LOCAL FRONTIERS

Electronic Health Records for Community Clinics

By Pedro Toledo, JD

The community health centers of the Redwood Community Health Coalition (RCHC) recently embarked on a joint venture to improve health care and health outcomes for their patients through shared information technology. RCHC will invest $11.5 million over the next four years in electronic health records (EHR) infrastructure; $4.5 million has already been raised. Ten health centers operating 18 sites of care in Marin, Napa, Sonoma and Yolo counties stand to benefit from this investment, making RCHC the largest consortium of community clinics in California to implement a shared EHR system.

RCHC’s EHR initiative is about more than just technology—it is about our patients. Caring for our patients is our highest priority. RCHC recognizes that information technology is key to increasing access, and to improving quality and coordination of care for our patients. To that end, RCHC clinics decided to jointly purchase and implement EHR software.

Collaborative EHR implementation yields multiple benefits. It promotes cost savings through bulk purchasing and reduces costs by utilizing a centrally managed information technology (IT) project team. Individual clinics lack the resources to implement the required training to transform human systems in preparation for successful EHR implementation; but by pooling resources, the clinics can achieve multiple levels of expertise. Embracing this collaborative effort yields cost savings by reducing the cost of EHR software, IT management and clinic staff training, enabling RCHC health centers to meet the growing needs of our community.

RCHC is implementing EHRs to streamline the clinical processes within our health centers, enhance care coordination between practice locations, and promote patient safety while reducing costs. We chose a provider-friendly EHR product from eClinical Works that interfaces with hospitals and other parts of the health care delivery system. An accompanying self-service patient and physician portal will provide a secure means for doctors and patients to communicate, make appointments online, view lab results, and enter health statements. Another component will offer a complete view of a patient’s health record by allowing various practices, beginning with the participating health centers, to view and update the patient’s electronic chart securely.

Our phased rollout of this technology began in January. We believe our EHR initiative will ultimately benefit the community by shifting the focus of health care from treatment to prevention, thus improving the quality of care and positively affecting health outcomes.

RCHC’s big footprint in our region makes this initiative particularly important. Our health centers are the medical homes for almost 150,000 people, making us the largest provider of care for the working poor and uninsured in Marin, Napa, Sonoma and Yolo counties. One-sixth of the residents in these counties use RCHC clinics as their medical home. Of these patients, one in three are Latinos, one in five are children, and four out of five live below the poverty level.

A recent UC San Francisco study on the benefits of EHRs at community health centers found substantial improvements in preventive and chronic care.[1] Implementation of EHRs will enable RCHC to emphasize prevention, chronic disease management, and coordination of care with other providers. In particular, we expect hospitals will see a decrease in unpaid emergency-room care, as uninsured and Medi-Cal patients will receive more appropriate, cost-effective care at RCHC health centers.

RCHC has invested many years into strategic planning, developing a consensus on a shared EHR vision and creating a strong quality improvement infrastructure on which our EHR initiative rests. We have established two medical director positions to support this venture, and we have already completed three related initiatives.

The first of these was the Clinical Systems Learning Community, a statewide collaborative for standardizing clinical performance measures; improving data collection, validation and reporting; and using data to improve processes.

We also completed the Quality Culture Series, a structured quality improvement (QI) program consisting of four two-day meetings held in each of our four counties over eight months. The charter was to develop a culture of quality within each participating clinic. Participants learned QI techniques, data analysis and team building. Clinic leaders from around the country were invited to share their expertise, and each clinic incorporated a significant QI project into their operations. The success of this innovative program has not gone unnoticed: a foundation recently asked RCHC to spread the Quality Culture Series to other clinic consortia.

Finally, RCHC recognizes that people and processes matter the most in any successful organizational transition. In 2001, we began a Continuous Quality Improvement workgroup that serves as our process-improvement committee.

Born from 1960s War on Poverty legislation, community clinics not only promote health, but are also an integral part of the social-justice movement. RCHC health centers share a mission and a mandate to serve every person who walks through our doors without regard to economic, cultural or social background. Our EHR initiative will help us fulfill this mission.

While RCHC continues to invest time and money into the EHR initiative, a growing list of community organizations have provided generous financial support, including Kaiser Permanente, Blue Shield Foundation of California, and the California Department of Health and Human Services. With their assistance, we are able to meet the growing needs of our community.

References

1. Miller RH, West CE, “Market watch: The value of electronic health records in community health centers,” Health Affairs, 26;1:206-214 (2007).