EHR Systems Change Adventures in a CHC

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

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 Health. Care Connect Integration Clinics in BH Centers • Virtual Clinic • Payson • Williams • Winslow • Mobile Medical Unit: School Based Health Services Employer based health services • • • North Country Overview

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

North Country Outreach Programs Well Woman/FIT at Fifty Health. Checks 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

Patient Population

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

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

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

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

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

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

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

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)

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

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