The District of Columbia Primary Care Association (DCPCA) was founded in 1996, in an effort to promote primary care and support health centers and free clinics in the community. Before DCPCA’s inception, the District did not have any coordinated effort to support primary care and community health centers through an association. In the years since its founding, DCPCA has focused on initiatives to enroll more health center patients in Medicaid, increase the use of the medical home model in DC and various efforts around increasing civic engagement and communication among local stakeholders. Currently, DCPCA focuses on capital improvements and physical expansions among its members (especially in wards seven and eight), improving quality of care and increasing efficiency, particularly through the use of health information technology. DCPCA also serves as an advocate for its members, particularly on the issue of local Medicaid reimbursement rates.
DCPCA currently has 14 health care provider members and a number of organizational member partners. While the association focuses on health center operations, its members vary greatly in the services they provide, with some focusing almost exclusively on health care and others specializing in securing food and clothing or providing other social services. Consequently, not all DCPCA members are federally-funded health centers, with some receiving little to no federal funds. DCPCA is governed by an eleven-member board of directors. Some of the member provider organizations are represented on the board of directors, although most are not. DCPCA has a staff of 29 regular employees, supported by interns and volunteers. The Association’s overall budget in 2008 was reportedly $20 million.
EHR Project Background. Between 2004 and 2005, DCPCA staff recognized an interest among its members in adopting an electronic health record (EHR). Most member clinics expressed some level of interest and some providers serving at DCPCA members had experience working with EHRs either at Veterans Administration hospitals or other sites. Overall, however, providers were discouraged by the high costs, lack of support for initial investments and questions about ongoing maintenance and sustainability. Despite these concerns, the Association recognized a certain level of need and interest among its members and DCPCA’s CEO Sharon Bakersville, lobbied the DC Department of Health to provide funding. These efforts culminated in a $5M grant from the DC government to implement a combined practice management system (PMS) and EHR. After being funded, DCPCA brought together 14 interested health centers to determine which centers would be most interested in implementing first, serving as “early adopters.” Six clinics volunteered: Bread for the City, Family and Medical Counseling Service, Inc. La Clínica del Pueblo, Mary’s Center for Maternal and Child Care, SOME (So Others Might Eat) and Whitman-Walker Clinic.
Motivations. Health center representatives expressed a number of motivating factors that led to their participation in the DCPCA PMS/EHR initiative. Most felt that the new system would improve continuity of care and communication within their health centers. One health center felt that the EHR would help them consolidate patient records. Before implementing the PMS/EHR, this center maintained separate paper records for individuals across the center’s departments. This fragmented system hindered development efforts as visiting funders would often note problems in the area of communication and collaboration across departments. Others hoped that the PMS/EHR would improve communication between staff that perform different functions within a center, particularly between providers and front desk staff. Some noted the amount of time they spend tracking down paper records and the prospect of running reports more easily. Others explained that the availability of grant funds served as a motivating factor in itself, citing limited capital and aging existing IT infrastructures at their centers. DCPCA staff supported this explanation in discussing their motivating factors, explaining that they observed inefficiencies and deficiencies in member centers’ infrastructures leading them to pursue an EHR despite some uncertainty among members. Still, others expressed a belief that “EHRs are the future” while some said that moving toward an EHR represented an effort to increase collection rates for reimbursement.