HIT Adoption and HIT Adoption and Opportunity: Opportunity:

Perspectives from the Perspectives from the Primary Care Safety Primary Care Safety

NetNetPresented byPresented by

Greta J. Stewart, MPH, CAEGreta J. Stewart, MPH, CAE

Oklahoma Primary Care AssociationOklahoma Primary Care AssociationHRSA/BPHC State LiaisonHRSA/BPHC State Liaison

Oklahoma Primary Care AssociationOklahoma Primary Care Association

What are CHC / FQHCs?What are CHC / FQHCs? Private, 501(c)3s (primarily) with Federal grant Private, 501(c)3s (primarily) with Federal grant

supportsupport Of high need, Medically Underserved AreasOf high need, Medically Underserved Areas

Services available to all people (of all payer types, Services available to all people (of all payer types, income, age, location, etc.) income, age, location, etc.)

Offer sliding fee scale regardless of Offer sliding fee scale regardless of abilityability to pay to pay (discounts apply for incomes <200% of poverty)(discounts apply for incomes <200% of poverty)

Provide comprehensive primary medical, dental, Provide comprehensive primary medical, dental, behavioral, enabling and health education servicesbehavioral, enabling and health education services

Directed by patient-majority boards of directorsDirected by patient-majority boards of directors Federally Qualified Health Center -- reimbursement Federally Qualified Health Center -- reimbursement

status for Medicaid and Medicare servicesstatus for Medicaid and Medicare services

Oklahoma Primary Care AssociationOklahoma Primary Care Association

Oklahoma CHC PatientsOklahoma CHC Patientsby Insurance Status, 2007by Insurance Status, 2007

Uninsured49.8%

Medicaid/CHIP26.2%

Medicare12.0%

Private12.1%

Source: BPHC, HRSA, DHHS, 2007 Uniform Data System

Range of Uninsured Rate: ~25% to 75%n=

>107,000

1. Identify the Development/Training/Implementation 1. Identify the Development/Training/Implementation TeamTeam Project ManagerProject Manager Multi-disciplinary group to help with system development Multi-disciplinary group to help with system development

(Need Provider leader/champion) (Need Provider leader/champion) Multi-Disciplinary TrainersMulti-Disciplinary Trainers IT Support StaffIT Support Staff

2. Design/Redesign Practice Protocols2. Design/Redesign Practice Protocols3. Customize EMR for Clinical Documentation/Develop 3. Customize EMR for Clinical Documentation/Develop

Encounter (Visit) Documentation FlowEncounter (Visit) Documentation Flow MModify templates to meet audit standards and/or practice odify templates to meet audit standards and/or practice

protocolsprotocols Build InterfacesBuild Interfaces Decide how each template will be used and who will enter data; Decide how each template will be used and who will enter data;

Determine the flow for documenting the encounter (visit)Determine the flow for documenting the encounter (visit)4. Develop Implementation Plan4. Develop Implementation Plan5. Develop Training Plans & Materials5. Develop Training Plans & Materials

Implementation PlanningImplementation Planning

IT Centered ResponsibilitiesStaff 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

Implementation Process Implementation Process (Staying on Track)(Staying on Track)

What worked well during What worked well during planning and planning and development process?development process?

1.1. Develop Project ORG chart Develop Project ORG chart

2.2. Include staff proficient in the appropriate tasksInclude staff proficient in the appropriate tasks

3.3. Assess staff level of computer literacyAssess staff level of computer literacy

4.4. Institute fun, but effective learning opportunitiesInstitute fun, but effective learning opportunities

5.5. Document, Document, DocumentDocument, Document, Document

What worked well during What worked well during transition to EMR?transition to EMR?

1.1. Solidify practice management processesSolidify practice management processes

2.2. Ensure generation of revenue Ensure generation of revenue

3.3. Closely monitor billing processes Closely monitor billing processes

4.4. Closely monitor denial management processesClosely monitor denial management processes

5.5. Train, Train, TrainTrain, Train, Train

Implementation Best PracticesImplementation Best Practices

Implementation Best PracticesImplementation Best Practices

May 28, 2009 Draft description for May 28, 2009 Draft description for establishment of RECs with comment period establishment of RECs with comment period ended June 11ended June 11

Meeting of partnersMeeting of partners

Late August 2009 guidance releasedLate August 2009 guidance released

Planning underway for application Planning underway for application (open to interested parties)(open to interested parties)

Regional Extension Center (REC) Regional Extension Center (REC) CollaborationCollaboration

PurposePurpose: : Provide technical assistance; Consult using Provide technical assistance; Consult using best practices; Communicate “Lessons Learned;” best practices; Communicate “Lessons Learned;” Support use of HITSupport use of HIT

GoalsGoals:: Encourage the adoption of electronic health recordsEncourage the adoption of electronic health records Assist clinicians, health centers, hospitals and clinics Assist clinicians, health centers, hospitals and clinics

to become “meaningful users”to become “meaningful users” Increase probability for successIncrease probability for success

PrioritiesPriorities: : Public or non-profit hospitals, CAHs, Public or non-profit hospitals, CAHs, CHC/FQHCs, others entities that serve the underservedCHC/FQHCs, others entities that serve the underserved

REC OpportunityREC Opportunity

DesignDesign:: Incorporate multiple stakeholders Incorporate multiple stakeholders Leverage local resourcesLeverage local resourcesCooperation and collaborationCooperation and collaboration

DefineDefine: : Geography and provider populationGeography and provider populationSupport levels and methodsSupport levels and methods

DescribeDescribe:: Structure of organizationStructure of organizationStaffing requirementsStaffing requirementsSustainability Sustainability

REC OpportunityREC Opportunity

Oklahoma Primary Care AssociationOklahoma Primary Care Association

For further information, contact

Greta Stewart, MPH, CAE Brent Wilborn, MSExecutive Director Director of Public Policygshepherd@okpca.org bwilborn@okpca.org

Jim Crawford Information Exchange Specialist jcrawford@okpca.org

Oklahoma Primary Care Association4300 N. Lincoln Blvd., Ste. 203Oklahoma City, OK 73105(405) 424-2282 • Fax (405) 424-1111www.okpca.org