As part of the Integrated Delivery System project (Project 2ai), Care Compass Network (CCN) has been working with partner organizations on an Electronic Health Record (EHR) Incentive Program. This initiative is meant to install or upgrade EHR systems at facilities across their 9-county region. Having an EHR or Electronic Medical Record (EMR) systems in place improves the quality of patient care. Also, as the Value-based Payment (VBP) Model becomes the way of the future, these systems are able to track a multitude of information that will be necessary for data reporting.
Since the project was approved for funding in January 2017 just under $7 million dollars has been contracted to date, serving 23 organizations. Funding for this initiative has been specifically earmarked for partners from primary care and long-term care facilities who either do not have an EHR in place or are bringing their current EHRs up-to-date to meet Performing Provider System (PPS) standards.
Jennifer Parks, CCN IT Project Manager, and her team began to identify qualifying partners, mostly Community-Based Organizations (CBOs), through one-on-one meetings soon after funding was approved. Readiness assessments were performed to understand what data gathering systems, IT infrastructure and IT supper were in place at each organization as well as that funding streams might be tied into the implementation. Through these assessments the team evaluated what level of support would be needed from CCN to move through the eight milestones indicated in the EHR contract. These milestones start with signing a contract with a vendor and continue all the way to the EHR contributing data to the local Regional Health Information Organization (RHIO).
In some cases, IT infrastructure and teams were already in place and so those CBOs needed only minimal support. Others, like the many small CBOs who do not have IT departments, needed more in-depth assistance. Because of this, CCN also provided funding for a consultant to assist those CBOs with the implementation. These consultants acted as a liaison with the vendor, helping the CBOs choose the appropriate system, work through installation and manage configuration with the local RHIO.
Having a consultant available was extremely helpful to Sharon Chesna, CEO of Mothers and Babies Perinatal Network. They administer four program areas that each encompass different scopes of services, measures, and intensity. “We almost needed four modules because they are so distinct,” she explains. Their consultant helped determine exactly what would be needed for each of these programs and assessed the existing hardware. “We don’t have the luxury of dedicated IT staff,” Chesna says, “we absolutely could not have done this without the consultant and the funds made possible through CCN.”
Following the launch of their EHR, Mothers and Babies has continued to work with their consultant for three months. The consultant is helping to train the staff and make modifications to the higher-level administration functions as the staff continues to learn how to work the backend of the system.
Groton Community Health Care Center unveiled their new EMR and IT infrastructure upgrade in April. Nasar Khan, President & CEO, remarks, “we were looking for a robust EMR system and one of the things that is very challenging, especially with a non-profit like us, is to have resources made available. Not only monetarily but professionally. None of us here are IT specialists. With CCN it was a very well organized and coordinated effort – a team effort.”
For those CBOs with IT staff, the CCN IT team made regular check-ins. This was to ensure that they were on target with the milestones, to lend a hand in assessing barriers that need mitigation, and to provide assistance navigating the vendors.
Before using EHRs many CBOs had homegrown databases or multiple systems that were both cumbersome and non-compliant for sharing data to the local RHIO. Some were keeping track of patient data using multiple logs. For years Mothers and Babies Perinatal Network was working with various databases, reporting to a multitude of government agencies that funded their programming. Sharon Chesna estimates that there were over 100,000 client encounters that went into these outside databases, but there was no way to retain the information. After years of losing information they had been looking into EHR options, but the pricing was not affordable for a small non-profit. Thanks to the funding from CCN for the implementation of their EHR system, Chesna says, “we can now look back at data and understand patient profess and how our programs are working.”
Workflow is streamlined with the use of EHRs. At Groton Community Health Care Center, Khan describes the efficiency the EMR allows for his staff. He gives the example, “for CNAs we have wireless touchscreen kiosks on the floors that we were able to install. As CNAs come out of the resident room they have one in a close proximity, so they can just stop and document and then be on their way to help another resident.” Time spent on paperwork is reduced, giving staff more time to spend with residents.
Staff training for the new EHRs is being done in various ways, from onsite classes to webinars and online trainings. As with any new process, there is a learning curve which presents opportunities for staff to troubleshoot and adapt as they become familiar with the system. At Groton Community Health Care Center, a Nurse Manager kept going over the character limit in one portion of a report she was working on. This led her to examine how she could start to condense the information she was sharing.
Staff at both Mothers and Babies Perinatal Network and Groton Community Health Care Center are embracing the new systems and acclimating to them. There is an understanding that these systems are helpful, time-saving and will improve documentation for their organizations. Khan notes that staff, from Nurses to CNAs to the Finance Department, are already seeing how their new systems are enhancing their productivity. “A lot of the stuff that folks used to do would duplicate their efforts by going into one system, then another one – now everything is in one place. This has created so much efficiency.”
Mothers and Babies Perinatal Network is seeing a similar outcome. Information is now being shared more easily within the agency and with agencies that clients are being referred to. The streamlining isn’t just help staff, it’s making interactions smoother for clients, as well. Mothers and Babies has now developed a central intake form which all clients fill out only once. With the EHR, if the client comes in again for another program, staff can see what paperwork has already been completed or what tests have been ordered. This prevents duplication, causing less frustration for clients and making their experience easier.
In addition to installing the new record-keeping systems the EHR Incentive Program has enhanced the IT Infrastructure of the CBOs in other ways. For example, Mothers and Babies Perinatal Network needed to replace nearly 80% of their computer systems because they were outdated and needed higher levels of security to begin to utilize an information sharing program. The funding for the new computers was wrapped into the EHR Initiative. “We have needed this desperately,” Chesna says. “We never would have been able to do this without Care Compass.”
Groton Community Health Care Center now has Wi-Fi available throughout the entire building, also thanks to funding from the EHR incentive. They have two channels, one for performing work and another for guests. Short-term rehab patients can now bring in electronic devices that can give them access to the internet. Because of this, patients are more connected to their families and friends, creating a better experience for them.
The impact of the EHR Incentive Program is immense for the CBOs that are involved. “I can say very clearly that without [CCN’s] unwavering support I don’t think we would be able to implement the EMR Initiative and the IT infrastructure upgrade the way we did. It would have been a lot more difficult and cumbersome. Because of them we were able to do this very efficiently,” says Khan. Chesna echoes the praise, “This [upgrade] is positioning us well as a CBO as we make a shift in the system to Value-Based Payments.”