Board of Health meeting discusses moving COVID funds, services post-COVID

Apr. 13—Sierra Marling

On April 5, the Madison County Board of Health met to discuss the implementation of new systems at the health department, how to spend excess COVID-19 fund reserves, and managing services as COVID-19 policies are lifted.

Health Education Director Lloyd Jordison said that — with 66.7% of the year being over — the Madison County Health Department projects the organization will break-even or have a small surplus at the end of the fiscal year.

He added that some further budget impacts the health department will be watching for are is how the declared end of the COVID emergency will affect programs like WIC and HANDS, the filling of positions, impacts from the last legislative session, and the possibility of further acquired grant funding.

New systems

Jordison also introduced the BARS — Budget, Accounting, and Reporting System (BARS).

"This is a new accounting system, that's going to affect us quite a bit. All but three health departments are going to be using this system," Jordison explained.

Jordison said the old system, which he claimed has been in use since "well before the nineties" is "cumbersome." He explained that the pieces "don't always tie together" and those problems would be alleviated by utilizing the new Workday system, implemented by Deloitte.

Jordinson also noted this change would be "bringing local health departments of Kentucky together into a common system."

The new program is projected to be implemented beginning April 1, 2024 and should require no new equipment purchases. Jordison said the health department was assured $20,000 to get onto the system, however, he added that they are going to be purchasing "some systems for some other reasons" and that those should adapt to the new Workday system.

Executive Director Nikita Vundi said they would also like to move the health department's documentation processes to CDP- exMRx Electronic Health Record. She said the initial implementation cost would be approximately $35,500, and that there would be a monthly fee calculated at approximately $1,600 a month, based on the amount of users they would need at the health department.

Information Manager Marty Hensley told the board the reason for the change is "pretty simple."

"Is it the best thing on the market? Absolutely not," he said.

However, Hensley said this new program would solve a lot of problems with the current state of documentation at the health department, including the struggles associated with maintaining the health department's large volume of paper records.

"By now, we have literally a room full of paper down there," said Hensley. "And if we don't have an appointment in Richmond, but we have one in Berea — sorry, you can't go there, because your chart is [in Richmond] — and somebody would have to physically carry it back and forth. With the electronic record, whenever the nurse sits down at a computer, she can call up your chart, and she can work on it."

Additionally, Hensley said the move to electronic documentation would put the health department in compliance with the American Recovery and Reinvestment Act, which declared that all public and private healthcare providers and other eligible professionals (EP) were required to adopt and demonstrate "meaningful use" of electronic medical records (EMR) by January 1, 2014 in order to maintain their existing Medicaid and Medicare reimbursement levels. Hensley said that public health was exempted, but lamented that "we [the health department] are, literally, now eight — going on nine — years behind the times."

According to Hensely, the new system will allow communication between health departments and providers, as well as WIC, while also providing secure cloud storage.

"If a tornado hits that building, your records are gone. I don't care how long we're supposed to keep it. This [the new system's storage] is in a data center that's backed up to another data center. So if something happens to it, they just roll it over to another server in an hour," she explained.

The board unanimously approved moving funds previously earmarked and unused for COVID staff funding to the Mass Vaccine Scheduler portion of the proposal for the CDP- exMRx Electronic Health Record and lowering the initial up front cost by $10,000.

The board also approved the purchase of a new vehicle that the health department can use using funds from cost center 725. Vundi reported the cost center had originally been established for COVID-related costs, but there was $83,000 remaining due to the health department's inability to use the funding.

"We have been unable to use this funding, we just haven't had the staffing available to do it because of other programmatic needs in the Health Department," she explained.

According to Vundi, the vehicle would only be used for traveling for community health clinics, community vaccine clinics, health fairs, mobile events, and vaccinations and immunizations for homebound community members and elderly shut-ins. She said they would prefer to purchase an all wheel drive four-by-four vehicle to traverse difficult rural terrain.

She pushed for a quick passing of this issue due to the unpromised security of these funds for next fiscal year as well as the length of the procurement approval process required by the Kentucky Department for Public Health.

Services after COVID

The Madison County Health Department will be transitioning some services from telehealth to face-to-face since President Joe Biden signed a House Bill ending the COVID-19 national emergency.

According to Ava Wright, director of nursing, the HANDS Program will move to being 100% face-to-face starting May 1 — the bill's marked end to the emergency.

She said the health department may still be able to offer occasional telehealth visits for this program during times of inclement weather or illness, but this is not confirmed.

WIC will also reportedly begin in-person visits for certification and recertification, beginning May 15. However, nutrition education visits will be available to WIC recipients via telehealth until August 11.

Wright said the health department has been doing in-person visits for some other services, such as immunizations, TB skin testing, and STD testing.

"We're excited to get families back in the clinic," she said. "I mean, obviously people would rather do telehealth, so we're kind of curious to see how our numbers will go and how the community's going to respond to having that change, but we're hopeful that it'll all work out."

The Home and Community Based Waiver program, which provides assistance to the elderly or to adults and children with physical disabilities to help them live in the community as independently as possible, is also planning their transition to in-person and back to pre-COVID stipulations by May 11.

Other business

The clinic actively pursued responses for a patient satisfaction survey. The surveys were disbursed via a link after telehealth visits; however, response rates were "fairly low" over the two month survey period. Wright reported that the majority of responses indicated that respondents were very satisfied with their services.

As of April 1, the health department has issued 32 of the 100 Food Handlers scholarships that had been approved back in December. All of those have been disbursed to occupants of Liberty Place, but other programs are eligible for these scholarships.