Analyze the case study, and develop the conclusions, recommendations, and implications.
Consider the implementation challenges in the case and the technologies used to meet them, along with the final questions posed at the end of the case.
Summarize your findings in a two page paper using proper APA formatting.
CASE STUDY:
Supporting Mobile Health Clinics: The
Children’s Health Fund of New York City
The Children’s Health Fund:
The Children’s Health Fund (CHF) develops and supportsa national network of 22 programs and two affiliates in 15to 17 states in the United States and the District ofColumbia. The mission of the CHF is to provide comprehensive health care to the nation’s most medicallyunderserved children, from birth up to age 24. In-personprimary health care, mental health, and oral health servicesare delivered by teams of doctors, nurses, dentists,psychologists, social workers, and nutritionists at morethan 200 service sites across the United States inpartnership with pediatric departments and specialists inaffiliated academic medical centers or Federally QualifiedHealth Centers (FQHC).
The CHF’s integrated approach to health care isconsistent with the concept of an “enhanced medicalhome” in which continuity of care is ensured via coordination across multiple healthcare providers and specialties.In the United States, the Medical Home concept is beingadopted as one aspect of health care reform to ensure ahigh quality standard of care that also seeks to increaseefficiencies and reduce costs for acute care. This type ofintegrated health care delivery is enabled by health information technology (HIT)—not only computer software butalso communications networks.1
The cofounder and president of the CHF, Dr. IrwinRedlener, received his M.D. from the University of Miamiin 1969. But his life mission for bringing medical care tounderserved children reportedly began when he was amedical resident in pediatrics at the Children’s Hospital ofDenver and saw a poster for VISTA (Volunteers in Serviceto America) with the words: “If you’re not part of the solution, you’re part of the problem.” Dr. Redlener’s quest tobecome part of the solution began with delivering medicalcare in Lee County, Arkansas, then working on earthquakerelief in Guatemala, followed by serving as medical director for USA for Africa, and this poster is hanging in hisoffice today.
An important motivation in my life has been working with kids whose situation makes them vulnerablefor reasons out of their control. They are desperatelyill, or living in extreme poverty, or disconnectedfrom medical care. I feel most energized by trying tohelp children who have the fewest resources.—Irwin Redlener3
In 1987, Redlener cofounded the Children’s Health Fund(CHF) in New York City. Its initial focus was on pediatriccare for homeless kids, and his cofounder was singer/songwriter Paul Simon. While working for USA for Africa, hehelped solicit the help of other recognized entertainers,including Joan Baez, Harry Belafonte, Lionel Richie, andMichael Jackson. When he learned that Paul Simon wasinterested in doing something for the homeless, he reachedout to him:
I was working for USA for Africa, setting up thegrant office in New York City. Paul Simon, who wason the We Are the World record, wanted to do something for the homeless. We visited a number ofwelfare hotels. In the Hotel Martinique [in TimesSquare] a thousand children and their families werewarehoused. Somebody suggested that we should geta van and bring doctors there.—Irwin Redlener4
That was the beginning of what would become CHF’snational network of Children’s Health Projects (CHP), inwhich health care is delivered via doctors, nurses, and other professionals in an RV-size mobile medical clinic (MMC) that is driven to locations where the people are who need it—such as city shelters for homeless families. The flagship program with the first MMC was launched in NYC in 1987, and by 2009 the program had been expanded to cities and some deep rural areas within CHF’s growing national network of clinics. The clinics are supported by 41 stale-of-the-an MMCs (32 medical, 3 mental health. 5 dental, I public health field office. and I health education) operating in different programs across the country (see the map in Exhibit I). By 2009, some had been in service for many years and while not obsolete, lacked some of the newest features, such as modular network cabling and upgraded electrical generators; 7 new MMCs were in some stage of procurement in June 2010.
The payments for the medical care provided by CHF primarily come from four sources: private individual and corporate donation. Congressional aid, and two government health insurance programs that support children living in poverty. These programs are Medicaid and the State Children’s Health Insurance Program (SCHIP). Medicaid insures kids whose parents earn little or no money: the federal government pays pan of the costs, hut programs are administered and partially funded by state governments SCHIP. a newer federal program initiated in 1997, insures children in families that earn too much to qualify for Medicaid, but too little to afford private health insurance. In February 2009. President Obarna signed a bill that continues funding for SCHIP ($32 billion over the next 4.5 years).
