As noted in the introduction, health centers have a special set of data and administrative requirements, and these requirements have direct implications for health centers’ needs for IT. Health centers are responsible for providing services to underserved and vulnerable populations, including Medicare and Medicaid recipients, the underinsured, and the uninsured. Health centers must maximize third party payments and collect fees from patients using a sliding fee schedule.
As such, health centers have a specific need to gather socio-economic data from their patients both to assess their eligibility for Medicaid, Medicare or other insurance or health care subsidization programs and to assess patient fees based on ability to pay. This is particularly challenging when working with populations that frequently fall in and out of eligibility for different programs and may seek care only at sporadic intervals and at different locations. Other special features of the context in which health centers operate are described below.
- Reporting and Tracking. Under their Section 330 grants, health centers annually submit Uniform Data System (UDS) reports providing aggregate data on encounters, payer mix, revenues and other key operational and administrative measures. The UDS includes requirements to report encounters by specific diagnosis and procedure and additional information such as birth weight and trimester of first prenatal visit for perinatal care. Other Federal funding programs, such as prevention grants, require health center grantees to submit annual reports describing, for example, utilization of services provided to a given group of patients. In addition, some services provided to special populations — e.g., pediatric immunizations or pregnancy counseling for teenagers — must also be tracked, both for UDS and non-Federal funders.
- Maintaining Patient Data. Health center administrative systems must accommodate the need for double and triple bookings to account for expected no-shows and cancellations which are common with the population they serve, as well as sliding fee schedules for determining patient out-of-pocket costs. In addition, health center providers (like all providers) must schedule and bill patients, and keep separate records of those patients’ appointments, medical histories, test results, orders, diagnoses, therapies and prognoses. This includes protecting individually identifiable health information that is transmitted or maintained by the center in any form per the Health Insurance Portability and Accountability Act (HIPAA) and associated regulations.
- Disease Registries for Vulnerable Populations. Many health centers are actively involved in providing disease management services to chronically ill patients including those with diabetes, asthma, and cardiovascular disease. As of April 2005, more than 600 health centers have participated in the BPHC’s Health Disparities Collaboratives, which were developed using the chronic care model for continuous care quality improvement and eliminating health disparities. An important aspect of participation in the Collaboratives is maintaining patients with specific diagnoses in a registry system that was designed around evidence-based guidelines to drive quality of care improvement. This registry, called the Patient Electronic Care System (PECS), is paired with an electronic management system called the Cardiovascular/Diabetes Electronic Management System (CVDEMS). CVDEMS was designed to assist providers in managing and tracking the quality of care provided to patients with diabetes and cardiovascular disease.
The unique responsibilities Federally-funded health centers face, as described above, place them in a prime position for investment in IT and health IT. Reporting requirements, administrative data management, and public health tracking projects can all be facilitated through the use of applications like practice management, EHRs and data warehouses. Many health centers have accepted the potential for health IT to improve efficiency and quality of care. Even during the relatively short time span of this project, we observed important examples of increased health IT adoption among health centers including use of applications such as EHR. Several factors have contributed to this trend, including various funding programs that have encouraged health center adoption of IT and health IT through participation in networks.