Meeting Community Health Care Automation Needs Through Collaboration

1
Meeting Community Health Care Automation Needs
Through Collaboration

• Ellen Hafer, Executive VP and COO, Massachusetts
  League of Community Health Centers
• Charles W. Jarvis, FACHE, Assistant Vice
  President, Healthcare Industry Services, NextGen
  Healthcare Information Systems

2
The Massachusetts League of Community Health
Centers

• The Massachusetts League of Community Health
  Centers(League) is the state primary care trade
  association for MA community health centers. We
  have 53 members representing a 100 of eligible
  centers participating in our organization.
• The Community Health Centers (CHC) serve 10 of
  the Commonwealths population. Their patient
  base is 40 uninsured, 40 Medicaid, 20 Medicare
  and commercial. The Leagues Mission is to
  provide leadership to its membership in achieving
  their goals and to promote accessible, quality,
  community responsive health care.
• We fostered development of a statewide HMO-NHP-,
  a state and national capital development
  organization, and a regional group purchasing
  program.
• The League is committed to community health
  centers achieving a 100 implementation of
  Electronic Medical Records to provide safe
  quality care and efficient clinical work
  environments to assure access to appropriate care
  for low to moderate income populations.

3
Automation Needs

• With the support of funding from Blue Cross Blue
  Shield of Massachusetts in 2004 the League
  completed a full study of the status of
  information systems and technology use at CHC in
  MA. Out of this study we focused on an in depth
  understanding of the need for EMR at CHC and
  developing an understanding and expertise in
  working with CHC on successfully planning and
  implementing an EMR.
• Of 53 community health centers in MA we
  identified 23 without EMRs. Clearly this is a
  much higher penetration then the estimated use of
  EMR at physician offices of 15 at the time. But
  it is also clear that CHC must achieve full 100
  EMR use expeditiously to maximize the value of
  public dollars to assure access to appropriate
  health care.

4
An Evolving Strategy

• With this commitment we have moved forward to
  develop a strategy to achieve a 100
  implementation of EHR at CHC. We joined the
  MAeHealth Collaborative and represent CHC needs
  there as well as support their efforts to seek
  statewide implementation of EHR and
  interoperability beginning with 3 pilot
  communities.
• We succeeded in 24 CHC being apart of the
  applicants to be pilot communities under MAeHC.
  But in the final selections only 1 CHC ended up
  being a part of the 3 selected pilot communities.
• The challenge remaining for the League was to
  foster the development of an integrated strategy
  to achieve successful EMR implementation at the
  23 remaining centers and to maximize
  collaboration horizontally to achieve
  efficiencies in implementation, pricing, and on
  going management.

5
Needs and Collaboration

• The League continued its BCBSMA funded pilot work
  with 4 CHC in 1 case to turn around a stalled EMR
  implementation and in 3 cases to assist with
  decision making and implementation resources.
  Through a competitive process 2 of the CHC
  selected NextGens EMR and a 3rd Center is in the
  final stages of decision making.
• With CHC being minimally a part of the MAeHC
  pilots the League took responsibility to provide
  information and support to CHC on implementing
  EMR and developing an expertise on CHC
  implementation issues through CHC projects.
• In assessing the overall projects and needs of
  the 23 CHC the League identified a strategy
  advocating for maximizing the implementation of a
  common EMR at the remaining CHC where feasible to
  achieve efficiencies.
• We also looked nationally at data on vendors and
  followed carefully the vendor evaluation and
  selection process of the MAeHC.
• All of this led us to strengthen our
  collaboration with NextGen. NextGen early on
  represented its commitment to support the
  development of a Regional Health Information
  Organization or solution that would provide for
  the needs of CHC throughout the State and
  potentially across State lines allowing for data
  exchange of multiple EMR systems for benchmark
  reporting.

6
A Strategy and the Challenges

• With limited funding the League has continued to
  work to support the increasing readiness and
  understanding of the 23 remaining CHC about EMR
  implementation and management. We have developed
  a readiness assessment tool for CHC, a project
  work plan template and cost information
  addressing implementation of EMR. We are
  developing a phased multi-year strategy to
  achieve readiness and implementation at the 23
  centers. We continue to invest in project
  management resources for EMR implementation at
  CHC to strengthen our expertise and ability to
  provide guidance to CHC in working together on
  EMR implementation. We are working with 3
  Centers to develop a users group in collaboration
  with NextGen to share work load, strategy and
  best practices. This will serve as a building
  block for future implementations.
• The key challenges for implementing EMR are of
  course first identifying adequate dollars to
  support the capital and operational costs
  recognizing the low margins of CHC and supporting
  the project management resources needed. These
  are of course challenges for private physician
  groups as well. Unique challenges for CHC
  include the complexity of services
  provided-medical and non-medical, the
  uncertainties of the revenue stream for Medicaid
  and uninsured patients, the accountability for
  use of public dollars with reporting requirements
  and service outcome expectations, the commitment
  to serve multilingual and multicultural
  populations, growth of uninsured, ancillary
  service needs of high risk populations, and the
  challenge to bring about business process change
  in a non-profit environment motivated by service
  access before the bottom line.