Mobile Medical Clinics at the Children’s Health Fund:
CHFs Mobile Medical Clinics (MMCs) are housed in 36- to 44-foot long blue vans, designed to provide a full range of pediatric primary health care including preventive care (e.g., childhood vaccinations), diagnosis and manage ment of acute and chronic diseases, mental health, dental, and health education services. In addition to care provided in the mobile clinics, care is provided at stationary clinical sites located in shelters, schools, and community centers, and traditional health clinics (e.g.. the South Bronx Health Center for Children & Families in NYC). The mobile clinics routinely visit low-income neighborhoods and homeless and domestic violence shelters to provide medical services. but MMCC’s have also been deployed to provide medical services in response to public health crises emergencies. including the 9/11 attacks on the World Trade Center, hurricanes Rita and Katrina in 2005, and the 2010 Gulf of Mexico oil spill.
Two primary CHF principles are at the heart of the design of the MMCs:
To provide high-quality pediatric primary care as well as mental health services, dental services, and social services to medically underserved populations with children.
To operate in partnership with a high-quality local medical institution, such as an academic medical center or FQHC, to ensure access to other medical experts as needed as well as coordinated health care for the local population.
Access to reliable, affordable transportation is a major constraint for those living in poverty at government-sponsored locations, as well as areas where there are few health care providers, known as HPSAS (Health Professional Shortage Areas). To help remove this constraint for low-income and homeless residents in New York and four other major areas, GlaxoSmithKlein provided a $2.3 million grant to support transportation funding in 2004: S35.000 on taxi rides and $20,000 on bus tickets for adults were spent by the Dallas Children’s Health Project (CHP) the prior year. In New York, this Referral management Initiative had dramaticresults: specialist appointment compliance rose from 5 toabout 70 percent.5
The medical home concept is based on the premisethat a returning patient will be supported by a trusted healthcare leant who knows the patient and has access to documentation of his or her health history. Exhibit 2 shows a model of the MMC and its layout, with a separateregistration area and waiting room, a nurse’s station, and examination rooms
The sides of the blue vans are painted (like“billboards” to clearly signal that they are CHF units withqualified medical personnel onboard. On a given dayduring a given time period each week, the MMCs arescheduled to be at the same location with the same medicalpersonnel onboard.
We don’t just show up like in an ice-cream man mode,give a shot and disappear. The protocol is that every Tuesday from X-time to Y-time the doctor is there.—Jeb Weisman. CIO
Providing high-quality primary care from a mobile clinicdoes present some unique challenges for supporting those who are delivering the health care, such as:
• Designing an environment which is consistent withand will support standard physician office and clinicprocesses. This includes providing the requiredspace and medical equipment to support high qualitydelivery of primary care, including sufficient, highquality electrical power.
• Complying with regulatory standards such as thoseset forth by JCAHO (e.g.. PC locations) and government legislation (e.g.. HIPAA laws for privacy and security of personal health information).
• Supporting a mobile unit that operates at multiple,primarily urban, sites—each with its own uniqueenvironmental factors.
• Providing computer and communications technologies within the MMC that are reliable and dependable, as well as off-site access to technical support.
Another important consideration is the overall cost foreach mobile clinic—including the initial costs for a state-of-the-art MMC as well as continuing operating costs. Themajority of the approximately S500.000 capital budget foreach MMC is allocated to the required medical equipmentand associated vehicle requirements (i.e., space, power, and transportation needs). Preventive care via a medicalhome should of course result in long-term cost savings forstate and federal payers as children receive immunizationsand regular health checkups that can avoid costly visitsto hospital emergency rooms, but these are difficult tomeasure. Given the national shortage in primary care physicians,CHF’s association with a major medical center also means that MMC may be part of medical residents’formal training rotation, often in pediatrics or communitymedicine, as part of the medical team.
Healthcare Information Systemsto Support Primary Care:
In the United States today, it is still not unusual to findpaper-based record keeping in physician practices (referredto as ambulatory or outpatient practices). Two types offunctionality are provided in software packages developedand maintained by vendors who specialize in the healthcare industry:
Practice Management Systems (PMS) supportadministrative (asks such as patient workflow andthe revenue cycle, with data including patient contact information, appointment scheduling, andpatient insurance plan information.
Electronic Medical Record (EMR) systems supportclinicians, such as patient diagnosis, treatment and physicianorders, with data including patient demo graphics (age, gender), family history information, allergies, medications, and clinical documentation ofdiagnoses. treatments, and outcomes for prior visitsand specialty referrals.
