“Richmond Enhancing Access to Community Healthcare,” or REACH, is a partnership between more than 13 public and private health stakeholders in Richmond, including safety net health centers (both CHCs and free clinics), an academic health center, the City Health Department, the Bon Secours Richmond Health System, HCA Healthcare, the Central Virginia Health Planning Agency, and the Richmond City Department of Social Services. REACH’s stated mission is to increase access to a comprehensive continuum of quality healthcare services for persons who are uninsured or underinsured. The consortium, which was incorporated in 2002, provides a resource for data about health care for uninsured people, assesses community health needs, assists low-income individuals in applying for low cost health care options, and coordinates both non-technological and technological efforts across its partnering providers. Services provided to REACH partners include site-specific training, user groups hosting, limited on-site technical support, maintenance and software upgrades of software, and booster trainings. The majority of these services are coordinated through the MORE Access software system.
MORE Access. REACH’s MORE Access (Medical Online Resource Enhancing Access) system, which was described by REACH respondents as the “hub” for the organization’s IT initiatives, was designed to facilitate eligibility assessment and patient information sharing, provide a foundation for data warehouse, and serve as a communication tool. MORE Access was built for REACH by a local vendor, XPerts that was selected during a competitive procurement process in 2001 following the consortium’s reception of an HCAP grant. The software collects and maintains data on clients and encounters, including demographic and financial information (including client tax forms). It also supports automated eligibility determination for Medicaid and other State and local assistance programs. Like CCNV, REACH provides its partners with access to the MORE Access software via the Internet using VPN connections.
Although MORE Access is primarily a data entry system for patient financial and demographic information, it also contains built-in applications for data warehousing, GIS mapping, document imaging, financial screening, eligibility determination, and limited report generation. REACH staff anticipate that the system will improve collaboration between providers, for instance by enhancing understanding of patient utilization across different health centers.
Interfaces. Important features of MORE Access that enhance the potential for its use among a wide range of community providers are built in interfaces that allow the online system to “talk” with health center practice management systems. To date, REACH has developed two specific interfaces. One is with ComCare’s Megawest system, as many REACH partners are also CCNV participants; the other is with a separate practice management program used by a health center that is part of the Virginia Commonwealth University Health System (VCUHS), where the MORE Access servers are housed.
The need for the Megawest interface was recognized early on in the program’s development, as one of REACH’s main goals is to reduce duplication of efforts across the region’s health center networks. ComCare participated in some of the discussions around this interface. REACH paid Companion Technologies to design the actual system, which creates a text file incorporating the data elements from Megawest that is then uploaded into MORE Access. This process is not seamless: the text file must be extracted and made available on the ComCare server, then copied to a ComCare staff member’s PC, then transferred via SSH Secure File Transfer Client to the ftp server at Virginia Commonwealth University, where it can finally be uploaded to MORE Access. Although there has been some discussion about a more direct interface (one that does not require multiple active processes), this has not yet been designed.
Data entered by health centers is stored and maintained in an Oracle database. REACH leadership envisions the database and reporting infrastructure as a precursor to a community level data warehouse that could produce basic encounter and client level information from across the community, as well as support individual health center UDS reporting.
Early Experience. REACH is in the process of re-implementing health center utilization of the system this spring, having experienced problems with the eligibility determination function during the initial rollout in 2002. The revamped MORE Access system is currently being rolled out at the consortium’s three participating health systems and will soon go live at the community-based health centers across Richmond, as well as the Richmond City Department of Public Health. REACH respondents explained that their go-live strategy called for implementing the new MORE Access at the health systems first to facilitate the development of a training package for the centers that would correspond exactly with the needs and requirements of the health systems. They have encountered a few setbacks with one of the health systems, but anticipate bringing the health centers on-line towards the end of April.
Interestingly, REACH respondents indicated that they had had no knowledge of CCNV during their consortium’s initial stages. They felt that this was in part due to the high staff turnover among the local health centers. The respondents regretted not having known about CCNV’s existence during the start-up, but they thought that the two consortiums would be collaborating more in the future. REACH does currently work with the VPCA and the state Primary Care Office. In the section that follows, we present an overview of health center experiences working with both CCNV and REACH. Exhibit 1 below provides an overview of State and local initiatives described above and their relationship with CHCs in Richmond and statewide.
Exhibit 1. Overview of State/Local CHC-focused IT Initiatives