D.C. RHIO Sets Ambitious Plans

By Maureen McKinney

May 27, 2008 | The District of Columbia Primary Care Association (DCPCA), a non-profit health reform organization based in Washington, D.C., recently announced the formation of a new regional health information organization, made up of six community-based health centers, which is aimed at improving health care for poor and underserved consumers.

The District’s government has provided $11 million in initial grant money for the formation of the RHIO and deployment of electronic medical records at six centers chosen as the cohort of early adopters. Over the course of the three-year project, EMR systems will connect the community health centers to local hospitals including Georgetown University Hospital and Washington Health Center.

The new RHIO is unlike many others that target low-income populations because it deals directly with community health centers – providers that form a critical safety net for patients and are often last in line for new technology, said Sharon Baskerville, DCPCA’s chief executive officer.

“We have a large population of poor and uninsured patients that were often receiving treatment in ERs, but health centers had no way to access that information,” Baskerville explained. “With that kind of siloed care, problems go unidentified. Our way of addressing the problem is different from any approach I’ve seen. I don’t think there is another group out there where the safety net group is leading the pack.”

Developing a network of community health centers was not without its obstacles and required plenty of special adjustments, said Baskerville. In the short term, the time and added costs associated with a large-scale EMR deployment can be overwhelming for an already understaffed and under-resourced center. 

“The truth is when you engage in something like this, you are asking cash-strapped health centers to jump into another frying pan,” Baskerville said. “The six early adopters decided that they had enough need to justify the added burden on staff and resources, and were willing to engage in the learning process.”

The RHIO’s EMR vendor, eClinicalWorks, Westborough, Mass., also made many changes to tailor their system to the needs of health centers, said Baskerville. For instance, eClinicalWorks’ existing mental health module proved insufficient to capture all of the necessary data from the centers’ large volume of patients so the company crafted an expanded version.

The District of Columbia RHIO plans to have EMR solutions installed at all six centers by September 2008, and hopes to have at least three functional by that time as well, said Baskerville. In addition, planners are looking to begin testing with local hospitals by November.

They are also hopeful that robust funding from the government and pro bono legal assistance will allow them to avoid many of the financial pitfalls that have plagued other RHIOs in the past.

“We’re going to try to take lessons from failed RHIOs and focus our energy on things like governance and a long-term business plan for sustainability,” Baskerville said. “I do hope that this becomes a model, not just for communities but for payers and the government. It needs to be clear that there must be incentives and large-scale programs that enable these kinds of providers to be involved.”


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