By 2008, only 4 percent of physicians in ambulatory settingshad a fully functional EMR; 13 percent had a partiallyfunctional EMR: but 50 percent of those in larger practices(1l or more physicians) had partial or full EMR support.7
Some vendors provide packaged solutions with PMSand EMR modules designed to exchange data with each other. However, since some of the clinical packages are designed tospecifically support certain types of care—such as pediatrics, OBI’GYN, cardiac care, and so on—specialty practices inparticular may have purchased software from differentvendors. In addition, software that supports electronicprescription transactions to pharmacies and insurers hasrecently been widely adopted as this capability has becomerequired for reimbursements by government and otherinsurers. Investments in software packagesto support clinicalprocesses in small practices (l-3 physicians) in particular willbe made at a much faster rate during the second decade of thiscentury due to financial incentives administered by Medicaidand Medicare to eligible physicians who have implemented certified electronic health record systems and reported specific metrics for Meaningful tise beginning in 2011 under the HITECH Act.8
The advantages of using computerized health information systems were recognized early on by the CHF. Jeb Weisman, the current CIO, Initially joined the organization in the late l980s prior to the implementation of the first MMC to lead the efforts to provide state-of-the-art support for the MMCs. Initially a home-grown system was developed and maintained.
Given the way the transitional housing system for thehomeless worked at the time—there were enforcedmoves every 3 weeks and that sort of thing—it wasincredibly important that you had a real history.Some of these kids were being immunized half a dozen times for measles, by the time they were 6 or 7because if something would shots up, it is better togive them shots than not... So you had as much asmedical over-neglect as under-neglect going on.
Records are vitally important.—Jeb Weisman
In 1999, CHF partnered with a now defunct vendor todevelop specialized technology for the MMC environment.This system was then phased out in 2007 when CHF partnered with another leading Electronic Health Record (EHR) software vendor eClinicalWorks.9 Given the CHF’searly investment in custom software that supported the data collection of detailed clinical data specifically for pediatriccare, Weisman’s team built in a similar data collectioncapability for use with the commercial software package.
Having this detailed information in a standard formatenables high-quality patient—physician interactions on notonly the first but also subsequent visits, in addition to providing the data needed for referrals, Medically underserved populations typically have higher levels of lead in their bloodstreams, asthma, and other chronic conditions.
One of the record keeping challenges faced by allphysician practices is the integration of laboratory andimaging results with the rest of a patient’s health record.
In a paper environment, the test results are typically faxed from the facilities performing and interpreting the tests tothe requesting physician, and then paper copies and film (such as x-rays or CAT scans) are filed in the patient’sfolder along with other hard-copy records. When testresults are not received in a timely manner, a nurse or otherstaff member typically makes a call to the test facility’sstaff and can receive the missing record in a relatively shorttime period. Today’s more sophisticated healthcare information system (HIS) solutions integrate electronic reports of test results with the patient’s record so that thephysician can quickly access all relevant data with thesame patient record interface.
However, maintaining an accurate medical historyfor a patient who lives in poverty and may be residing in ahomeless shelter or other temporary housing k more complicated than for patients with a more permanent address,In cities and towns with CHF clinics, a patient served by aspecific clinic in a given neighborhood in the Bronx thismonth may be domiciled in a different shelter in a differentborough and show up at a permanent clinic or MMC in adifferent location in NYC the next month. To retrieve arecord from another clinic may require a phone call andfax capabilities.
Both telephone and fax capabilities are therefore basicrequirements for not only retrieving missing data but alsoconsulting with other medical experts, and supporting patient referrals to other clinicians, including specialists. Anideal solution to capture the patient data that have previously been collected for the same patient—especially when thesame software package is being used at multiple clinics—would be to have it available in structured electronic form.
Connectivity Needs to Support MobileMedical Clinics
There are therefore two primary communications needsfor clinicians to deliver quality healthcare via a mobileclinic: (1) access to patient data previously captured atanother medical facility (or MMC) but not yet available inthe patient record system in the clinic and (2) access to personnel at another medical facility for either an emergency consult or referral, or a more routine referral. In anideal world, all of the network requirements describedbelow for a mobile clinic environment would be satisfied.However, some unique challenges are associated withMMC service environments.
Network availability and reliability. The number Inetworking requirement is that remote access to dataand people needs to be available. Yet the MMCs aredeployed mostly in dense urban areas—and sometimes in sparsely populated rural areas—that may not provide network availability or may not provide reliable access to voice and data networks.
