County eyes $1M request for clinic records

Apr. 08, 2014 @ 06:14 PM

County officials are weighing a request from Lincoln Community Health Center for nearly $1 million to help pay for a new patient-records computer system tied directly to the Duke University Health System’s.
Lincoln and Duke Health executives pitched the idea to County Commissioners this week, arguing it would promote efficiency and make it easier for doctors on both ends to collaborate.
“Most of our patients are [also] served by the Duke Health System, whether it’s seeing consultants in the office, being served in the emergency department or being hospitalized there,” said Howard Eisenson, Lincoln’s chief medical officer.
Commissioners appeared receptive, but some were unhappy the two organizations want a quick decision.
Lincoln and Duke want to get the new system up and running by mid-August, to jibe with an already scheduled software changeover in Duke’s labs and help Lincoln meet regulatory deadlines tied to Medicaid reimbursements.
It’s possible to do all the installation and training work involved in three months, but that means working on tight deadlines and getting a decision from the commissioners by early May, said Tom Owens, Duke Health’s chief medical officer.
That left Interim County Manager Lee Worsley, Commissioner Ellen Reckhow and Commissioner Fred Foster all feeling county officials had been presented a fait accompli, especially for having learned only last week the request was coming.
Worsley said county administrators would need “three to four weeks, at minimum,” to analyze the proposal and negotiate a contract between the three organizations.
He also pointed out that they’re already busy working on the county’s fiscal 2014-15 budget, and that incoming County Manager Wendell Davis is scheduled to take over next week.
Reckhow, meanwhile, indicated she’d like to see some bargaining with Duke, which has offered to help pay for the new system.
“I’m very surprised that a request for $1 million has come in with an expectation of almost an instantaneous response,” she said.
But the commissioners nonetheless agreed to schedule a discussion and likely vote on the request for May 5, the day of their next Monday morning work session.
The Lincoln clinic is on Fayetteville Road and for the most part serves a low-income clientele. One of its board members, Craig Savage, said 85 percent of its patients “have no funds to contribute to” paying for their care.
Commissioners Chairman Michael Page favored speedy action on the request.
“Until we spend some time really seeing the challenges you guys deal with, dealing with a special part of our population, I think we would realize the significance and importance of trying to make this happen,” he said, nominally addressing Savage and the other Lincoln officials present.
Lincoln and Duke Health expect the new system to cost about $2 million. Duke would pick up the check for half that, leaving the county to cover the rest. Lincoln would shoulder the ensuing $250,000 or so in annual operating costs.
The system derives from and ties in with the Epic Systems patient-records database Duke Health began rolling out at its hospitals and clinics in 2012. Forbes magazine that year reported the database would cost Duke about $700 million over seven years.
The Epic system is proprietary software, written in a programming language used mainly in the health care trade and high finance. The system is nonetheless becoming a de-facto standard for hospitals and major clinics in this area, as UNC Health Care is in the midst of switching to it also.
Before it can go online at Lincoln, officials need to upgrade the clinic’s computers and networking. They also have to train clinic workers on the new software, a coaching process that will continue a month or so after the “go-live” date in August.
But “what Lincoln would receive is everything we’ve built in the last three years, ready to be used,” Owens said, arguing the proposed 50-50 cost split is fair. “Epic out of the box still requires a lot of work to get it to really meet all the needs of any community and of the providers. We have contributed a lot to that development.”
County leaders have several places they can turn to for money to put into the deal, starting with the “community health trust fund” it accumulates from the rent Duke pays it each year for leasing Duke Regional Hospital.
The fund ended fiscal 2012-13 with $13.8 million in the bank.
Worsley cautioned, however, that only about $7 million of that is prospectively available for the Lincoln deal. The rest is earmarked for paying an assortment of debts, including some costs for the county’s new Health and Human Services Building.
He added that officials also regard the health fund as a prospective source of money for purchases by the county ambulance service, including one coming up sometime soon of new cardiac monitors.