| Agency Description VDH will use state general funds to pilot test and implement an electronic health record system (EHR) within VDH family planning clinics. This system will need to have the capacity to handle over 60,000 individual client records annually, across several different health departments and be certified to meet Meaningful Use requirements established by Centers for Medicare and Medicaid. It will collect standard client demographic information, health history , physical examinations , have the capacity for electronic orders for laboratory tests and receive results from the laboratories, and electronic submission of prescriptions to community pharmacies. The system should be capable of alerting clinical staff when there are data omissions and when data deviates from normal findings and prompting staff to fix the error or add more information. The system will also need to document family planning visits, and will need to be customizable to collect client encounter level information as required to meet the Family Planning Annual Report (FPAR), as well as report using Title X compliant forms. It must allow for interoperability between VDH family planning clinics and other providers (such as pharmacies and laboratories) and non-VDH family planning clinics (such as Federally Qualified Health Centers).
VDH will evaluate the most cost-effective means of implementing an EHR to accomplish these objectives. VDH will conduct a pilot of the system in a single local health department family planning clinic to determine feasibility prior to fully developing and rolling out to other clinics. A second approach will be to develop an EHR that will build on, and interface with existing systems, such as WebVision and the Virginia Vital Events and Screening Tracking System (VVESTS).
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| Consequences of not funding/Justification The U.S. Department of Health and Human Services (HHS), Office of Population Affairs has identified developing and implementing certified and interoperable electronic medical record systems (EMR) as a priority for grantees, to ensure the sustainability of family planning and reproductive health services. Failure to implement an EMR will make VDH less competitive in securing future grant funding and reimbursement from marketplace exchanges, putting VDH in jeopardy of losing over $3.5 million in federal funds and nearly $1 million in revenue. Since 1970, publically supported Family Planning clinical services have been provided in 34 Health districts or 132 cities and counties health departments. During SFY 2015, 55,375 clients received physical exams, contraceptive methods and education, and prevention screenings. While the VDH billing system (WebVision) is electronic, the medical record system is paper format, which does not meet federal program requirements and does not allow clinics to be considered in marketplace exchanges as essential community providers. Title X requires programs to bill third party payers as a means for sustaining services for women and men not qualified for insurance, e.g. teens and undocumented women and men. It is best to have mix of payers in order to build a strong sustainable revenue system, even as a safety-net provider.
An Electronic Health Records system is a requirement of the Title X federal grant, without the system those federal dollars are at risk. The loss of Title X funds also means that the local health departments will not have access to federal pharmacy discount program administered by the U.S. (HHS) Health Resources and Services Administration (HRSA) known as 340B. Not having access to this discount program would increase pharmacy estimated costs from $2.2 million to $15.8 million; an annual increase of over $13.5 million dollars. Coupled with the loss of direct Title X funding, the total annual impact to the state would be a loss of $17 million. Implementing an EHR will support VDH’s compliance with federal standards for clinical practice. For example, mandatory protections assure compliance with patient confidentiality and HIPPA. An EHR can also reduce paper waste, reduce transcription/interpretation errors (of handwritten notes) and allow greater client protection due to the federal and state mandated system protections. Implementation of an EHR can also support other VDH initiatives, such as tracking encounters with community health workers (CHW) providing ongoing clinical data on patients that are engaged with CHWs. Clients needing safety net services due to lack of community providers should not experience services that do not meet the national standard of quality care.
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| Explanations and Methodologies During the 2015 and 2012 Federal Program Site reviews, the Federal Title X Regional Office Consultant has warned VDH that future program funding is jeopardized as VDH is not in compliance with the federal priority of program sustainability through the use of electronic medical records systems. In fact, for the first time in VDH Title X history, FFY 2013 a second grantee was awarded Title X funds and reduced the amount of VDH award by $750,000. As the Affordable Care Act has funded physician offices and federally qualified health centers to implement EMR, no similar program has occurred for local public health clinics. A recent environmental scan of local confidential family planning providers resulted in affirming that in the majority of health districts, there are no other providers able to assume this program. Finally, a brief evaluation of internal agency and federal program funds are wholly inadequate to implement an EMR system without additional state support.
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