Meaningful use from community health point of view
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Levine testified to the HIT Standards Committee hearing on meaningful use last week, offering the good and bad of EHR implementation, RECs and the road to electronification from a Community Health Center (CHC) perspective.
“There is much to commend in the HITECH Act; it is hard to argue with policy goals that focus on improving quality, safety, efficiency and coordination of care for patients and populations,” wrote Levine. “But, as with all major change, the translation of policy to practice must be managed by those who are mandated to implement that change.”
In an interview, Levine commended the Massachusetts REC and the Massachusetts League of Community Health Centers for having “a really good vision of where healthcare was going from the technology standpoint,” and supporting EMR and integrated systems efforts.
Thanks to that vision, Family Health Center began an EMR implementation about two years ago (NextGen EHR), putting in practice management first “because we have so many different payors that it was critical to do that first,” she said. “Then we began to move toward EMR implementation and took a phased-in approach. Practice is divided into teams [of] physicians and support staff. We implemented by going team by team. We have some satellite clinics, we’re about to finish up six school-based health centers. They go live in a couple of weeks, and that will get us fully electronic.”
That’s the good news. The bad news is that productivity took a hit, and continues to take one. “I think we’re at least six months off from getting back to where we were before we started,” Levine said. “It’s a hard new process for people to learn and it really changes their style of practice. It takes time. There’s a lot of work on the back end after the [patient] visits are finished.”
“There is that kind of a sense that you’re turning the Titanic, because it’s a complete transformation of the systems that you have in place,” Levine said. “Everything changes. …You have this amazing system, you’re trying to maximize it by trying to get it to do everything possible. And then you move into the clinic where you’ve got to concretize your workflow, because that’s what the training is based on, the workflow changes are based on what the medical assistant is going to do, what the nurse is going to do, how people are going to talk to each other by tasking back and forth.
“It totally changes the style of practice of the physician and for the nurse practitioner, because now they’re typing instead of looking at the patient and they’re pointing and clicking, and all these things they’ve never been trained to do. It’s a complete shock to the system of the organization, and it takes a real adjustment."
Family Health helped to ease that adjustment by having as much trainer support on hand as possible, familiarizing physicians with the EMR template, and getting them used to looking at the screen and at the patient. In addition, “we try to give them as much feedback as possible, showing them the good side of electronic records,” such as getting lab orders with the click of a button, she said.
The financial challenge for CHCs moving to an EMR isn’t so easily alleviated, according to Levine. Family Health Center was the only community health center on the REC panel and “there was a lot of interest in the fact that what we were paying the REC in Massachusetts was very different than what the person next to me who was from Arizona, was paying … Nothing. Massachusetts charges $600 per provider,” she said. “There are a lot of health centers around the country, and I think some of the experience we have is probably comparable to the experience that others have had. The expense to implement EMR, move to meaningful use, is something all health centers are struggling with.
“CHCs have a different take on the world of healthcare: They’re mission-driven organizations, federally qualified health centers developed to provide care for people who couldn’t get care. We exist to take care of people, providing exceptional care to anyone regardless of their ability to pay. We emphasize the idea of a comprehensive approach to care so we look at what we do as a team.
“We want to be recognized as the organization itself—all of our providers are employed; they don’t own the community health center, but they are part of a larger organization. The REC was looking at us not as one organization, but as an organization with a lot of individual providers,” said Levine.
The state REC could recognize CHCs’ unique role in the state’s healthcare spectrum—they provide primary care to the bulk of the Massachusetts Medicaid population, and could perhaps be charged nothing to enroll, or a minimal amount as an organization, said Levine. “There aren’t a lot of deep pockets and the help they need might be a little different than what Partners [HealthCare] might need,” she said.
“Despite all of the expense and the work, I think in the long run it’s all going to be worth it, because I think it will really do a lot to keep quality care where it should be, and care coordination. It’s really going to be useful moving forward: It’s just going to be a lot of work getting there.”