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Electronic Networks of Care Initiative

About this initiative...
Background
Grantees
Journal Articles

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Background

This initiative funded six demonstration sites for 4 years to promote the enhancement and evaluation of existing health information electronic network systems for People Living with HIV/AIDS (PLWHA) in underserved communities. SPNS also funded the University of California San Francisco as the Evaluation and Support Center to coordinate a cross-site evaluation of services and provide technical assistance and support to the demonstration projects.

For this initiative, an electronic network was defined as the electronic exchange of health information by a group of HIV care providers, including providers of both medical and ancillary care. A primary care provider was defined as an agency that delivers continuing, comprehensive, and preventive HIV/AIDS medical care.

The electronic exchange of health information should include, but is not limited to, laboratory, diagnostic, medical, and service utilization; referrals; and ancillary care support, such as case management, counseling and testing, transportation, and substance use and mental health services. The network must electronically connect several points of service. Interconnectivity should enable tracking of client medical and supportive care information from one point of service to another. The effectiveness of these networks will be measured by documenting improvements in the early detection of HIV infection and reduced time of entry into care; the management of patient health information, including referrals, appointments, maintenance, and retention of clients in the care system; and health outcomes and quality of life.

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Grantees

HRSA awarded grants under its Special Projects of National Significance program to the applicants listed below. Each abstract provides both contact information and a brief description of their project.


Bronx Lebanon
Bronx-Lebanon Hospital Center is a designated New York AIDS Center, serving the health-related needs of PLWHA through its Comprehensive Care Center, dedicated inpatient unit, and long-term care facility. In conjunction with nine service network sites, Bronx-Lebanon established an innovative model to promote the enhancement and evaluation of an existing health information electronic network system linking New York City providers serving people living with HIV/AIDS (PLWHA). The Hospital and its partners  operated an electronic network of care system using more than one software application to manage data.  It enhanced the existing database to receive data transmitted in a standardized format. Bronx-Lebanon's outpatient HIV/AIDS program, the Comprehensive Care Center (CCC), served as the information hub for the network, with a centralized database containing the desired clinical patient-associated data to provide comprehensive primary medical care and support services for PLWHA in New York City. The project used management information services from its existing clinical database to coordinate care, improve communication, and develop novel, proactive workflows to deliver a comprehensive range of patient services.

Linkages for exchanging electronic health information were enhanced among the project partners who provided a comprehensive set of services to PLWHA including health, housing, educational, employment, legal and other social services. The Service Network Sites  focused on serving the residents living in the medically underserved neighborhoods of the South and Central Bronx borough in New York City. The residents are predominantly ethnic minority, African-American (30%) and Hispanic/Latino (60%), including recent waves of new immigrants from West Africa, the Caribbean and Central America.

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New York Presbyterian Hospital
New York Presbyterian Hospital enhanced its existing electronic health information (EHI) network for its HIV Special Needs Plan (SNP), SelectHealth. The Hospital implemented the Continuity of Care Records (CCR) as its standard in EHI exchange. The SelectHealth CCR Project aggregated critical patient information to provide "a snapshot in time," making it easily available via a secure Internet connection to patients living with HIV/AIDS and their care providers.  The CCR project fundamentally shifted care to ensure that provider, case manager, and any other designee can electronically reference a member's clinical, pharmacy and referral information at the time of service. This innovation has the ability to significantly improve treatment protocols, patient retention, health outcomes and quality of life for people who are living with HIV/AIDS (PLWHA) and who are struggling with the now chronic nature of their disease.

The need for consolidating health information in a Continuity of Care Record (CCR) that is accessible to any physician, case manager, or member in a large network is absolutely crucial for improving quality of care and overall health outcomes. As an HIV SNP, SelectHealth provides an overarching structure and coordination framework for the provision of services to PLWHA in the Bronx, Brooklyn, Queens, and Manhattan. Enhancement of Select Health's EHI network and implementation of Continuity of Care Records  provided a replicable and sustainable model of HIV/AIDS care that ensures that all patients and their providers will have access to critical member-level health information when they need it.

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Duke University
The Regional Health Information Integration Project (RHIIP) worked intensively with an existing regional network of HIV care, comprised of one Ryan White (RW) Part C funded HIV primary medical provider, three RW Part B contracted HIV ancillary care providers, and one regional RW Part B funded HIV Care Consortium on a network administered by the North Carolina HIV/STD Prevention and Care Branch.  The North Carolina HIV/STD Prevention and Care Branch administers a wide area network using CAREWare to collect data for administrative and reporting functions. Using this network, RHIP developed a regional health information consortium (RHIC) to support administrative and clinical functioning through the sharing of electronic health information among partner agencies. RHIP worked with the RHIC to develop policies, protocols, and interventions to plan and implement a shared network with the ultimate goal of improving patient health outcomes and satisfaction.

