Systems Integration Project

The Monroe County Systems Integration Project aims to establish connections between 300 local health, education and human services organizations by building technology and establishing relationships across sectors. This project is a priority identified by the Regional Economic Development Council, the Rochester-Monroe Anti-Poverty Initiative (RMAPI), and others as a critical need for our community, as well as a key need and priority identified by people living in poverty.

Over the upcoming months and years, the Systems Integration Project and key community partners will shift the way our community works together to help individuals and families seeking support. This means people will have better access to services and information, and providers will be better informed to help their patients and clients.

When fully implemented the SIP will both enable and evaluate coordinated cross-sector interventions that support a family’s transition from crisis to stable to thriving.

The core components of the SIP, which will be implemented through 2024, include:
  • Improved access and integrated service delivery created via advanced front-door protocols and right sized program capacity
  • A robust change management process inclusive of community driven design, prototyping, multi-sector pilots, rapid cycle improvements, training and technical support, adaptive leadership and technology utilization
  • A shared digital dashboard that offers multi-sector users a 360-degree view of more than 150,000 individuals and a shared digital closed-loop referral system used by more than 300 health, education and human services providers
  • A shared data hub and analytic engine that compiles new and existing data to both inform implementation of new cross-sector workflows and provide a means for measuring shared accountability for sector-specific outcomes, including evaluation of return on public and private investments
  • Consumer-driven informed consent management
The SIP is innovative and unique in both scope and scale.  As such, the SIP will be a cutting-edge, replicable path to improved prosperity and wellbeing across New York while concurrently creating efficiency and cutting cost.

Collective Vision
The greater Rochester community is working across a diverse network of committed providers to build an interconnected, person-centered system of health, human services, and education leveraged by a unified information platform, to improve the health and economic well-being of individuals and families, especially those who are vulnerable and/or impacted by poverty.
Systems Integration Prototyping Project
From November 2019 through February 2020, twenty-nine multi-disciplinary teams learned and then used human-centered design to develop, test and iterate prototypes of new service delivery workflows. The solutions created span across the education, health care and human services sectors, and showcase ways to work across and within each sector more collaboratively to drive better results for individuals and families. Each teams’ goal was to address challenges identified within our community, and design solutions that are desirable, viable, and feasible. To see the great work the teams completed, check out our Poster Presentation Gallery. We look forward to working with these prototyped ideas to create a new, integrated service delivery model.

Systems Integration Project - Data Ecosystem

The SIP is currently evaluating proposals from qualified software and systems integration vendors and will select partners to design develop and implement an integrated Data Ecosystem that enables coordination and collaboration across the health, human services and education sectors.

Check back here for updates on our Phase 1 implementation which is focused on designing, developing and testing a 360-degree view of a person dashboard (and supporting infrastructure) by March 31, 2021.

The linked business requirements document and use cases describe our Phase 1 scope in greater detail.

Systems Integration Summit 10.21.2020: Recap
The SIP Staff hosted a virtual summit for all who currently work on the project to come learn more about systems change in action and our collective work ahead. The summit also offered two Key Note speakers: Aqua Porter and Dr. Anthony Suchman. All summit materials can be found here: PowerPoint Presentation and Video Recording.
There were a few questions asked throughout the course of the event please see the answers below:

Q: How many vendor proposals are being evaluated?
A: The RFP was posted to the SIP website and emailed to 100 organizations including 18 that responded to last year’s Request for Information (RFI) and 36 organizations identified through the NYS MWBE Directory. From these outreach efforts, we received 21 proposals to evaluate.
Q: What is/was the closed loop referral technology platform being used?
A: Currently leveraging United Us through outside groups licensing
Q: Is there a summary of the impact of the Emergency Food Delivery Pilot?
A: Please view the linked summary of the Emergency Food Delivery Pilot Report
Q: There has been mention of Behavioral Health and Education. Will there be pilots that focus on these areas? If so, is it known which area of systems integration will be the focus (intake, consent, navigation, etc.)?
A: The conversations to scope and plan a Children’s Behavioral Health pilot focused on suicide prevention are happening now. More information to follow regarding which parts of the integrated system will be scoped into the pilot.
Some History
In 2015, a team of experts from IBM analyzed Rochester’s high rates of poverty, including the highest rate of child poverty (50.1%), the highest rate of extreme poverty and the second-highest rate of poverty overall in the nation. IBM’s Smarter Cities Challenge study found Rochester to be “program rich but results poor,” and cited to a number of reasons why Rochester needs to make fundamental changes to reduce poverty. This led to community leaders and people living in poverty, confirming the need for an integrated system. Thus, the Systems Integration Project was identified as a priority by the Regional Economic Development Council and the Rochester-Monroe Anti-Poverty Initiative (RMAPI). As a demonstration project, NYS will benefit from the SIP by investing in a single integrated system with an eye toward how to replicate this work in other areas.

How We Work

Meet the Staff

The Monroe County Systems Integration Project formally and adamantly affirms its commitment to creating a re-imagined system that is equitable, just and anti-racist. Please read the SIP's Anti-Racism Declaration here

ACT Rochester
Action for a Better Community, Inc. 
Boys and Girls Club of Rochester
Catholic Family Center
Children's Institute
City of Rochester
Common Ground Health
Congressman Joe Morelle's office
Coordinated Care Services Inc.
Education Success Foundation
ESL Charitable Foundation
Excellus BCBS
Finger Lakes Performing Provider System
Systems Integration Team Members

FLRDEC c/o Empire State Development
Goodwill of the Fingerlakes/211
Greater Rochester RHIO
Ibero-American Action League, Inc.
Monroe County Department of Human Services  
Monroe County Medical Society
Monroe County Public Health
Monroe County School Board Association
Monroe County Sheriff
Nazareth College

NYS Commissioner of Education/ BOCES
RTS: Regional Transit Service
ROC the Future
Rochester City School District
Rochester-Monroe Anti-Poverty Initiative 
Rochester Regional Health
Seventh Judicial District
The Children's Agenda
United Way of Greater Rochester
University of Rochester Medical Center

Accountable Health Partners
Anthony L. Jordan Health Center
Baden St. Settlement
Center for Governmental Research
Diocese of Rochester
EnCompass: Resources for Learning
Exercise Express LLC
Farash Foundation
Greater Rochester Health Foundation
Additional Participating Organizations

Greater Rochester Summer Learning Association / GRSLA
Greece Central School District
Harter, Secrest & Emery  
Hillside-Catholic Charities Behavioral Health Care Collaborative
Human Service Development 

Jewish Family Service
Judicial Process Commission
Kids Thrive 585, Inc
Law NY


Mary Cariola   
New York State e-Health Collaborative
Rochester Spinal Association
Rochester/Monroe County Homeless Continuum of Care, Inc
St. James Mercy Hospital
St. John Fisher College
St. Josephs Neighborhood Center
The Legal Aid Society of Rochester
Trillium Health, Inc.
Underberg & Kessler
Villa of Hope
Please check back for more updates or contact Margaret Whelehan at