Design Considerations for Community Mental Health Management Information Systems Burt H. Lowe* Barry Sugarman
ABSTRACT: Many community mental health centers are presently faced with the necessity of implementing a management information system. This article offers guidelines for centers dealing with this situation. Whether a center chooses to adapt an existing system or develop one of its own, careful planning prior to the implementation of the system can help ensure that it will meet the needs of the center and operate successfully. The guidelines are organized into the categories of data considerations, people considerations, and system considerations. The first two categories are of general interest, whereas the last category is more technical in nature.
As a result of increasing external pressures from federal requirements, state regulations, and third-party payer demands, community mental health centers are becoming acutely aware of their need for a management information system. In all but the smallest centers, a management information or accountability system means an automated procedure for collecting, storing, analyzing, and reporting information. Under the time constraints of external pressures, many centers have hastily developed such a system, often at substantial cost, only to find that (1) the data collected were not the data needed; (2) the reports produced were hard to interpret at best and meaningless at worst; (3) the system was too inflexible to meet new external requirements as they arose; (4) the reports were of little use internally by management in their decision-making processes; (5) too much staff time was taken up with increased paperwork, reducing the time available for services; and (6) erroneous data was entered into the system either inadvertently or malevolently. These unfortunate situations might have been largely avoided if sufficient thought and planning had gone into the design of the information system before it was implemented. The purpose of this article is to offer the prospective user of an accountability system some guidelines in selecting or designing a system that will best meet his needs. These guidelines fall into three general categories: data considerations, people considerations, and system considerations. The first two of these categories will be of interest to all individuals who are involved in community mental health accountability. The third category, system considerations, is more technical and will be relevant primarily for *Mr. Lowe is affiliated with the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02114. Dr. Sugarman is affiliated with the Mental Health and Mental Retardation Board of Montgomery County, Dayton, Ohio 45402, and the School of Medicine, Wright State University, Dayton, Ohio, 45401. 21 6
Community Mental Health Journal, Vol. 14 (3), 1978 0010-3853/78/1500-0216500.95 9 1978 Human Sciences Press
Burr H. Lowe and Barry Sugarman
217
individuals connected with the data processing aspects of management information systems. DATA CONSIDERATIONS Ten data considerations are discussed in this section. These considerations apply to both the collection of data and the manner in which it is reported.
Reporting only essential information. A report that is not read is useless and a waste of the costs involved in producing it. The more information contained in a report, the less likely it is to be read. A report should be brief and tailored to the needs of the person receiving it. It is more reasonable to produce several different reports for several levels of management than to force managers to figure out what is useful to them in a multipurpose report. Collecting only essential information. This effects both the system itself and the people involved in collecting the data. It is a poor use of resources to use staff time in collecting information and storage space in saving information that "might someday" be useful.
External requirements. The system should produce the required reports for all external agencies to w h o m the center is accountable. Much of the information is the same for many of these agencies and need only be reorganized and reformatted to meet external requirements. Collecting the same information more than once is a procedure that can be avoided with a well-designed management information system. Individualized program data. Each program within an agency will usually have data it wishes to collect that are not meaningful to other programs. Rather than require all programs to record information useful to only one of them, or creating individualized forms for each program (which may be a feasible alternative), space should be left on each input document for the recording of information of the program's choice. This information can be summarized or listed on the report the program receives without requiring separate programming for each unique kind of information recorded. Distribution of reports. It is even more wasteful for the director of a center to receive a report on each client admitted than it is for each individual staff member to receive a report summarizing the activities and costs of the center as a whole. The distribution of reports should be determined by the level of summary of information contained in the report.
Level of collection of data. Although it is relatively simple to aggregate data collected at one level (for example, program) to a higher level
218
Community Mental Health Journal
(for example, center), it may be impossible to go in the other direction. If, for example, services-rendered information is reported to the system by program but cost information is reported to the system only for the center as a whole, it becomes impossible to determine unit costing at the program level. Data should be reported to the system at the lowest meaningful level.
