In this section we outline next steps beyond implementation involved in the DCPCA’s engagement with member health care providers on health IT.
Current health information exchange. DCPCA has not begun sharing EHR data across health centers at this point, although health center representatives indicated that such sharing would be useful. In working with other health centers, members still need to submit requests for patient records in paper. The new PMS/EHR has led to new information sharing in other areas though. Participants noted that eCW has facilitated easier prescriptions refills and lab refills (although one participant noted difficulty tying ordered labs to funding sources). Members also expressed some concern about maintaining compliance with HIPAA.
Quality improvement. DCPCA’s quality improvement (QI) initiatives are still in the beginning stages of development. One health center, Whitman-Walker Clinic, reports that it has begun using eCW for quality, but most other centers are just beginning to consider how to use the EHR to improve quality. Participants noted that having the EHR has served as a type of motivation for developing QI initiatives. In their view, the EHR has forced them to pay attention to data quality for things like reporting. Having spent resources to develop clean data sets, these centers see the additional cost of pursuing more formal quality improvement initiatives as low. The existence of additional health center data has also led DCPCA to pursue a central quality improvement program. One health center agreed that having additional data made QI a possibility, but felt that additional training would be needed to capitalize on the opportunity.
Future directions. DCPCA plans to expand its PMS/EHR initiative to all of the health centers in DC. It is their hope that such an expansion will help to control costs for individual health center participants. Additionally, DCPCA is moving forward with a RHIO (regional health information organization). The DC government has provided $6 million in grant support to help develop the RHIO. DCPCA hopes that the RHIO will help to expand the utility of the EHR, providing health centers with a more complete picture of patients’ care, particularly in hospital settings. Participating hospitals include: Washington Hospital Center, Georgetown University Medical Center, Howard University Hospital and Providence Hospital. DCPCA is also developing resources to increase members’ use of functionality available in eCW. This may take the form of another staff member devoted to the PMS/EHR initiative. Both DCPCA member representatives and staff indicated that they had more or less mastered the basics of using eCW, but felt frustrated that they could not make use of more of the system’s available functionality.