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EHR & Systems Change Adventures in a CHC

Learn about the journey of implementing electronic health records and systems change in a Community Health Center (CHC), including challenges, successes, and strategies for improvement.

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EHR & Systems Change Adventures in a CHC

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  1. EHR & Systems Change Adventures in a CHC Elizabeth Markona, Health Promotion Programs Manager, and Amanda Guay, Director of Community Health Programs

  2. North Country Overview 20 Existing Clinics • Ash Fork • Bullhead City • Flagstaff • Grand Canyon • Holbrook • Kingman • Lake Havasu City • Round Valley • Seligman • Show Low • St. Johns • 4 North Country HealthCare Connect Integration Clinics in BH Centers • Virtual Clinic • Payson • Williams • Winslow • Mobile Medical Unit: • School Based Health Services • Employer based health services

  3. Comprehensive Primary Care Services • Primary Care Medical Services (Family Practice, Internal Medicine, OB/Gyn, Pediatrics) • Dental Care • Behavioral Health Counseling • Prenatal Care • Preventive Screening • Diabetes Management Program • Integrative Medicine • Pharmacy • Telemedicine • Outreach Programs • School-Based Health • Employee Health • Care Coordination

  4. North Country Outreach Programs • Well Woman/FIT at Fifty HealthChecks • Maternal & Child Health • Diabetes Program • RESEP • HIV/AIDS Ryan White • NACASA • Domestic Violence • Hermosa Vida • SBIRT Well Woman Program Nuclear Blast, Nevada 1952 Prenatal Program

  5. Patient Population

  6. Establishing the Focus for Cancer Screening Systems Change • Assess CHC Readiness • Leadership Buy-In • Data Collection and Reporting Capacity • Create a Measurable Aim • Illustrate the Value • Go Beyond the Numbers • Be Specific • Don’t Go it Alone

  7. Assess CHC Readiness Leadership Buy-In • Establish clinical indicator as a priority for the organization • Agreement that the change is important Data Collection and Reporting Capacity • EHR enables comprehensive monitoring and reporting

  8. Create a Measurable Aim Develop a specific, measurable, achievable, realistic and time related goal • Establish baseline • Inform by UDS and Meaningful Use • Consider resources and low hanging fruit • Communicate the goal and monitor progress Build the infrastructure to collect the data and provide feedback to the system on progress toward the goal • Share the data and receive feedback to improve the quality/utility of the data • Getting credit for care provided - Document

  9. Illustrate the Value • Meeting care opportunities for patients • Positions the CHC to meet expectations • Communicate the business case

  10. Go Beyond the Numbers • Share patient stories • Demonstrate missed opportunities • Identify provider champions • Provide links to screening for uninsured patients/resources

  11. Be Specific Provider Specific Reminders • Use available reports/manual audits • Pilot provider specific feedback • Develop new reports (free text) • Create clear referral system within EHR • Establish specific steps in workflow

  12. Don’t Go it Alone • Evidence-Based Programs • Leverage Other Contributing Efforts • EHR Network • PCMH efforts • Affordable Care Act provisions • UDS reporting requirements

  13. Successes • Recommitment of leadership • FFHP report - Provider specific feedback on patients they will see • Provider initiated clinic successes (Lake Havasu City and Kingman) • Enhanced capacity with EHR • EHR enables comprehensive screening rate reporting (patient universe) •  expedited audits by location, provider, insurance status, etc. •  “term” searchable charts (Hysterectomy) • Provider reminders and communication from a distance (satellites)

  14. Challenges • Exemption considerations in reporting • Provider preferences and ability to customize EHR: modifiable views of EHR, provider-specific visit-flows • Documentation • location and frequency of documentation • when to document (patient reported) • control of forms and options for documentation within EHR (Alliance EHRS Network) • Resistance to flags, accuracy of flags, flag fatigue • Patient empanelment

  15. Questions? • There is an, “incredibly important, and largely unnoticed, role that health centers play in improving the health of not just their individual patients, but their communities.” • David Fukuzawa, Kresge’s Program Director for Health

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