• Data security. At a minimum. HIPAA requirements for data security must be met. User data must be encrypted at the database server level, and additional encryption and “network tunneling” are needed for protection of patient data at the network level.
• Easy to use with zero on-site support.Networking technologies in the MMCs are thereto support the high-quality delivery of pediatricprimary care. Since the highly trained and educatedmedical staff is not necessarily sophisticated inknowledge about networking technology andmaintenance of equipment, it is critical for the networking solution to be “push-button” technologyand require little infield maintenance and provisioning.
• Inexpensive to deploy and operate. The installednetworking equipment should not add significantexpense w the cost of an MMC. The network solutions should also be readily available and easy toacquire plus easy to install in the MMC.
• Network throughput(data rate) and latency.The data rate must support the transfer of text-based tiles (medical health records and patientreferrals). The transmission of high-density medical images (e.g., digital X-rays) requires muchhigher throughput races and therefore provides adifferent challenge. Another critical requirementis to minimize network latency: large latencyresults in inefficiencies and possible confusion onthe part of the MMC staff (e.g.. “Is the networkconnection still active or not? Why is it taking solong to load?”).
Connectivity Solutions: What Workedand What Didn’t
Since the launch of the first MMC in the 1987, severalnetworking solutions have been tried and newer technologies have become available and affordable. Two differentwireless network solutions were tried, with mixed results.
Satellite-Based Access
In 2005, a number of MMCs were equipped withrooftop-mounted satellite antenna systems. These antennasystems were equipped with a setup function whichautomatically unfolds the antenna and raises the antennafrom a horizontal (“flat”) position to a position where the antenna then performs a scanning operation co detect the strongest available satellitesignal ¿md begins establishing a communications link withthe satellite. When the system is powered down, the antennafolds back into the original hori7ontal position. Althoughthese systems were expensive and designed for mobile operation, they proved to be mechanically unreliable.
You have these structural limitations to the system. Every day it goes up and down but unlike mom-and-pop casual use, we’re dealing with vital health careinformation and communications. Invariably, themechanical system breaks down—a gear strips, aconnector fails, or a circuit fries. We have had doctors and nurses climbing on the roof to manuallylower the antenna system. and these are high-end, sophisticated devices .... Well, that is not good onmany levels, not the least of which alienates users towards the technology.
—Jeb Weisman
They also posed structural problems for the MMCs (due totheir weight). In some situations, the satellite communications also had unacceptably large latency due to the natureand design of satellite communication systems.
It is interesting how expectations get managed inthese kinds of environments. In terms of throughput orcapacity in a perfect world, most of the data that youare moving is simple structured textual data. So actually you need very little bandwidth, but you needbandwidth without significant latency.... A 1.5Megabit satellite connection is way different from 1.5Megabit connections on a wired line or even inWimax, or whatever the flavor of the month is, in atraditional Ethernet-based system. The latency is akiller. It is deceptive for the end user: even if thethroughput is okay to move that image down, or to move those data up, they don’t trust it—because ittakes longer to refresh than we are used to today athome or in the office. Do they step away and hopetheir data are refreshed when they are taking care ofthe patient, or do they stand there for twice as longwaiting for something to happen? Very often wirelesscommunication at the satellite level can make thingsworse than just going with the flow—which is to say‘we are here, we are in a box in the middle ofnowhere, and we just have got to manually write itdown and deal with it later.’—Jeb Weisman
Cellular Wireless Networks – Wireless Modem Solutions
First piloted in 2004 and formally entered into service in2007, the MMC was equipped with a Sierra WirelessAirLinkPinPoint X wireless modem that provided ThirdGeneration (3G) wireless service with a “fall-hack” capability to 2.5G wireless service in areas where 3G servicewas not available. The advantage of this specific wirelessmodem was that it supported both 3G standards widelydeployed in the United States: both Universal MobileTelecommunications Service (UMTS, and cdma2000. The potential for 3G rates is in the range of several Mhps, sothis wireless solution provided the MMC with a high datarate to and from the Internet. However, the transmission ofpatient data requires cellular coverage and reliability at amission-critical” or “professional” level. hut today’s general purpose wireless networks are designed for “consumer levels. 1f the wireless coverage is not available andreliable, this solution can only be used to support MMCcommunications that are not mission critical.
