The Power of a Small Grant: Building a Public Health-Oriented Electronic Medical Record System in New York City

Communities in Charge

Field of Work: Helping community coalitions design and establish sustainable health care delivery systems.

Problem Synopsis: In 1998, 44.5 million people in America did not have health insurance, according to the federal Health Resources and Services Administration (HRSA). In the absence of comprehensive federal efforts to expand health coverage, the burden of caring for uninsured individuals falls on states and local communities. Often, local health care systems are not organized to promote prevention and early intervention, coordinate care and services or monitor access to and quality of care. When people do not receive the care they need, the costs are borne by providers, local governments and, ultimately, local taxpayers.

Synopsis of the Work: In July 1997, the Board of Directors of the Robert Wood Johnson Foundation (RWJF) authorized $16.8 million to support Communities in Charge: Financing and Delivering Health Care to the Uninsured (CIC). CIC was designed to help broad-based community coalitions design and establish sustainable health care delivery systems. Each year, the New York City Department of Health and Mental Hygiene serves more than 8 million New York City residents, as well as more than 3 million who work in or visit the city each day.

Recognizing the potential for health information technology to reduce disparities and improve health, particularly among underserved populations, the city's health commissioner formed the Primary Care Information Project in January 2005, to help primary care providers in medically underserved areas improve preventive care by adopting electronic health records while maintaining a population-based focus on health outcomes.

Key Results: The CIC grant from RWJF grant helped the health department create a framework for health information exchange, which it then used to leverage more than $75 million in support.