Community Partners HealthNet ( CPH) is a non-profit organization that provides information technology and administrative services to ambulatory care safety net health centers in eastern North Carolina. The network is based in Snow Hill, North Carolina approximately 80 miles southeast of the Raleigh-Durham area. The majority of its members are located in the area between Snow Hill and the South Carolina border in the eastern part of the state including Greene County Community Health Center located in Snow Hill itself, Kinston Community Health Center located 30 miles due south of Snow Hill, Steadman-Wade Health Center located in the very small town of Wade located southwest of Snow Hill on Interstate 95 and Robeson Healthcare Corporation also located off Interstate 95 close to the South Carolina border.
While these health centers serve a population typical of other health centers in the nation, namely a disproportionate share of Medicaid and uninsured individuals, they each have specific characteristics. Because many of these health centers are located in small towns or rural areas where they are one of a limited set of ambulatory care providers and where the population is older than in urban areas, these health centers see more Medicare patients than many health centers. Also, Robeson is unique in that it is located near large Indian reservations in the southern part of the State. In addition to serving the American Indian population, some Robeson sites serve a large number of African Americans, stemming from the distribution of racial/ethnic groups in Robeson’s service area.
CPH was founded and incorporated in 1999 and was initially meant to help health centers adapt to Medicaid managed care. While Medicaid managed care did not become a reality in the state, several of the original partners, maintained the organization to provide assistance on administrative and information technology (IT) needs. The organization began by collaborating on a joint project around Y2K compliance and continued to build a shared infrastructure for providing practice management services. To do this, the network leveraged a series of HRSA network grants including the Integrated Communications Technology (ICT) grant and the Integrated Service Delivery Networks (IDSN) grant.
Around 2001, the network began looking into options for electronic medical records (EMRs) and opted to learn more about an application called Cliniflow that was developed by an Israeli firm. In 2002, the network entered into a contractual relationship with the vendor, which subsequently changed its name to MicroMD and was purchased by Henry Schein, Inc. Greene County Health Care began use of the MicroMD EMR product in 2004, Steadman-Wade began implementation and use two years later, Kinston implemented in August 2007 and Robeson went live at all of its sites in January 2008.
CPH indicates that it operates largely as an application service provider (ASP) and hosting service for its member health centers. Health center members pay annual membership dues which are currently $15,000/year as well as additional fees based on the number of users at each health center to help cover the costs of licensing software and support services. In addition to the EMR product, CPH also supported implementation of the MicroMD practice management system as well as the Dentrix dental record system which are also products owned and supported by Henry Schein, Inc. The network also developed and supports the use of a data warehouse that regularly compiles and stores data from all the applications it supports and allows health centers to access reports on utilization and efficiency metrics drawn from each of these systems.
As part of its hosting function, CPH supports all of the issues associated with HIPAA compliance of electronically-stored patient data, backs-up data from these applications, supports training and implementation of the applications at each health center site, works out connectivity issues with the sites and acts as a convener of users to allow for discussion and resolution of common issues. CPH also provides direct technical support to users for the MicroMD EMR system: however, staff members note that direct technical support for the MicroMD Practice Management system and Dentrix dental record application are provided directly by Henry Schein.
Figure 1 below provides an illustration of the network configuration and applications provided to various members. As depicted below, Community Partners HealthNet centrally maintains servers housing its data warehouse, applications ( EMR, PM and dental) and Citrix which serves as a “Metaframe” across which the health centers can access these applications. Connectivity to most health centers is maintained through the Internet, the exception being Greene County Healthcare which, due to its proximity to the network, has a dedicated fiber optic connection. CPH is also connected, via the Internet, to an off-site facility where servers replicating the three production servers are housed and updated nightly as back-up.
Figure 1: Network Configuration at Community Partners HealthNet
As with the other site visits conducted under this project, NORC staff travelled to North Carolina to meet in person with staff from CPH including their Executive CEO, Doug Smith as well as executive, clinical and IT leaders from member health centers. In addition to discussing topics related to EMR implementation and impact, we asked discussants to describe their motivation for health IT adoption and their experiences, positive and negative, in working in the network framework to support health IT adoption and maintenance. We also asked networks and health centers to comment on the sustainability of their health IT initiatives and expected financial returns from their IT investments.