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The City of Philadelphia has signed a deal to roll out eClinicalWorks e-medical records system for use by 230 clinicians providing care at eight outpatient clinics run by the city's department of public health and several correctional facilities in the city.

The city is spending about $9 million on the EHR software, and expects to "break even" on its investment by 2015 or 2016 through improved process efficiencies, better coordinated patient care, and improvements in "charge capture" for the services provided to patients, said Gordon Zeis, Philadelphia's EHR program manager.

While the facilities currently use electronic systems for lab and pharmacy processes, the new e-health record system will replace paper charts and manual work currently used for recording patients' clinical information at the city's prisons and also its health clinics, which typically provide care for low income and uninsured patients, Zeis said in an interview.

Annually, the health clinics in total care for about 100,000 patients during 324,000 encounters and the correctional facilities provide care for about 40,000 patients, Zeis said.

In addition to the EHRs, the city also plans to roll out eClinicalWorks Electronic Health eXchange software to facilitate the exchange of patient data among those participating facilities, and perhaps eventually with clinicians at other healthcare organizations with patients' consent, Zeis said.

But before the city healthcare and correctional facilities can exchange patient data with other healthcare providers such as area hospitals, "there are many legal issues that need to be worked out first, such as patient consent, " he said. In addition, "funding is always an issue, too."

"This is a large undertaking so we've divided it up into manageable portions--four stages," said Zeis.

"Stage 1 will establish functionality in women's correctional facilities for the clinical module, scheduling and ambulatory health centers for the practice management module, as well as one health center for the clinical module," he said. Stage 2 rolls the functionality out to remaining corrections facilities and ambulatory health centers. Stages 3 and 4 move further in the larger public health structures and throughout the city and state, he said. "My high-level estimate is about a year each stage," he said.

Software is being hosted externally in a HITECH Level 2 certified facility with secure high-speed transmission protocols in place.

When the implementation is completed, the new system will also help the city formulate new public health policies, such as preventive and wellness programs.

For instance, through analysis of patient data, the city could possibly identify zip codes where pregnant women tend not to receive all their recommended pre-natal care, and implement communication efforts, outreach, or other programs to counter that trend.

"If we can use the information to help deliver pre-natal care, it could improve outcomes" of new babies who might otherwise require critical and expensive neonatal hospital care, he said.

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