For the clinicians working in the mobile clinics, dependable and predictable wireless access to the Internetis more critical than achieving higher data rates. 3G andthe emerging 4G networks do have the required throughput(4G wireless networks are promising 100 Mbps) for trans-mitting more than text-based data. However, what thesenetworks do not deliver is reliable and dependable coverage (i.e., network access) at the level required.
A hybrid alternative that has been tried is to delayData transmission from the MMC until there is access fromThe van to a wired broadband solution, such as in a community center or school.
Delayed Broadband Wire Access
In this mode of operation, the MMC operates as a “store-And-forward” device: patient records, medical referrals, andDigital images are stored on an MMC server until wiredBroadband internet access is available. A typical configuration is to have a wireless LAN (Wi-Fi) connection via awireless router from the MMC to the broadband accesspoint into the other facility. The obvious disadvantages ofthis approach are the delay in accessing and transferringinformation, and the security of the wireless LAN link. Inaddition, the MMC is not always able to use a nearby third-party’s wired network due to local restrictions on accessto its wired broadband connection or HIPAA security concerns.
Many of these organizations or institutions, particularly ones that are city based, won’t allow you to install your own telecom infrastructure in their buildings. So we can go to shelters where they even oftenhave an Internet or network-based infrastructure andwe are not allowed to connect to it. Plus then we havesome problems around shat I will generically refer to as a HIPAA issue-we can’t just go through any oldnetwork ... HIPAA rules are actually changing substantially—becoming much more restrictive, muchbetter prescribed and sct out, and much more painfulif you violate them. . . . So when we look at the solutions, we have to make sure we can tunnel. -Jeb Weisman
Asynchronous Multi-Master DatabaseReplication (AMMR)
In the absence of a reliable, high-speed networking solution to enable patient data transfers from the MMCs to thecentral server at the headquarters of the New York CHP inthe Bronx. a more hands-on solution has been adopted toenable (1) the integration of patient record data collected atmultiple sites and (2) provide a backup capability. But italso requires physical proximity of the servers in theMMCs to the CHP offices.
Banks figured out years ago that if you could put ateller machine in a town in Montana, people would useit and you would make money on every transaction.But do you think there was telecommunications out tothat town? There was not. So how did it work? AMMR.At some point the cash machine could dial up in the middle of the night, when rates were lo and send thedata up to Wells Fargo. It all got merged together, business rules were applied, and then it sent back downinserts to the (ATM] database. [The ATM] knows whatit needs to know and makes it through another day,without real-time high bandwidth telecom.
What happens here is that all the servers fromthe vans are physically brought in to a central location so that there are X number of what we cull thelaptop servers connected to the master or primaryserver. We press the button and it goes through akind of round robin, moves the data up to the masterfrom each one, applies business rules, aggregates thedata. and then copies the identical data set to everysingle one of those Iserversi. We do it throughinserts; we are not actually copying 10 gigs of datadown to each one, so it is a very efficient process.And when you are donc, each one of those devices isan exact working copy of the entire data set. It’s anelegant solution to an inelegant problem.-Jeb Weisman
Other Support Challenges and Solutions
The IT infrastructure on the mobile unit includes a serverbuilt from a Panasonic ToughBook laptop (CF3O) and anumber of client computers which are a lighter-dutyToughBook. They support a wireless Ethernet capability,but the recommended MMC solution is wired—because ofgreater throughput and more reliability:
These generators—anywhere between 5 and 20 kilo-warts—are underneath the mobile units, and theyproduce electromagnetic radiations. You don’t get alot of wireless connectivity when you have got 20kilowatt generators standing under your feet. . . . It isa 36 fool van, and you arc 20 feet (or 15 feet) fromthe server and you cannot make a wireless connectionthat is reliable—the power is too dirty.. . . Even thebest regulated generator will produce increasinglydirty power with a lot of harmonics and a lot ofbrownouts. Brownouts are the danger. In a spike. The thing explodes, melts... you just buy a new one. Buta brownout slowly degrades the electronics in delicate medical equipment. You don’t know that it isdying, and it begins to create false data or fails at anunexpected time. Plus you have got air conditionersand air filtration in the mobile unit, which have thesebig startup power needs. So what you have to do is toput at least a real time UPS in front of these thingsand preferably something like a line conditioner voltage regulator that pre-cleans it and then gets it to theUPS, because the UPS is for the most part not builtfor this degree of dirty power.
-Jeb Weisman
Inkjet printers also have to he used instead of laser printers—because laser printers can’t generally be used with a UPS thatfits in the mobile environment. Unfortunately, the operatingcost of an inkjet printer is higher.
