| Agency Description The Virginia Department of Health is a critical partner in Virginia’s health safety net. To assure that VDH efficiently and effectively operates its preventive health clinics, state general funds are needed to design and implement an electronic health record system (EHR). This system will need to have the capacity to handle over 332,076 individual client records annually, across a network of 119 local health department sites. It will collect standard demographic information, health history with alerts, physical examinations with alerts; have the capacity for electronic orders for laboratory tests and results, and prescriptions. The system will also need to document visits, and will need to be customizable to provide documents required for federal grant reporting. It must allow for interoperability between VDH clinics and other providers.
Other agencies have tried and failed to successfully create an electronic health record (EHR) system. VDH retained the services of a consultant to conduct a gap analysis of our current system. From this analysis, a cost estimated was provided (see attached). However, the analysis did not clearly address all of VDH’s unique needs/requirements. VDH’s responsibility to protect the public goes beyond the traditional primary care kind of clinical services and extends into understanding the interdependence of social determinants as well as the physical manifestations of health.
Given the lessons learned from observing other efforts, VDH intends to approach the development of a system by fully mapping out all of the processes that will need to be included. Indeed, we have queried health departments across the country and there does not exist an electronic health record designed to support public and population health. Such a health record would need to rely heavily on interoperability with multiple different data sources and would be a natural extension of the excellent work currently underway in Virginia on the Emergency Department Care Coordination as established by HB 2209/SB1561.
VDH would need a dedicated resource with the capacity to link the various stakeholders to identify those VDH specific needs. Those efforts will include exploring the limited efforts of other state health departments. The GF requested will be used to retain a Business Analyst (preferably with public/private EHR system experience) to help guide the agency as we continue critical needs assessment. VDH presents a unique challenge in developing an EHR as our needs don’t mirror either hospital or private provider operations. An action group has been formed to address these unique requirements. This new position would assist that team in better articulating system requirements. The business process component of an EHR would facilitate streamlining Community Health Services processes as well client health record management. This would enable VDH to reduce cost to the state by becoming more efficient at billing and collection of revenue. Once the system is deployed the FTE will assist in agency-wide training and will continue to be the EHR system’s SME to ensure that the software maintains all functional capabilities. The analyst will also be integral in identifying any new requirements and working with Office of Information Management staff to meet those needs in addition to ensuring the system’s continual compliance with state IT security standards and ensure interoperability with other systems.
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| Consequences of not funding/Justification Federal grants have identified developing and implementing an interoperable EHR as a priority for grantees, to ensure the sustainability of clinical preventive services. Failure to implement and EHR will make VDH less competitive in securing funding, putting VDH in jeopardy of losing over $4.3 million in federal funds. In addition to losing these direct federal grant funds, the agency risks the loss of the authority to purchase a wide range of pharmaceuticals under the 340B Drug Pricing Program which would cause the Commonwealth to incur significantly higher drug costs. VDH estimates that the increased costs would be approximately 350% greater than current prices. 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. One additional area that could greatly benefit from an EHR is billing and collection of accounts receivable. The agency currently lacks a streamlined automated process to facilitate billing and collections of amounts due from individuals and 3rd party payers (e.g. Insurance companies). An accounts receivable module would maximize district revenue and potentially help off-set the systems costs in the not too distant future. |