7
A Plateau or A Launching Pad

• The federal and state government have been
  increasingly supportive in defining the need,
  value and performance expectations that support
  EMR implementation. Incremental finances and
  resources target implementation. But there is
  not a clear strategy or plan for sustaining the
  multi-year support required to achieve the scope
  of change needed in business process and
  financials incentives to achieve successful wide
  adoption of EMR.
• To face this reality we need technical and
  project partners that are willing to address the
  unique role of CHC service, reporting and
  resource needs. We need partners that will stay
  the course seeing the value in our approach to
  community based health care for the health care
  system not just the next marketing frontier.
• The collaboration with NextGen, BCBSMA and MAeHC
  has enabled us to develop a vision and strategy
  to meet needs of CHC and evolve a business plan
  to seek dollars.

8
The NextGen Approach

• NextGen has a long and successful history of
  working with community health centers nationwide.
• In Massachusetts, we are currently providing our
  software in Joseph E Smith, Harbor Health and
  Lynn Community Health Centers.
• As a company, we have developed a concerted plan
  to address community health nationwide and we
  back this up with philosophy, product, service,
  government relations and financial resources.

9
Philosophy

• NextGen firmly believes that integrated health
  networks can provide a more complete level of
  service to clients because of greater resources,
  ability to standardize care around best
  practices, opportunity to gather aggregate data
  across care venues to show improvement in health,
  and opportunity to reduce operating expenses by
  combining resources.

10
Product

• The top rated EPM/EMR in the ambulatory
  healthcare setting as reported by several
  authorities including the Anderson Consulting Co.
• A commitment in promise and practice for full
  interoperability with all qualified technology
  vendors in the marketplace.
• The offering of a community based health portal
  to integrate all health information from various
  sources and sites and across all technology
  products.

11
Service

• A commitment from program planning to post
  product implementation support.

12
Government Relations

• Participate in meetings of HRSA Bureau of Primary
  Health Care in Rockville Md. With MA CHC to
  better understand the needs and roles.
• We have established a relationship with
  leadership of the National Association of
  Community Health Centers to understand their
  strategy.
• We have visited the offices of Senators Kennedy
  and Kerry and supported articulation by the
  League of their commitment to care and the use of
  automation as a tool to enhance that commitment.

13
Financial Resources

• NextGen has committed 1 million to develop an
  automated data network supporting health centers
  in MA and surrounding states.
• NextGen has supported efforts and activities to
  help acquire the necessary funds at the state and
  national government level to help Massachusetts
  centers achieve their technology goals.
• NextGen is ready and able to provide product
  pricing well below what individual centers can
  get on their own to support a collaborative
  implementation strategy.

14
Scope

• The NextGen product base is a full service
  practice management and clinical system.
• The products are fully integrated-the only such
  system in the industry.

15
Community Solutions

• NextGens commitment to
• Patients
• Providers
• Centers
• Network
• Data

16
(No Transcript)
17
(No Transcript)
18
Planning

• NextGen offers an effective appropriate
  partnership opportunity to work with all the
  Massachusetts Community Health Centers to create
  an effective clinical network throughout all of
  New England with the Centers in the Mass League
  forming the base.

19
Planning-cont

• The NextGen philosophy is to create
  interoperability with other products already in
  existence in some Massachusetts Centers.
• NextGen proposes the implementation of a
  community health repository that will collect all
  information from participating centers and
  collect available data around each patient for
  optimal patient care through effective clinical
  data integration and exchange.
• NextGen proposes this in several phases over a 3
  year period consistent with the development of
  the technology program for the collective centers.

20
Next Steps

• Introduction of an automation strategy for those
  centers ready for implementation.
• Introduction of the integration strategy between
  NextGen centers and those on other technology
  platforms
• Discussion regarding use of a community based
  data portal
• Discussions with Bureau of Primary Health
  regarding networking strategies
• Discussions with surrounding states regarding the
  development of an automated New England CHC
  consortium
• Collaboration within Massachusetts on state
  automation strategies as part of the
  Massachusetts e-Health collaborative.