HIT Adoption and Opportunity: Perspectives from the Primary Care Safety Net

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HIT Adoption and Opportunity Perspectives
from the Primary Care Safety Net

• Presented byGreta J. Stewart, MPH, CAE
• Oklahoma Primary Care Association
• HRSA/BPHC State Liaison

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What are CHC / FQHCs?

• Private, 501(c)3s (primarily) with Federal grant
  support
• Of high need, Medically Underserved Areas
• Services available to all people (of all payer
  types, income, age, location, etc.)
• Offer sliding fee scale regardless of ability to
  pay (discounts apply for incomes lt200 of
  poverty)
• Provide comprehensive primary medical, dental,
  behavioral, enabling and health education
  services
• Directed by patient-majority boards of directors
• Federally Qualified Health Center --
  reimbursement status for Medicaid and Medicare
  services

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Oklahoma CHC Patientsby Insurance Status, 2007
Private12.1
Range of Uninsured Rate 25 to 75
n gt107,000
Medicare12.0
Uninsured49.8
Medicaid/CHIP26.2
Source BPHC, HRSA, DHHS, 2007 Uniform Data
System
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Implementation Planning

• 1. Identify the Development/Training/Implementatio
  n Team
• Project Manager
• Multi-disciplinary group to help with system
  development (Need Provider leader/champion)
• Multi-Disciplinary Trainers
• IT Support Staff
• 2. Design/Redesign Practice Protocols
• 3. Customize EMR for Clinical Documentation/Develo
  p Encounter (Visit) Documentation Flow
• Modify templates to meet audit standards and/or
  practice protocols
• Build Interfaces
• Decide how each template will be used and who
  will enter data Determine the flow for
  documenting the encounter (visit)
• 4. Develop Implementation Plan
• 5. Develop Training Plans Materials

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Implementation Process (Staying on Track)
IT Centered Responsibilities Staff Centered Responsibilities
Decision on IT Support Phases of Implementation
Internal Affiliation with Hospital How to Implement EMR Across Multiple Sites
ASP Training Plans
Set up of System/Server/Hardware Train-the-Trainers
Decision on Point of Care Devices Schedule Staff/Providers to minimize impact on patient access/care
Go-Live/Go-Live Support Develop Training Manual and Quick Reference Guide
Post Go-Live Support/IT Help Desk Go-Live/Go-Live Support
Post Go-Live Support
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Implementation Best Practices

• What worked well during planning and development
  process?
• Develop Project ORG chart
• Include staff proficient in the appropriate tasks
• Assess staff level of computer literacy
• Institute fun, but effective learning
  opportunities
• Document, Document, Document
• What worked well during transition to EMR?
• Solidify practice management processes
• Ensure generation of revenue
• Closely monitor billing processes
• Closely monitor denial management processes
• Train, Train, Train

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Implementation Best Practices
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Regional Extension Center (REC) Collaboration

• May 28, 2009 Draft description for establishment
  of RECs with comment period ended June 11
• Meeting of partners
• Late August 2009 guidance released
• Planning underway for application (open to
  interested parties)

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REC Opportunity

• Purpose Provide technical assistance Consult
  using best practices Communicate Lessons
  Learned Support use of HIT
• Goals
• Encourage the adoption of electronic health
  records
• Assist clinicians, health centers, hospitals and
  clinics to become meaningful users
• Increase probability for success
• Priorities Public or non-profit hospitals, CAHs,
  CHC/FQHCs, others entities that serve the
  underserved

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REC Opportunity

• Design Incorporate multiple stakeholders
• Leverage local resources
• Cooperation and collaboration
• Define Geography and provider population
• Support levels and methods
• Describe Structure of organization
• Staffing requirements
• Sustainability

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For further information, contactGreta Stewart,
MPH, CAE Brent Wilborn, MSExecutive
Director Director of Public
Policygshepherd_at_okpca.org
bwilborn_at_okpca.org Jim Crawford Information
Exchange Specialist jcrawford_at_okpca.org
Oklahoma Primary Care Association4300 N.
Lincoln Blvd., Ste. 203Oklahoma City, OK
73105(405) 424-2282 Fax (405)
424-1111www.okpca.org