Effectiveness data for program evaluation. An information system per se is concerned only with the quantity, type, cost, and efficiency of services rendered. It is not concerned with the quality or effectiveness of these services. Most centers are interested in this latter kind of information, and an accountability system lends itself well to such applications. The major enhancements to an information system needed to enable it to determine effectiveness of service are (1) some measures of outcome, and (2) enough variables collected on clients, staff, and programs to make reports of relative effectiveness meaningful. Follow-up data. If the system is to deal with the effectiveness of its services at all, follow-up data must be collected. Determining the change in a client's condition from intake to termination alone is an insufficient measure of the effectiveness of a program. To obtain follow-up data a center must decide on the procedure and instruments to be used in collecting the information, obtain client permission to contact him for this purpose, and design the accountability system to accept these data and associate them with the correct client and program. Kinds of data to be collected. The data collected for an accountability system should be relevent to answering one of the following questions. To w h o m was service provided? By whom? When? What type of service? H o w much service was provided? H o w was the service delivered? At what cost? With what results? Data collected not falling into any of the above categories should be reconsidered to determine their usefulness. Nondirect service data.
Traditionally data are collected exdusively on clients admitted for treatment. The multifaceted role of the community mental health center is such that many of its services, perhaps its most valuable, do not fall into this category. Consultation to groups or organizations outside the center, education to specific groups or the public at large, telephone counseling and crisis intervention are all outside the traditional definition of treatment. The information system should process information about these activities of a center, as well as the more commonly considered services. Indirect services such as case conferences, supervision given or received, and paperwork may or may not be helpful for the center to record. The questions of h o w this information will be used and of what value it will be need to be answered by each center individually.
Burt H. Lowe and Barry Sugarman
219
PEOPLE CONSIDERATIONS One of the frequently overlooked aspects of a management information system is the impact it has on the people involved: the dients, the staff, and the management. This section addresses considerations in this area.
Confidentiality of client information. A centralized data bank of client information opens the door to possible breaches of client confidentiality even wider than with manual files. The two additional sources of possible violations of confidentiality are the computerized files themselves and the reports that contain client identifying information. Although the former is the less likely of the two to be a source of a breach of confidentiality, it arouses the most fear among those unfamiliar with computer systems. Two features can be incorporated into a system that greatly diminish the likelihood of unauthorized access to data directly from the computer. First, passwords can be assigned to files containing identifying information. Without the proper password, the file would not be accessible. Second, clientidentifying information can be encoded such that without the decoding algorithm, the information is meaningless. The other source of possible breach of client confidentiality, the reports themselves, can be minimized by removing individual identifying information from all reports except those for which it is essential (for example, bills). The only people who should receive information that identifies a client are the staff person responsible for the treatment and that staff member's immediate supervisor. Paperwork. Time spent by staff members recording their activites reduces the time available to them for performing those activities. An information system that substantially increases the amount of this paperwork may be more harmful than helpful to a center. In most cases the system can be so designed that the forms which must be completed replace current ways of recording activity, the net result being little increase or possibly a decrease in the amount of staff time spent in filling out forms. Form design.
The forms required by the system should be designed for the convenience of the people filling them out and not for the convenience of the programmers of the system. This includes both the layout of the form and the coding schemes used for various items. The codes should, if possible, be meaningful to the person recording the data. This can often be accomplished by using mnemonic letters instead of numbers for the codes.
Reports for every level. Frequently an information system requires the information to be provided by front-line staff, and the reports are seen only by managers and administrators. The accuracy of the data provided will increase substantially if front-line staff receive reports based on data that are helpful to them in their activities.
220
Community Mental Health Journal
Resistance to evaluation.
One of the frequent reactions to the implementation of an information system, especially if it incorporates outcome data, is fear on the part of staff members that they will n o w be evaluated on isolated data by administrators who do not understand the nature of the staff members' work. The system should be used to evaluate treatment and programs, not individual staff, and this should be made clear to them. The reports produced by the system can be one of the inputs to the overall evaluation of a staff member, but certainly not the only or even the primary one.
Phased implementation.
The success of any new system is often related to h o w smoothly it was initiated. Phased implementation means not inundating staff with all the n e w forms at one time, but introducing them in some sequence so that staff are familiar with one form before having to learn a n e w one. The same reasoning applies to output reports from the system, with the provision that among the first reports produced by the system should be those of value to front-line staff.
Interference with treatment. Another complaint often heard from treatment providers is that obtaining needed information from clients interferes with the therapeutic process in that it impedes the establishment of a trusting relationship, or that it is inappropriate to attempt to get some information under certain circumstances. Although there is not a simple solution to this issue, some procedures can be established to minimize the occurrence of it. It might be advisable to have a receptionist obtain much of the demographic information required from clients. Provisions should be made to permit obtaining the data at a time subsequent to the initial interview when circumstances make that necessary. SYSTEM CONSIDERATIONS Eleven system considerations are addressed in this section. The first five of these the authors consider mandatory for a welldesigned management information system. The importance of the latter six considerations depends on the needs of the particular center, and the sophistication of the system.
