As described above, this site visit focuses on health center experience working with the Health Federation of Philadelphia (HFP), a private, non-profit membership organization which provides shared services to a consortium of consolidated health centers in the Philadelphia area. All consolidated health centers in the Greater Philadelphia Region are eligible to be members of HFP. As mentioned above, HFP currently has seven member community health centers as well as a collaborative relationship with the City of Philadelphia’s AHS clinics.
Background on HFP. HFP was founded in 1983 as a non-profit corporation and federation of Philadelphia region consolidated health centers. The federation’s leadership consists of a dedicated Chief Executive Officer (CEO) and a contracted Chief Information Officer (CIO) who report to a Board of Directors which consists primarily of the executive directors of member health centers. Overall, HFP provides the following types of services to member health centers
- Representation and advocacy. HFP represents health centers at city-wide coalitions and acts as an advocate for health centers with federal, state and local governments.
- Collaboration. The HFP provides a forum where health centers can come together to address common administrative and operational issues.
- Program coordination. HFP assists with centralized program development and implementation. For example, HFP often contributes services necessary for applying for grants such as those offered by BPHC and managing activities funded under those grants.
In recent years, the HFP has focused attention around supporting health center needs in the area of health information systems. HFP is operating a data warehouse and is facilitating a pilot EMR program being initiated in a HFP member health center. To support its information systems programs HFP receives funding from the Administration for Children, Youth, and Families; the Department of Housing and Urban Development; the Philadelphia Departments of Public Health and Human Services; AmeriCorps; and various foundations. The data warehouse is paid for partially by a BPHC SIMIS grant acquired in 1999 as well as from an initial contribution by the member health centers. We end our discussion of HFP with a description of an ongoing electronic medical record (EMR) pilot project being run through the federation.
Data warehouse history and vision. The HFP’s data warehouse project grew out of an initial focus around helping health centers make the most out of available practice management applications. Initially, the HFP facilitated a community-wide evaluation of practice management vendors to identify a “best in class” product and encourage use of that product on a community level. Having conducted the evaluation, however, they found that a common implementation was not feasible given the varied experiences and needs of member health centers. Instead, HFP and member health centers decided on developing a community-level solution to enhance access to practice management data on a health center and consortium level.
While practice management products typically include some reporting function including the ability to create standard reports required for UDS, some health centers describe problems with data reliability and significant burden associated with developing custom reports. For the most part, these applications allow users to program reports through a technical process after reviewing a complex set of database specifications. In most cases, practice management system databases are designed with to promote administrative efficiency rather than full-featured reporting. For example data may be stored in a “flat” rather than a relational format ideal for producing reports. Additionally, most operational databases are geared towards transactions, e.g., updating data, and retrieving discrete data elements, such as the time of an appointment, to be displayed on an application screen. To answer reporting questions, such as the number of appointments scheduled during one year broken down months, would require additional queries and/or views to group and summarize data. Health centers often lack the expertise and resources to take full advantage of this less than ideal reporting capacity and are left wanting for more flexible, user-friendly tools for accessing and analyzing their practice management data.
The HFP’s data warehouse addresses this concern by integrating practice management data across health centers into a community-wide data format designed to facilitate flexible reporting and data dissemination on both a community and health center level. The new data warehouse would store and maintain data using a sophisticated structure and, importantly, provide access to these data via a user-friendly interface that allowed non-programmers to access manipulate and analyze data in real time from their own desktop. In theory, the data warehouse would add value in a number of ways. First, it would allow more convenient and reliable access to data on the health center level. Second, it would allow an assessment of safety net ambulatory health center experience on a community-level and identify differences in practice patterns across centers. Finally, the data warehouse represents and important public health tool for enhancing understanding of insurance status, health status and health care experience of indigent populations living in Philadelphia.
Vendor Selection and System Installation Process. HFP contracted with Ingenix, a subsidiary of United Health Care, to support the data warehouse project, in part because Ingenix had an existing warehouse architecture that could serve as a shell for the new project. Working with Ingenix, HFP identified data requirements and built interfaces to extract these data from various practice management systems. These requirements expand on data elements present in UDS and HCFA 1500 reports.
Following identification of data requirements, HFP faced the challenge of building interfaces to facilitate transfer of data from individual health center systems. This was a particular challenge because of the proprietary nature of these databases. Two practice management vendors agreed to provide Ingenix with the details that allowed Ingenix to program data extracts to pull data appropriate data from the vendor systems. In other cases, Ingenix provided the data warehouse architecture to the practice management vendors who then developed programs to produce extracts from their own databases at significant additional cost to the project.
HFP supplied all the hardware and supportive network infrastructure for the data warehouse using SIMIS funds and set up internet communication linkages. The extraction process took two years to finalize, after which health centers sent their extracted data to the centralized database as a trial run. Currently, the system holds this data from 2002 and HFP is in the process of running accuracy and quality assurance checks to eliminate any errors caused during data transfer or coding.
It is important to note that once data from 2002 are validated, HFP will face the additional cost of creating new extracts for health centers that changed practice management vendors between 2002 and 2003. In some cases health centers had to turnover practice management systems unexpectedly because of vendor decisions to upgrade and discontinue support of older products. One important challenge facing HFP and member health centers, especially given the turnover in practice management systems, is streamlining data extraction and validation. The goal over time will be to facilitate regular transfer of data from health centers to the data warehouse to minimize time it takes for events to be reflected in data warehouse output.
Ongoing data warehouse support activities. HFP support for the individual centers’ data warehousing efforts is provided by the two IT staff at the consortium, the part-time CIO and the Network Administrator. The Network Administrator runs a basic or “level one” helpdesk, which the centers can call if they experience problems accessing their data warehouse information or generating reports. Ingenix, which provides the data warehouse software through a yearly license, also operates a helpdesk for more complicated user support. Additionally, the HFP has made some efforts to facilitate collaborative support groups involving information technology staff from various health centers participating in the data warehouse project.
EMR pilot. In 2002 the HFP arranged to conduct a pilot EMR project across several health centers using CliniFlow’s EMR product, which was compatible with Medical Manager and HealthPro, two practice management vendors used by area consolidated health centers. Although the original grant provided funding for the four data warehouse participants to do the pilot, further investigation revealed that available funds would support only one health center’s participation in the pilot program. Additionally, agreements between CliniFlow and the two key practice management vendors broke down during early stages in the project. This left HFP and the pilot health center to come up with an alternate approach, still in development, involving the use of a WebMD EMR product called “Intergy”. We describe health center progress related to EMR in greater detail below.