HIV service delivery in North Carolina is organized around the provision of HIV medical care in centrally located clinics, most often Academic Medical Centers or local Ryan White funded Part C Early Intervention Clinics, while ancillary care services (mental health, case management, and emergency assistance) are provided within local communities. This fractured service provision made coordination and communication difficult, and placed greater importance on systems which directly support patients' ability to enter and continue with medical care. The intervention was anchored by Winston-Salem and included the 13 surrounding rural counties served by network partners. The target patient population was predominantly poor, non-white, and disenfranchised.

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St. Mary Medical Center Foundation - Long Beach, CA
The Comprehensive AIDS Resource Education (CARE) Program expanded its information technology network to include four points of service across a heterogeneous group of providers, each utilizing a different clinical management software application. Patient data is  managed in CARE's central database, and CARE evaluated the intervention's effect on the quality of patient care and on patient health outcomes.  The CARE program enhanced the EMR system to improve utilization of its technological capabilities by establishing a bi-directional lab interface allowing physicians and lab to electronically exchange information, including electronically requisitioned blood tests. The program also established an electronic prescription ordering interface that allows providers to electronically order and refill patient prescriptions at multiple local pharmacies.

The project improved the efficiency and effectiveness of the referral process, resulting in a decrease in the time it takes newly diagnosed patients to get into the appropriate level of care, which is replicable among regional providers. The project also studied the effects of enhancements to CARE's EMR, including its usefulness in increasing patient adherence to treatment and increasing the timeliness of provider's access to critical lab results.

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Louisiana Public Health Information Exchange (LaPHIE)
Louisiana State University Health Care Services Division (HCSD) used health information technology (HIT) to share information across providers to afford opportunities for prevention and linkage to HIV specialty care and supportive services for several vulnerable and hard to reach populations.  The goals of the project were: 1) to improve the health of the under/uninsured PLWHA through the use of public health informatics to ensure the timely transfer of data for surveillance and improved linkage to HIV care and supportive services; 2) to conduct analyses to determine the extent to which the network data exchange provides benefit and value; and 3) to build capacity and knowledge resources for the ongoing development and implementation of public health information exchange systems.

Sharing information across an integrated, interoperable electronic network provides patients early access and continuity in clinical care and ancillary services, thereby improving health outcomes.  It also reduced costs associated with morbidity and mortality from patients with advanced disease due to delayed entry into care, and it prevents HIV transmission leading to new pediatric and adult infections. 

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City of Paterson
The City of Paterson's Information Technology Networks of Care Initiative promoted the development and application of electronic health information systems to improve clinical applications for persons living with HIV/AIDS. The project facilitated the expansion of clinical information available to care providers in the counties of Bergen and Passaic, New Jersey through the use of a web-based health information system, e2. Partners in the project shared pertinent clinical information to enhance performance improvement, health care delivery efficiencies and optimal client outcomes.  Project activities took place in an STD/HIV Counseling and Testing site in Paterson and an HIV Counseling and Testing site in Bergen County. These sites assisted in the development and expansion of the existing system,  and focused on the improvement of information exchange related to HIV diagnosis and referral to medical care, patient management (referrals, appointments, and care retention) and health outcomes/quality of life measurement.

The health information system, e2, is a web-based single electronic platform for the collection and processing of clinical, service and utilization data. Its system characteristics make it an effective tool for these applications and include customized and user-friendly data entry and reporting mechanisms; an array of utilization, quality and care management modules; cost management especially for clinical users; accuracy and privacy; and opportunities for client/patient involvement. It has been in use by all Part A providers since 2004, and it has received the recognition of state and national HIV/AIDS organizations including the National Quality Center and the New Jersey Department of Health and Senior Services.

The overall goal of the demonstration project was to advance the exchange of clinical information through electronic health information systems. Three additional goals supporting the project included (1) enhancement of linkages between counseling/testing and engagement into care through timely sharing of test results, (2) improvement of management of health information through integration and coordination and online access to lab and other test results; and (3) enhancement of quality management through timely and accurate process improvement and outcomes data.

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Journal Articles

Magnus M, Herwehe J, Murtaza-Rossini M, Reine P, Cuffie D, Gruber D, & Kaiser M. Linking and Retaining HIV Patients in Care: The Importance of Provider Attitudes and Behaviors. AIDS Patient Care and STDS, May 2013; 27(5): 297-303. PubMed Abstract

Cajina A and Xavier J. The SPNS Information Technology Networks of Care Initiative.  International Journal of Medical Informatics, October 2012; 81 (10): 651-653.  (No abstract available).