Requirements for All Systems Modularity. The system should be constructed of separate modules which interact to store, process, and retrieve data. The modules should be independent of one another and therefore allow the modification of one of the modules without change to the others. There should be at leastone module for each function performed by the system.
Logical separation of data and programs.
The form and content of the data processed by the system should be kept logically separate
Burt H. Lowe and Barry Sugarman
221
from those elements of the system that process these data; that is, the data elements of the system should not be integral parts of the modules themselves, but kept in tables. The result of this approach is that the data elements can be changed without changing the processing modules.
Extensive input validation.
Every item on each input document should be examined to ascertain that the data contained therein are in the required format and consistant with the other data on the document. Minimally, this could consist of checking for alphabetic characters in an item that requires numeric data, such as admission date, and verifying that the codes used are permissible. Extensive validation involves cross-checking items for consistency, and comparing identification numbers with the files to ensure that the element for which service is being recorded is an existing one.
File conversion. Most centers will have been collecting data in some manner on their clients, staff, and programs prior to the implementation of the system. Although the format in which data must be entered into the new system will undoubtedly be different than the format in which it was collected prior to that time, provision should be made to convert the files that already exist into the format acceptable by the new system. The transcription of information from one form to another is a poor use of staff time, whether it be professional staff or clerical staff, In most instances, a schema can be devised whereby information can be keypunched directly from existing forms, providing that the n e w system is made capable of accepting this form of the data. File maintenence. The system should have the capability of purging erroneous records from the files, accepting corrections or changes to the data already entered in the system, and deleting outdated records from the files. If the files are nonsequential (see below), the system should periodically reorganize the files to ensure efficient use of storage space. Requirements for Some Systems Depending on Sophistication Desired Nonsequential processing of files. Nonsequential file processing permits access to records in a file without having to start at the beginning of the file and search sequentially through all previous records until the desired record is found. Without this feature, it becomes very costly to determine the interaction of data elements in one file with those in another.
Variable-length fields and records. All major files should consist of variable-length records, and some fields within the records should be of variable size; that is, these records and fields should not be tied to a specific length. Not only does this feature avoid wasting storage space for
222
Community Mental Health Journal
short records, but facilitates the inclusion of additional information in a record at subsequent times.
Self-monitoring. In the process of validating input to the system, the system should keep track of the kind of document on which an error occurred, the datum item containing the error, the type of error detected, and the originating point of the document in error. This procedure provides the information necessary to redesign the input documents, develop more comprehensive instructions for completing those documents, or retrain selected staff in the use of the documents. System initiated reporting. Most systems receive two kinds of input: those generated because of the occurrence of an event (for example, admission forms) and those generated by the passage of time (for example, budget forms). The system should be designed so that when circumstances occur as a result of either previous events or the passage of time, a message will be generated by the system and sent to the responsible person informing him of the need to submit the required data. An example of this would be a reminder to collect follow-up information on a terminated client.
Exception detection and highlighting. Even if the bulk of reports produced by the system is limited to the information essential to the individual receiving the report, it is often easy to overlook a significant bit of information when it is presented together with much other data. Exception detection and highlighting refer to indicating on a report--either by additional sections or, for example, by following an exceptional figure with asterisks--a condition considered worthy of special note. These circumstances can result from such things as deviation from a predetermined statistical norm, substantial change in the same information from the previous month, or the passage of time without action being taken. Special report capability. It is not unusual for the result of examining a report to be a request for more information or the same information summarized differently. In addition, external circumstances such as the arrival of auditors may require the data in the system to be reported in a manner that is not part of the standard reports. In order to meet such needs the system should have the capability of producing special reports without reprogramming. Two possible approaches to this capability are (1) creating a "user language" in which one can specify the items he wishes in a report and the manner in which he wants this information summarized, or (2) structuring the data stored by the system so that they are compatible with available statistical packages. CONCLUSIONS It should be noted that the above considerations are not intended to be an all-inclusive list. They address the major areas of concern in
Burt H. Lowe and Barry Sugarman
223
implementing an information system that apply to most community mental health centers. Each center, undoubtedly, will have its own unique situation that requires special considerations. The point that cannot be overemphasized is that the usefulness of any management information system is a direct function of the planning that goes into it before it is implemented.
