CommunityRx, an E-Prescribing System Connecting People to Community Resources

In 2011, the US Centers for Medicare & Medicaid Services (CMS) called for health care innovations to advance health care’s “three-part aim,” while stimulating “the workforce of the future.”¹ CMS encouraged innovations targeting underserved communities. Our idea, CommunityRx, was a new e-prescribing system that would make it as easy to connect a patient to community resources as it was to prescribe a drug.²

In 2012, CommunityRx received a CMS innovation award. We had 6 months to engineer the e-prescribing system and 30 months to implement and sustain it. During this period, CommunityRx integrated with three electronic medical record systems and generated more than 250 000 community e-prescriptions (“HealtheRx’s”) for more than 113 000 Chicagoans. To test a collective social impact model for sustainability, I founded two information technology enterprises—NowPow, LLC, a community e-prescribing company, and MAPSCorps, 501c3, a nonprofit youth asset mapping and workforce development organization. Both entities are headquartered on Chicago’s South Side, returning tax base and meaningful information technology jobs (> 70 full-time employees today) to the community.

Health care, public health, and community-based organizations in Chicago, Illinois, and eight other US states are now e-prescribing community resources. NowPow participated in the Agency for Healthcare Research and Quality’s EvidenceNOW effort, working with hundreds of small Midwest primary care practices in the Healthy Hearts in the Heartland study,³ and it supports several CMS accountable health communities awardees.⁴ By 2018, MAPSCorps had employed more than 1600 youths (for half in Chicago, it was their first paid job) in an annual asset census that generates public use data for Chicago, New York City, and two rural areas of North Carolina (www.mapscorps.org). As one example of collective impact, NowPow purchases MAPSCorps data, providing NowPow with the most accurate community resource data for e-prescribing and yielding revenue to help sustain MAPSCorps’ mission.

A physician–scientist and self-proclaimed engineer of solutions to injustice who never imagined herself an entrepreneur, I still spend most of my time conducting research in my University of Chicago lab. The injustice? Poor quality data about community resources is unnecessarily impeding health across communities. Two discoveries intrigue me most.

First, we find in two studies that half of people who receive a HealtheRx use the information to help someone else.^2,5 Unlike drug prescriptions, a community prescription delivered to an individual spreads to others, presumably to the benefit of both the sharer and the receiver of the information. We are now using agent-based modeling to study the dynamic and multilevel impact of prescribing community. Second, as with drug e-prescribing, we are realizing the power of metadata generated from each transaction. Aggregating community e-prescription data reveals real-time geospatial distribution of demand, supply and delivery of community resources, and objective, comparable indicators of capacity and quality of community organizations serving people’s needs. Communities can use these data for health system building⁶ and to identify, sustain, and replicate successful, health-promoting ventures. Anchor institutions such as nonprofit hospitals, foundations, and banks can make data-driven investments to meet community benefit obligations, drive equity, and support the health of their own workforces.

Community, not drugs, determines health. But it was the drive to connect patients to drugs with more efficiency, fewer errors, and higher trackability that thrust the infamously messy handwriting practice of medicine into the digital economy. In our community, we believe that connecting the people we serve to the assets of our communities can and should be at the center of public health and health care workflows and should generate powerful data that improve the lives of whole people.⁷ To achieve this goal, public health scientists along with health care professionals and community practitioners must adopt interoperable digital workflows and a surveillance strategy that precisely tracks all the health-promoting community assets, what they do, who they serve, and, ultimately, how they perform.