Shade SB, Chakravarty D, Koester KA, Steward WT, & Myers JJ. Health information exchange interventions can enhance quality and continuity of HIV care.  International Journal of Medical Informatics, October 2012; 81 (10): e1-e9. PubMed Abstract

Steward WT, Koester KA, Collins SP, Maiorana A, & Myers JJ. The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges. International Journal of Medical Informatics, October 2012; 81 (10): e10-20.  PubMed Abstract

Myers JJ, Koester KA, Chakravarty D, Pearson C, Maiorana A, Shade SB, & Steward WT. Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings. Journal of Medical Informatics, October 2012; 81 (10): e21-e29.  PubMed Abstract

Magnus M, Herwehe J, Gruber D, Wilbright W, Shepard E, Abrams A, Foxhood J, Smith L, Xiao K, DeYoung K, & Kaiser M. Improved HIV-related outcomes associated with implementation of a novel public health information exchange.  International Journal of Medical Informatics, October 2012; 81 (10): e30-e38. PubMed Abstract

Virga PH, Jin B, Thomas J, & Virodov S. Electronic health information technology as a tool for improving quality of care and health outcomes for HIV/AIDS patients.  International Journal of Medical Informatics, October 2012; 81 (10): e39-e45.  PubMed Abstract

Messer LC, Parnell H, Huffaker R, Wooldredge R, & Wilkin A. The development of a health information exchange to enhance care and improve patient outcomes among HIV+ individuals in rural North Carolina.  International Journal of Medical Informatics, October 2012; 81 (10): e46-e55.  PubMed Abstract

Schnall R, Smith AB, Sikka M, Gordon P, Camhi E, Kanter T, & Bakken S. Employing the FITT framework to explore HIV case managers' perceptions of two electronic clinical data (ECD) summary systems. International Journal of Medical Informatics, October 2012; 81 (10): e56-e62. PubMed Abstract

Gordon P, Camhi E, Hesse R, Odlum M, Schnall R, Rodriguez M, Valdez E, & Bakken S. Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City.  International Journal of Medical Informatics, October 2012; 81 (10): e63-e73. PubMed Abstract

Bell DS, Cima L, Seiden DS, Nakazono TT, Alcouloumre MS, Cunningham WE. Effects of laboratory data exchange in the care of patients with HIV.  International Journal of Medical Informatics, October 2012; (10): e74-e 82.  PubMed Abstract

Herwehe J, Wilbright W, Abrams A, Bergson S, Foxhood J, Kaiser M, Smith L, Xiao K, Zapata A, & Magnus M. Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS. May-June; 19 (3): 448-452. PubMed Abstract

Maiorana A, Steward WT, Koester KA, Pearson C, Shade SB, Chakravarty D & Myers JJ.  Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges. Implementation Science, e-published April 19, 2012; (7): 34. Fulltext Article

Schackman BR, Dastur Z, Rubin DS, Berger J, Camhi E, Netherland J, Ni Q, & Finkelstein R. Feasibility of using audio computer-assisted self-interview (ACASI) screening in routine HIV care. AIDS Care, August 2009; 21 (8): 992-999. PubMed Abstract

Magnus M, Herwehe J, Proescholdbell RJ, Lombard F, Cajina A, Dastur Z, Millery M, & Sabundayo BP. Guidelines for effective integration of information technology in the care of HIV-infected populations. Journal of Public Health Management and Practice, January-February 2007; 13 (1): 39-48. PubMed Abstract

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Part F - SPNS Resources

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The SPNS program began with some of the first Federal grants to target adolescents and women living with HIV, and over the years, initiatives have been developed to reflect the evolution of the epidemic and the health care arena.



Part F - SPNS Products and Publications

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SPNS Staff

Adan Cajina
Branch Chief
acajina at hrsa.gov
301-443-3180

Pamela Belton
Public Health Analyst
pbelton at hrsa.gov
301-443-4461

Renetta Boyd
Public Health Analyst
rboyd at hrsa.gov
301-443-4549

Chau Nguyen
Public Health Analyst
cnguyen1 at hrsa.gov
301-443-5785

Natalie Solomon
Public Health Analyst
nsolomon at hrsa.gov
301-443-7753

Melinda Tinsley
Public Health Analyst
mtinsley1 at hrsa.gov
301-443-3496

Jessica Xavier
Public Health Analyst
jxavier at hrsa.gov
301-443-0833