ABSTRACT: Many community mental health centers are presently faced with the necessity of implementing a management information system. This article offers guidelines for centers dealing with this situation. Whether a center chooses to adapt an existing system or develop one of its own, careful planning prior to the implementation of the system can help ensure that it will meet the needs of the center and operate successfully. The guidelines are organized into the categories of data considerations, people considerations, and system considerations. The first two categories are of general interest, whereas the last category is more technical in nature.
As a result of increasing external pressures from federal requirements, state regulations, and third-party payer demands, community mental health centers are becoming acutely aware of their need for a management information system. In all but the smallest centers, a management information or accountability system means an automated procedure for collecting, storing, analyzing, and reporting information. Under the time constraints of external pressures, many centers have hastily developed such a system, often at substantial cost, only to find that (1) the data collected were not the data needed; (2) the reports produced were hard to interpret at best and meaningless at worst; (3) the system was too inflexible to meet new external requirements as they arose; (4) the reports were of little use internally by management in their decision-making processes; (5) too much staff time was taken up with increased paperwork, reducing the time available for services; and (6) erroneous data was entered into the system either inadvertently or malevolently. These unfortunate situations might have been largely avoided if sufficient thought and planning had gone into the design of the information system before it was implemented. The purpose of this article is to offer the prospective user of an accountability system some guidelines in selecting or designing a system that will best meet his needs. These guidelines fall into three general categories: data considerations, people considerations, and system considerations. The first two of these categories will be of interest to all individuals who are involved in community mental health accountability. The third category, system considerations, is more technical and will be relevant primarily for *Mr. Lowe is affiliated with the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02114. Dr. Sugarman is affiliated with the Mental Health and Mental Retardation Board of Montgomery County, Dayton, Ohio 45402, and the School of Medicine, Wright State University, Dayton, Ohio, 45401. 21 6
Community Mental Health Journal, Vol. 14 (3), 1978 0010-3853/78/1500-0216500.95 9 1978 Human Sciences Press
Burr H. Lowe and Barry Sugarman
217
individuals connected with the data processing aspects of management information systems. DATA CONSIDERATIONS Ten data considerations are discussed in this section. These considerations apply to both the collection of data and the manner in which it is reported.
Reporting only essential information. A report that is not read is useless and a waste of the costs involved in producing it. The more information contained in a report, the less likely it is to be read. A report should be brief and tailored to the needs of the person receiving it. It is more reasonable to produce several different reports for several levels of management than to force managers to figure out what is useful to them in a multipurpose report. Collecting only essential information. This effects both the system itself and the people involved in collecting the data. It is a poor use of resources to use staff time in collecting information and storage space in saving information that "might someday" be useful.
External requirements. The system should produce the required reports for all external agencies to w h o m the center is accountable. Much of the information is the same for many of these agencies and need only be reorganized and reformatted to meet external requirements. Collecting the same information more than once is a procedure that can be avoided with a well-designed management information system. Individualized program data. Each program within an agency will usually have data it wishes to collect that are not meaningful to other programs. Rather than require all programs to record information useful to only one of them, or creating individualized forms for each program (which may be a feasible alternative), space should be left on each input document for the recording of information of the program's choice. This information can be summarized or listed on the report the program receives without requiring separate programming for each unique kind of information recorded. Distribution of reports. It is even more wasteful for the director of a center to receive a report on each client admitted than it is for each individual staff member to receive a report summarizing the activities and costs of the center as a whole. The distribution of reports should be determined by the level of summary of information contained in the report.
Level of collection of data. Although it is relatively simple to aggregate data collected at one level (for example, program) to a higher level
218
Community Mental Health Journal
(for example, center), it may be impossible to go in the other direction. If, for example, services-rendered information is reported to the system by program but cost information is reported to the system only for the center as a whole, it becomes impossible to determine unit costing at the program level. Data should be reported to the system at the lowest meaningful level.
