The PCIP was formed from the recognition that high costs and low quality inherent in the Healthcare system of the U.S. is largely due to a system that is antiquated and fragmented (DOHMH, 2006a). The inability to properly collect and use health information is one of the primary problems associated with proper health care maintenance. The PCIP. was formed in response to this need. The primary care physician acts as the conduit between the patient and the healthcare system. However, the physician often has no means to effectively transmit the information that they collect to other entities within the system. The PCIP grew out of a need for the primary health care Physician to be able to transmit the needed information to others in the Healthcare system.
There are three essential parts to the PCIP. The first is the Primary Care Health Information Consortium (PCHIC). This entity consists of a collaboration of community health care centers, public health entities, and other entities whose goal is ensure the proper implementation of the EHR (DOHMH, 2006a). The purpose of this consortium is to make certain that the new system meets the needs of both doctors and the patients that they serve. They also want to make certain that the voice of community health centers remains an integral part of the national health care debate. Community health centers are the front line for patients in underserved areas. It is important that the system developed meets their needs as well as the needs in more financially affluent areas. The consortium will ensure proper oversight of the project from a grassroots level. The consortium is an important part of the PCIP.
The second part of the PCIP is known as eRx. This is an electronic prescription and health care system pharmacy information system that ahs been in use for several years in the New York area. ERx has become in integral part of the Healthcare system in the New York area. However, many physicians in underserved areas do not have access to this valuable system. The PCIP will expand use of eRx to over 2,000 physicians in underserved areas over the next three years.
The third part of the PCIP has already been discussed. It involves the EHR system. Electronic Health Records (EHR) will be expanded to over 1,000 clinicians in underserved areas. This will enhance disease surveillance and allow bilateral communication between doctors and the DOHMH.
Implementing the PCIP means a major overhaul of the current system. This is no easy task. The PCIP represents the most highly interconnected medical data system in the United States. The PCIP will serve as a model from which other systems can be developed in other areas of the U.S. Taking this into consideration, it is important that this system be well designed and implemented. Therefore, it was decided that the committee should consist of members from many areas of the health care system. The PCHIC was formed in 2005 to provide oversight and recommendations for the implementation of the PCIP.
The consortium consists of 29 community health centers (CHCs). These centers are located in underserved areas of the city and will serve as a voice for the underserved patients in these areas. The Community Health Care Association of New York State (CHCANYS) will also provide support for the project from the area of administration of the community health care centers. The consortium will also include Primary Care Development Corporation (PCDC), a major stakeholder in the development of the system. The project will be spearheaded by the New York City Department of Health and Mental Hygiene (DOHMH) to make certain that the new system addresses the needs of the public, as well as the individual patients. The primary care physicians can be seen as patient advocates and the DOHMH can be seen as addressing the concerns of the community at large. The New York Presbyterian Hospital and 10 Medicaid managed care companies will also be included in the consortium (DOHMH, 2006b).
The PCHIC consortium was formed in 2005 with a grant from the Robert Wood Johnson Foundation (DOHMH, 2006b). The consortium was intended to address and identify the various stakeholders involved, without placing weight on any one category of stakeholders. The stakeholders included representation on all levels of the health care system, from physicians to managed care companies. The physicians will provide the best information as to the practical aspects of the system from an operations perspective. They are perhaps the most important link between the new system and the patient.
There are several stakeholders that were not included in the consortium, but that may be impacted by the system. The consortium includes no representatives from health agencies that are not associated with the Community Health Centers, but that still operate in low income areas of the city. There are many private physicians that are located in the identified underserved areas, but that are not linked the Community Health Care Center (AHQF, 2006). These physicians have a stake in obtaining proper patient records and information. However, under the current system, they still may not have access to eRx or EHR. A special effort needs to be made to contact physicians that fall into this category to make certain that the new system truly serves the community that it was intended.
The consortium did not list any specialists in its rank, only primary care physicians. Specialists may not have access to information in the EHR system. They often receive patients from primary care physicians and unless they are included in the loop, then one cannot state that the new system addresses the needs of the entire community in underserved areas. Specialists and physicians that do not operate in Community Health Centers should be included among the stakeholders in the system. If the goal of the system is to eliminate disparities, then effort must be taken to identify each and every one of the stakeholders and to include them in the consortium.
The consortium also did not address problems associated with communities that are underserved, not because of financial status, but because of language barriers. Language barriers could also be a source of potential disparity in the dissemination of medical information. New York has many small pockets of ethnic groups that may not necessarily be Medicaid recipients, but who may not have access to the information due to language or cultural barriers. The consortium should consider the inclusion of one or more representatives from this community as well. The goal of the consortium was to serve the community. However, there are several stakeholders that will be affected by not being allowed access to the EHR, but that were not included in the consortium as participants. These stakeholders need to be included if the PCIP will make the claim that it serves each and every community in the New York City area.
Identifying the Target Population
Before we go any further in addressing the implementation issues concerning the PCIP, it is necessary to step back and make certain that we know who the PCIP is designed to serve. Throughout this report, we have referred to the "underserved" community. However, how do we know who is underserved and who is not. We identified several classifications of people who have a stake in the outcome of the project, but that were not identified in the formation of the consortium and are still not considered among its members. Let us now examine the definition of underserved communities used by the writers of the PCIP.
The community-based health care system grew out of concerns over access to quality health care in rural areas and inner cities (DOHMH, 2006b). Rural areas and Inner city areas were the first identified as having a need to serve the poor. Community-based health care centers (CHCs) were designed to serve the unique needs of these populations. Often individuals in these areas do not have access to needed health care for financial reasons. The CHCs were formed to assess the needs of these communities and to provide for their needs. Their purpose was under the assumption that quality health care is a basic need of life and that no one in America should be without this basic necessity of life. Since their formation, CHCs have formed an integral part of the health care network of the United States.
The demographic make-up is different than any other city in the United States, except for perhaps Chicago, Los Angeles, or Dallas. Many cities across the United States consist of a central portion of the city that gradually radiates from the center into what can be considered the suburbs. This means that most major cities have only one major inner city district where a majority of the underserved population is located. New York City is unique in this respect. New York is like many cities packed together. It has many populations of underserved clients based in various…