- The Washington Times - Thursday, July 19, 2007

alking about the need to put medical records in electronic form is easy.

Actually designing and implementing such a system is another, far more complicated matter, as officials and constituent members of the District of Columbia Primary Care Association (DCPCA) are learning daily.

With $5 million in funding supplied by the city, the agency’s Medical Homes division has embarked on a pilot project to digitalize procedures in six of its 10 clinical centers. The centers operate 21 sites serving the underinsured and people without ready access to basic health care. The project’s long-term goal is to be able to link the centers and, later, electronically connect all the centers with local hospitals and other medical facilities to form a regional network.

The District three years ago gave the agency $21 million to build the centers, known as Medical Homes — a concept that allows clients to think of the centers as facilities where they always are welcome. Some 26,000 patients were being served at the time by the agency.

“Primary care is preventive care,” says Orlene Grant, director of Medical Homes Programs and Special Projects, who is overseeing the project. Any talk about the computerization of services, she insists, “has to get back to the human factor” — how a so-called paperless office will better serve clients.

The first center planned to operate this way will be the Whitman-Walker Clinic, expected to be wired fully in November. Next in line will be Bread for the City, So Others Might Eat, Mary’s Center, Family and Medical Counseling Service, and La Clinica del Pueblo. Four others will follow when money becomes available.

When the system is up and running, centers will be able to register patients and chart appointments and diagnoses electronically. The system also will be able to link Medical Homes clinics with Medicaid and Healthcare Alliance offices.

“The potential for better patient care is tremendous,” Ms. Grant says.

It’s not a novelty in Washington to find physicians in private practice going this route: installing the necessary hardware and software to improve record-keeping and billing procedures. Few would dispute the advantage in terms of efficiency alone, both as a cost-saving measure and, more importantly, in the ability to have medical histories readily accessible with key data in hand when treating patients.

The private Washington ENT Group at 2021 K St. NW, for example, went largely paperless seven years ago. Physicians there greet patients using hand-held wireless devices similar to laptops or personal digital assistants that are comparable to the old-fashioned chart and cumbersome files. All past information pertinent to the patient is available at the click of a few keys with the help of a stylus. Prescriptions and lab-test orders are handled electronically as well.

Involving in this manner a city health agency — especially one in which member clinics operate on something of an autonomous basis as they do under the DCPCA — is unusual.

Computerized regional health networks are happening all over the country, notes Sharon Baskerville, DCPCA’s executive director, who describes the project’s overall aim as being able ideally to provide “a permanent safety net system that guarantees access to care and eliminates disparity.”

“But a lot of these have failed,” she adds. “I’m determined not to have this one fail.”

Such a program, she says, “is crucial in the future to get the city connected from a health perspective.” Hence, her goal “to create a sort of business model that can survive and be sustained while preserving the mission [the centers] always had of not turning anyone away.”

Making the system work requires careful implementation, to be done in stages. The first challenge was getting the centers to work together in ways to which they are not normally accustomed. Hence, the development, in agency-speak, of “a collaborative learning model.”

Then, too, there is what Ms. Grant calls the larger issues of privacy matters, “issues everyone across the country is dealing with. There are lots of conferences on data sharing and legal practices specializing in the subject.”

An outside consulting group was hired to oversee coordination and training strategies. To this end, personnel from the various centers met recently to discuss their mutual needs and expectations. A key consideration is agreeing on how to customize and standardize data at all six centers when the software is in place.

“It’s a major challenge — the first time the health centers have worked cooperatively on one project.” Ms. Grant says.

More than 50 software companies were reviewed before the decision was made to hire eClinicalWorks of Westborough, Mass., which has made a specialty of catering to agencies that serve “the needy and economically deprived,” in the words of company president Girish Kumar Navani. The company is the same one chosen by New York City’s Department of Health and Mental Hygiene to upgrade that agency’s body in charge of delivering primary care services.

“Most such companies don’t have anything to do with community health centers,” Ms. Grant notes. “You’re not looking at bed capacity. … Primary care is family-oriented and deals with prevention and survival needs.”

EClinicalWorks had to make two key technical adjustments in catering to primary care agencies.

“One is they actually bill their insurance company based on the income level of a patient,” Mr. Navani says. “Our physicians — yours and mine — normally don’t charge us according to how much we make. Then, too, there are lot of strict requirements on reporting and a need to show a demonstrated quality of care.”

In October, Newsweek magazine reported that although the country spends an estimated $2 trillion a year on health care, only 24 percent of health care providers use electronic information technology. Most authorities in the field agree that reliance on computerization would reduce the risk of medical errors and lower costs of health-care delivery overall.

As recently as February, U.S. Secretary of Health and Human Services Michael O. Leavitt was quoted saying that so-called electronic “interconnectivity” soon would be a requirement for dealing with the federal government. Estimates for installing such a system vary but initially can be in the six figures for a group practice.

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