Effectiveness data for program evaluation. An information system per se is concerned only with the quantity, type, cost, and efficiency of services rendered. It is not concerned with the quality or effectiveness of these services. Most centers are interested in this latter kind of information, and an accountability system lends itself well to such applications. The major enhancements to an information system needed to enable it to determine effectiveness of service are (1) some measures of outcome, and (2) enough variables collected on clients, staff, and programs to make reports of relative effectiveness meaningful. Follow-up data. If the system is to deal with the effectiveness of its services at all, follow-up data must be collected. Determining the change in a client's condition from intake to termination alone is an insufficient measure of the effectiveness of a program. To obtain follow-up data a center must decide on the procedure and instruments to be used in collecting the information, obtain client permission to contact him for this purpose, and design the accountability system to accept these data and associate them with the correct client and program. Kinds of data to be collected. The data collected for an accountability system should be relevent to answering one of the following questions. To w h o m was service provided? By whom? When? What type of service? H o w much service was provided? H o w was the service delivered? At what cost? With what results? Data collected not falling into any of the above categories should be reconsidered to determine their usefulness. Nondirect service data.
Traditionally data are collected exdusively on clients admitted for treatment. The multifaceted role of the community mental health center is such that many of its services, perhaps its most valuable, do not fall into this category. Consultation to groups or organizations outside the center, education to specific groups or the public at large, telephone counseling and crisis intervention are all outside the traditional definition of treatment. The information system should process information about these activities of a center, as well as the more commonly considered services. Indirect services such as case conferences, supervision given or received, and paperwork may or may not be helpful for the center to record. The questions of h o w this information will be used and of what value it will be need to be answered by each center individually.
Burt H. Lowe and Barry Sugarman
219
PEOPLE CONSIDERATIONS One of the frequently overlooked aspects of a management information system is the impact it has on the people involved: the dients, the staff, and the management. This section addresses considerations in this area.
Confidentiality of client information. A centralized data bank of client information opens the door to possible breaches of client confidentiality even wider than with manual files. The two additional sources of possible violations of confidentiality are the computerized files themselves and the reports that contain client identifying information. Although the former is the less likely of the two to be a source of a breach of confidentiality, it arouses the most fear among those unfamiliar with computer systems. Two features can be incorporated into a system that greatly diminish the likelihood of unauthorized access to data directly from the computer. First, passwords can be assigned to files containing identifying information. Without the proper password, the file would not be accessible. Second, clientidentifying information can be encoded such that without the decoding algorithm, the information is meaningless. The other source of possible breach of client confidentiality, the reports themselves, can be minimized by removing individual identifying information from all reports except those for which it is essential (for example, bills). The only people who should receive information that identifies a client are the staff person responsible for the treatment and that staff member's immediate supervisor. Paperwork. Time spent by staff members recording their activites reduces the time available to them for performing those activities. An information system that substantially increases the amount of this paperwork may be more harmful than helpful to a center. In most cases the system can be so designed that the forms which must be completed replace current ways of recording activity, the net result being little increase or possibly a decrease in the amount of staff time spent in filling out forms. Form design.
The forms required by the system should be designed for the convenience of the people filling them out and not for the convenience of the programmers of the system. This includes both the layout of the form and the coding schemes used for various items. The codes should, if possible, be meaningful to the person recording the data. This can often be accomplished by using mnemonic letters instead of numbers for the codes.
Reports for every level. Frequently an information system requires the information to be provided by front-line staff, and the reports are seen only by managers and administrators. The accuracy of the data provided will increase substantially if front-line staff receive reports based on data that are helpful to them in their activities.
220
Community Mental Health Journal
Resistance to evaluation.
One of the frequent reactions to the implementation of an information system, especially if it incorporates outcome data, is fear on the part of staff members that they will n o w be evaluated on isolated data by administrators who do not understand the nature of the staff members' work. The system should be used to evaluate treatment and programs, not individual staff, and this should be made clear to them. The reports produced by the system can be one of the inputs to the overall evaluation of a staff member, but certainly not the only or even the primary one.
Phased implementation.
The success of any new system is often related to h o w smoothly it was initiated. Phased implementation means not inundating staff with all the n e w forms at one time, but introducing them in some sequence so that staff are familiar with one form before having to learn a n e w one. The same reasoning applies to output reports from the system, with the provision that among the first reports produced by the system should be those of value to front-line staff.
Interference with treatment. Another complaint often heard from treatment providers is that obtaining needed information from clients interferes with the therapeutic process in that it impedes the establishment of a trusting relationship, or that it is inappropriate to attempt to get some information under certain circumstances. Although there is not a simple solution to this issue, some procedures can be established to minimize the occurrence of it. It might be advisable to have a receptionist obtain much of the demographic information required from clients. Provisions should be made to permit obtaining the data at a time subsequent to the initial interview when circumstances make that necessary. SYSTEM CONSIDERATIONS Eleven system considerations are addressed in this section. The first five of these the authors consider mandatory for a welldesigned management information system. The importance of the latter six considerations depends on the needs of the particular center, and the sophistication of the system.
