Elizabeth Markona, Health Promotion Programs Manager, and Amanda Guay, Director of Community Health Programs

EHR & Systems Change Adventures in a CHC

EHR & Systems Change Adventures in a CHC

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

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

Well Woman/FIT at Fifty HealthChecks

Maternal & Child Health Diabetes Program RESEP HIV/AIDS Ryan White NACASA Domestic Violence Hermosa Vida SBIRT

Prenatal Program

Well Woman Program

Nuclear Blast, Nevada 1952

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

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

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

Meeting care opportunities for patients

Positions the CHC to meet expectations

Communicate the business case

Share patient stories Demonstrate missed

opportunities Identify provider

champions Provide links to

screening for uninsured patients/resources

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

• Evidence-Based Programs• Leverage Other Contributing Efforts EHR Network PCMH efforts Affordable Care Act provisions UDS reporting requirements

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)

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