

This recommendation has been fully implemented. The mission of Telemedicine Services, as outlined in the 2008 "Federal Receiver's Turnaround Plan of Action," is to improve access to care for patient-inmates. However, telemedicine also provides cost-effective care with reduced guarding and transportation costs. The implementation and expansion of telemedicine, has led to improved access to medically necessary specialty services statewide. OIG results indicate that court-ordered timeframes for patient-inmate specialty referrals increased from a 71% compliance rate in Round 1 (2008) to 94% compliance rate in Round 3 (2012) (Attachment 1).

Utilization of telemedicine continues to increase as the inmate population decreases (Attachment 2), indicating acceptance and effectiveness of the modality for medical consultations. Telemedicine-appropriate referrals seen via telemedicine have also increased (44% -2011, 53% -2012 and 59% -2013; Attachments 3-5). Institutional utilization management follows a standardized process with community-standard clinical guidelines to approve referrals (Attachment 6) and determine appropriateness for telemedicine before the consultations. In addition, Telemedicine conducted the following expenditures analysis on the per-encounter cost basis (Attachment A). The analysis indicates that while the annual operational costs of Telemedicine have been steadily contained, we have been improving access to care with the same level of resources. The average estimated per telemedicine encounter savings have been steadily maintained at around $226 per encounter for the last three fiscal years.

California State Auditor's Assessment of Annual Follow-Up Status: Resolved

Health Care Services states that its mission of telemedicine, while providing some costs savings with reduced guarding and transportation costs, is to improve access to care. It provided documentation of its increased use of telemedicine and asserts a standardized referral process for telemedicine referrals to ensure appropriateness, and presumbly effectiveness, of its telemedicine program.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #11 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.

Annual Follow-Up Agency Response From November 2013

CCHCS has fully implemented this recommendation. CCHCS has analyzed the costs between telemedicine and traditional consultations and found that telemedicine appointments are billed at the same Medicare rates as in-person visits; therefore, do not reflect cost savings over traditional specialty service encounters beyond the estimated $7.2 million in guarding and transportation costs avoided (Attachment 7 & 8) and potential litigation and public safety costs avoided.

Cost savings is not the only criteria for deciding between a telemedicine consult and traditional consultations as the primary goal of telemedicine is to provide timely access to care. Beyond cost savings and avoidance, Telemedicine Services provide increased access to medically necessary care, particularly in those remote locations where local medical facilities do not provide all the needed services to support the patient-inmate population. Additionally, the use of telemedicine reduces transport of inmates into communities for healthcare through remote management, increasing public safety. The use of telemedicine services is primarily based on efficacy and efficiency of patient care, as well as the needs of each individual institution, rather than cost effectiveness and those factors do not lend themselves to tangible measurement. Nonetheless, with program expenditures totaling $3 million in FY 2011/2012 and $3.3 million in FY 2012/2013 (Attachment 9), guarding and transportation estimated cost avoidance represents a net gain for the CCHCS Telemedicine Program.

California State Auditor's Assessment of Annual Follow-Up Status: Resolved

Health Care Services states it analyzed the costs and determined that telemedicine does not reflect cost savings over traditional specialty services appointments beyond the savings from medical guarding and transportation costs avoided. Further, it states that the use of telemedicine provides increased access to medically necessary care, particularly in remote locations where local medical facilities do not provide all the needed services.

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #12 To: Correctional Health Care Services, California

To increase the use of the telemedicine system, Health Care Services should continue to move forward on its initiative to expand the use of telemedicine in Corrections' institutions.

Annual Follow-Up Agency Response From December 2010

Office of Telemedicine Services (OTS) has completed the "Phase II Expansion of Telemedicine Encounters" at five institutions. Informed by the "Six Institution Initiative" in Phase I, this Phase II Expansion facilitates telemedicine services at five institutions. Site visits and training by nurses have increased at institutions for telemedicine readiness. A plan to actively monitor institutions in a more structured way is adopted to provide avenues to resolve barriers more proactively. OTS has implemented the default of five specialties including: nephrology, cardiology, endocrinology, dermatology, and orthopedics. (See 2010-041, p. 100)

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Recommendation #13 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.

Annual Follow-Up Agency Response From October 2014

CCHCS has completed all of the short-term goal recommendations and long-term recommendations from the consultants review (Attachment 1).

The CCHCS has completed implementation of a basic electronic medical records management system. The CCHCS Telemedicine Services (TMS) currently utilizes three enterprise applications, Telemedicine Scheduling System (TMSS), Electronic Unit Health Record (eUHR), and Report Manager, to effectively manage telemedicine scheduling and health information storage and retrieval.

Nursing Service's Professional Education Unit developed a standardized statewide curriculum inclusive of telemedicine clinic overview/management; mock clinic skills return demonstration, and knowledge competency validation. Initial training was provided to the Nurse Consultant Program Review staff on August 11, 2014. The training session sign-in sheet is enclosed (Attachment 2). Ongoing training will be provided to the statewide telemedicine nursing staff on this curriculum on

October 17, 2014.

The enterprise eUHR and the Medical Scheduling and Tracking System (MedSATS) scheduling system are fully deployed and operational. A more robust CCHCS/CDCR enterprise eUHR (including scheduling) development is tentatively planned for implementation commencing in 2015.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Annual Follow-Up Agency Response From November 2013

Details on the implementation plan and status are summarized in the attached table (Attachments 10-13)

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From September 2012

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.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #14 To: Correctional Health Care Services, California

To increase the use of the telemedicine system, Health Care Services should maintain a focus on developing and improving its computer systems, such as the Health Care Scheduling System, to increase the efficiency of using telemedicine.

Annual Follow-Up Agency Response From December 2011

Telemedicine Scheduling System (TMSS) - In January 2011, TMSS was upgraded to its second major version, release 2.0. This release allows for resolution of bugs as well as functionality enhancements that improve efficiency of scheduling operations. In July 2011, management reports were added to the system that allow for more thorough scheduling and provider management.

Health Care Scheduling System (HCSS) - As of October 2011, this system has been released to all three women's institutions including California Institute for Women, Valley State Prison for Women, and Central California Women's Facility. During the pilot phase, Office of Telemedicine Services (OTS) identified areas of improvement that have since been implemented, providing a foundation for ongoing use of HCSS by institution telemedicine staff as it continues to be deployed statewide. OTS will continue to work in conjunction with the rollout of HCSS to enhance and integrate scheduling of telemedicine encounters.

MedWeb - MedWeb was successfully implemented and Telemedicine Coordinators were trained at all institutions and provider HUB sites as of October 5, 2011. MedWeb allows the institution and HUB site locations to upload, send, and view patient/inmate information and electronic files via a Health Insurance Portability Accountability Act (HIPAA) compliant transport retention medium. This increases the efficiency and reduces the time needed for data transport for telemedicine clinic preparation. (See 2011-041, p. 120)

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

All Recommendations in 2009-107.1

Agency responses received after June 2013 are posted verbatim.