Requirements for All Systems Modularity. The system should be constructed of separate modules which interact to store, process, and retrieve data. The modules should be independent of one another and therefore allow the modification of one of the modules without change to the others. There should be at leastone module for each function performed by the system.
Logical separation of data and programs.
The form and content of the data processed by the system should be kept logically separate
Burt H. Lowe and Barry Sugarman
221
from those elements of the system that process these data; that is, the data elements of the system should not be integral parts of the modules themselves, but kept in tables. The result of this approach is that the data elements can be changed without changing the processing modules.
Extensive input validation.
Every item on each input document should be examined to ascertain that the data contained therein are in the required format and consistant with the other data on the document. Minimally, this could consist of checking for alphabetic characters in an item that requires numeric data, such as admission date, and verifying that the codes used are permissible. Extensive validation involves cross-checking items for consistency, and comparing identification numbers with the files to ensure that the element for which service is being recorded is an existing one.
File conversion. Most centers will have been collecting data in some manner on their clients, staff, and programs prior to the implementation of the system. Although the format in which data must be entered into the new system will undoubtedly be different than the format in which it was collected prior to that time, provision should be made to convert the files that already exist into the format acceptable by the new system. The transcription of information from one form to another is a poor use of staff time, whether it be professional staff or clerical staff, In most instances, a schema can be devised whereby information can be keypunched directly from existing forms, providing that the n e w system is made capable of accepting this form of the data. File maintenence. The system should have the capability of purging erroneous records from the files, accepting corrections or changes to the data already entered in the system, and deleting outdated records from the files. If the files are nonsequential (see below), the system should periodically reorganize the files to ensure efficient use of storage space. Requirements for Some Systems Depending on Sophistication Desired Nonsequential processing of files. Nonsequential file processing permits access to records in a file without having to start at the beginning of the file and search sequentially through all previous records until the desired record is found. Without this feature, it becomes very costly to determine the interaction of data elements in one file with those in another.
Variable-length fields and records. All major files should consist of variable-length records, and some fields within the records should be of variable size; that is, these records and fields should not be tied to a specific length. Not only does this feature avoid wasting storage space for
222
Community Mental Health Journal
short records, but facilitates the inclusion of additional information in a record at subsequent times.
Self-monitoring. In the process of validating input to the system, the system should keep track of the kind of document on which an error occurred, the datum item containing the error, the type of error detected, and the originating point of the document in error. This procedure provides the information necessary to redesign the input documents, develop more comprehensive instructions for completing those documents, or retrain selected staff in the use of the documents. System initiated reporting. Most systems receive two kinds of input: those generated because of the occurrence of an event (for example, admission forms) and those generated by the passage of time (for example, budget forms). The system should be designed so that when circumstances occur as a result of either previous events or the passage of time, a message will be generated by the system and sent to the responsible person informing him of the need to submit the required data. An example of this would be a reminder to collect follow-up information on a terminated client.
Exception detection and highlighting. Even if the bulk of reports produced by the system is limited to the information essential to the individual receiving the report, it is often easy to overlook a significant bit of information when it is presented together with much other data. Exception detection and highlighting refer to indicating on a report--either by additional sections or, for example, by following an exceptional figure with asterisks--a condition considered worthy of special note. These circumstances can result from such things as deviation from a predetermined statistical norm, substantial change in the same information from the previous month, or the passage of time without action being taken. Special report capability. It is not unusual for the result of examining a report to be a request for more information or the same information summarized differently. In addition, external circumstances such as the arrival of auditors may require the data in the system to be reported in a manner that is not part of the standard reports. In order to meet such needs the system should have the capability of producing special reports without reprogramming. Two possible approaches to this capability are (1) creating a "user language" in which one can specify the items he wishes in a report and the manner in which he wants this information summarized, or (2) structuring the data stored by the system so that they are compatible with available statistical packages. CONCLUSIONS It should be noted that the above considerations are not intended to be an all-inclusive list. They address the major areas of concern in
Burt H. Lowe and Barry Sugarman
223
implementing an information system that apply to most community mental health centers. Each center, undoubtedly, will have its own unique situation that requires special considerations. The point that cannot be overemphasized is that the usefulness of any management information system is a direct function of the planning that goes into it before it is implemented.