The CHF’s NYC office provides the initial on-site IT setup and (raining for new MMC’ programs and ongoingremote help desk support most of the MMC teams supportedby CHF have gone 100 percent live with electronic recordkeeping for all of their patients within the first week. One ofthe reasons for the fast stand-up is that the training team nowincludes a clinician vino is an experienced user of the EMR:
Our training team typically consists of me, another person on our staff—kind of an application specialist—and we typically take either a medical director or ahigh-level clinical provider from one of our projectswithin the network who has been using eClinicalWorksout in the field. That actually makes a huge difference.We always have members of the training team staywith [the MMC team], on-site, in clinic support.Usually they are there for the first afternoon of seeingpatients live with the system, and then also for the nextmorning. We try to split it that way so that we go tomore than one site—covering as many sites as possiblein case there are any technical or clinic process problems. One of the great things thathas really worked sowell for us in our training is not separating outaccording to role during the training: we are not training all of our providers in a room by themselves, nottraining the registrar alone, or the nurses. They aredeveloping [their own) built-in tech support: they arelearning each other’s jobs and how to help each other.This is how a clinic really works and the trainingsimulates this.
—Jennifer Pruitt. Director,Clinical Information Systems
Mobile Health Clinics for Crisis Response
In 2003, Dr. Redlener also became the first director of LimeNational Center for Disaster Preparedness withinColumbia University’s Mailman School of Public Health.One of the goals of this center is to deal with the aftermathof major disasters and assess the impacts on high risk, vulnerable children and communities. Prior to that date, CHF had already sent its MMCs to respond to crises related toHurricane Andrew (1992) and the 9/11¡ World TradeCenter attack in New York City (2001).
The best choice for communications technologyfollowing a natural disaster is highly dependent on thecrisis situation. If cell towers and base stations previously available in the region have not been lost, theexisting commercially available cellular network can beutilized. However, this is the same network available forpublic cell-phone service, and following a disaster therecan be network overload due to an increase in calldemands by the public. Most wireless providers do notimplement a call-priority capability, so a mobile clinic’susage of the network will typically compete with callsfrom the public at large. In worse scenarios, there maybe no cellular network access available in the emergency relief area. The same may be said during otherpublic disruptions such as blackouts. In 2003, a largeportion of the United States lost electrical power.Within hours virtually all cell phone communications inNew York City had failed as uninterruptible powersupply batteries were depleted and generators failed orwere adequately sized for the scale of the outage. Apossible alternative, of course, is to use the MMC vansequipped with their own generators and with satelliteantennas.
Just days after Hurricane Katrina hit New Orleans in2005, Redlener personally accompanied two mobile healthcare units with a team of medics co provide vaccinations and treat infections in the Gulf coast region. In the initial weeks, they had treated more than 7,000 patientswhose doctors’ offices had been wiped out—either washedaway or flooded. The following ear, a study by the centerreported that one in three children that werehoused in trailers sponsored by the Federal Emergency ManagementAgency FEMA) had at least one chronic illness, and thenumber of children housed in trailers in the Baton Rougearea were twice as likely to be anemic than children inNYC’s homeless shelters. The need for more ongoinghealth support for children was clear, and CHF helped toestablish and finance new mobile clinics in the Gulf port (Biloxi. Mississippi and in the New Orleans and Baton Rouge, Louisiana, areas.
The Future
By early 2009, Dr. Redlener was on another quest: to builda awareness about the long-term health impacts on childrenfrom economic recessions. His ‘Kids Can’t Wait” campaign emphasized that missed immunizations and earlyhealth assessments have long-term impacts that can be hard to recover from.
By mid-2010, the need for mobile clinics in theUnited States was even more widespread, and the television coverage of the 2009 earthquake devastation in Haitihad greatly increased public awareness about the need forquick. mobile healthcare solutions. Installing technology on a new MMC, training the staff on-site, and providingremote support for the first weeks of operation was now awell-honed capability among the NYC-based CHE staff.
However, CIO Weisman wonders how even bettersupport could be provided for the mobile clinics and whatnew support challenges lie ahead. Are there newer moreaffordable network communications solutions that shouldbe cried? Will the federal government’s HITECH stimulusfunds and Meaningful Use standards lead to better software integration solutions? Will the increase in software adoptions at physician offices make it more difficult for him to retain his staff’? What combination of conditionscould emerge that render the mobile medical clinic modelobsolete?