SKYCAP’s technical infrastructure is designed to accommodate challenges associated with supporting networked health care applications in a rural environment, including relative lack of reliable, high-speed data transfer capabilities and lack of IT resources and expertise on the part of health care providers. The following section describes basic technical aspects of SKYCAP’s network model, including the means by which health care providers or FHNs create or modify records and access information from the master client index.
Provider Integration Model. SKYCAP used grant money to purchase and network dedicated workstations at each participating provider site to allow data entry and reporting. Data is entered through a total of eight SKYCAP workstations located at provider sites around the service area. At least one terminal sits in the emergency room of each of the two area public hospitals. The other six terminals are located in clinics in a separate office designated for SKYCAP use. Each terminal is networked to the central SKYCAP server via a frame relay connection. Once entered, client data resides in the central server maintained at the University of Kentucky Center for Rural Health. As of March 2004, this model will change to a virtual private network (VPN) model where providers have access to SKYCAP via the Internet. This platform will offer substantial reduction in cost relative to maintaining a separate frame relay connection and paying telecommunication charges for each health center.
User Access and Privacy. Users access the system using an individual password that is encrypted upon transmission to insure that client records are protected from unauthorized use. Under a roles-based access model, physicians have more access to the system than social workers so that each user is only able to see client information pertinent to their site and realm of activity. Everyone who uses the system receives confidentiality training for interacting with patients. Access is determined on an individual basis, with the executive director maintaining control over what information each individual should be able to access. Each client is provided with a consent form which is completed and verified before any data is entered in their record.
Support and Training. Data Futures, Inc., the local vendor of SKYCAP, provides support for the SKYCAP staff. If individual users experience a problem with the system, they call the SKYCAP’s technical staff that provides basic support (for example issues related to system connectivity). If their information technology staff can not help the user, calls go to Data Futures for more advanced support regarding use of specific application functions. Data Futures handled the majority of information technology implementation and support up until mid-2003; SKYCAP is now trying to take over more of that role. Since they also have access to the information technology department at the University of Kentucky, they are able to save money by using resources internally. Data Futures, Inc. trained the SKYCAP administrative staff how to use the system and they, in turn, trained other users including FHNs and clinicians.
System Upgrades. Data Futures currently updates the SKYCAP program’s client tracking software that is hosted at the main SKYCAP offices, and the SKYCAP technician updates the workstations at individual physician sites and at other sites. The SKYCAP database resides in a Microsoft SQL Server 2000 database that is running on a server that SKYCAP paid for but is now aged. New hardware was purchased upon their move to a new building in March 2004. Data backup and disaster recovery processes are in place and have been tested. The University of Kentucky provides and updates general productivity software such as the Microsoft Office Suite.
Relationship with Data Futures, Inc. After completing an informal vendor search, SKYCAP eventually selected Data Futures, Inc. mainly because they were willing to create a system customized to SKYCAP’s needs rather than using an already-made system and because of their local presence in Harlan county. The company was thought to be interested in working with SKYCAP as they hoped to develop a program that they could market in other communities. Data Futures has implemented a similar software in 11 networks around the nation so far comprised of over 100 sites who are now vested partners in assuring success of the system. Other networks that selected Data Futures were interested in having a combination patient record/case management software that was able to be used as a community-wide solution to coordinate care among a variety of partners. One network with a regional access program was in the process of implementing the Data Futures software in order to perform case management and disease tracking among their uninsured and underinsured patients so that they could ensure that this population was able to gain access to necessary healthcare, including hospital care, primary care, and mental health and other social services. They stated that Data Futures was available at a lower cost than other electronic medical records software and was less clinical-based making it easier to share across a variety of users.
Interfaces with Existing Systems. There are currently no interfaces with existing data collection systems. Future plans are to interface the system with programs that track eligibility as well as other software that
contains useful client data that SKYCAP may not currently track or track as consistently. By integrating data held in other medical and administrative databanks, the SKYCAP database could increase in value as it would hold a greater amount of standardized information to better inform health center participants of their client population and patterns of care they provide. Interoperability with existing provider systems would also potentially encourage greater use of the SKYCAP application as it reduces or eliminates the need for double entry of data, a common complaint among current users.