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Bringing Affordable EMR Capabilities to Community Health Centers
By Doug Smith, for HealthLeaders News, April 10, 2007
Community health centers, funded under Section 330 of the Public Health Service Act, are on the front lines of our nation’s efforts to provide comprehensive medical and dental care to uninsured and underinsured people. Patients who receive care from community health centers live in medically underserved urban or rural areas. Health centers operate on tight budgets and are hard pressed to find the funds to invest in healthcare IT systems. We cannot compete with private physician practices to hire and retain IT professionals.
Consequently, it is not surprising that health centers lag behind the private sector in adopting electronic medical record systems. According to a study by the National Association of Community Health Centers, only 8 percent of health centers are using EMRs, compared to 18 percent of private, office-based primary care physicians. Furthermore, 89 percent of surveyed health centers cited lack of capital as the biggest barrier to EMR implementation.
But the patients treated at these centers often have chronic and complex medical problems, so it becomes critical that we treat them with the most comprehensive, high-quality healthcare services available. In order to help physicians provide appropriate and effective care, we must find a way to implement and maintain EMRs.
A cooperative approach to EMR adoption
I helped undertake a broad review in 1999 of some 60 EMR vendors and systems for a presentation at an NACHC conference. One of my main conclusions was that unless a community health center is very large, it needs the economies of scale of a cooperative, network organization for group purchasing of an EMR as well as for the IT expertise and resources to manage and support the software. An EMR is just not otherwise affordable or practical for most health centers alone.
We developed just such an approach in North Carolina through Community Partners HealthNet, Inc. Founded in 1999, Community Partners HealthNet is a network of seven community health centers. These centers operate 43 medical and dental clinics with 105 providers (including 90 physicians and mid-level providers and 15 dentists). Together, we annually serve approximately 150,000 patients, more than half of whom are low-income and underinsured.
We established an EMR selection team that included the medical directors of the seven community health centers in our organization. The team worked for six months to choose a system. The physicians wanted an EMR that would be intuitive and easy to use. To ensure the required scalability and system performance, the three EMR systems selected for presentations and demonstrations had to be Windows-based, client/server systems using SQL as the database.
We chose MicroMD EMR from Henry Schein Medical Systems. The physicians were comfortable with its organization and presentation of patient information. We were also confident in the system’s performance and processing speed as well as with how straightforward it was for us to get data from MicroMD EMR into our data warehouse.
Cost was also a factor. Our contract with Henry Schein Medical Systems, which is based on a per provider license fee, helps make the EMR affordable because of our group purchasing power. The average purchase and implementation cost of an EMR system is $32,606 per full-time physician, according to a 2005 survey published by the Medical Group Management Association’s Center for Research and the University of Minnesota School of Public Health. For Community Partners HealthNet, the initial cost for MicroMD EMR was less than half of the MGMA estimate.
Sharing resources for implementation
Through shared resources, Community Partners HealthNet serves the participating community health centers through the operation of CPH, an application service provider for member health centers. CPH hosts MicroMD EMR, manages a data warehouse and tracks clinical outcomes for member organizations. We also host a practice management system for dental providers. Our centers are connected to CPH through secure firewall-to-firewall virtual private networks. Citrix clients are installed on PCs or thin clients, which are used to access the centrally managed EMR. CPH also provides access via the Web using the Citrix Secure Gateway. This gives our health centers’ providers secure access to the records from any PC with an Internet connection.
CPH has three full-time IT professionals on staff: a hardware specialist, a programmer/report writer, and a training and software specialist. Centralizing these positions has been critical to our success. Sharing centralized IT staff enables the health centers to benefit from IT professionals that they would otherwise not be able to afford individually.
Implementation status
The timeline of the MicroMD EMR adoption for the community health centers in Community Partners HealthNet stands as follows:
EMR deployment at Kinston Community Health Center is in process now while Robeson Health Care Corporation is planned for 2008. Our other member, Goshen Medical Center, has no current plans for the EMR.
EMR uses and benefits
Implementing an EMR is a long-term process that involves fundamental changes in clinical workflow. In terms of lost productivity, it is less costly to implement an EMR gradually. This mitigates the problem of lost revenue. In addition, we maintain lean IT staffing to control costs. The trade-off--for instance, with just one trainer--is that it takes more time to bring the EMR to each health center.
For the participating health centers, the EMR has been instrumental in streamlining the collection and presentation of clinical data. A majority of the providers prefer access to patient charts via the EMR in exam rooms. Patients can view the same information that the provider sees. This makes patients feel that the chart is not “hidden” from them. Also, graphs and charts are viewable to assist the clinical staff with reviewing and discussing changes in patients’ blood pressure, weight and body mass index, and diabetes condition indicators.
The EMR helps our community health centers improve the quality of care. For example, medication interaction alerts are especially useful because our patient population includes so many people with multiple medical conditions and prescriptions.
Clinical tracking and outcomes measurement supported by EMR data have also proven to be vital to quality improvement. We undertake peer review and develop provider comparisons without tedious, time-consuming manual pulling of charts. For example, reducing racial disparities in health outcomes is a fundamental goal for community health centers. Community Partners HealthNet developed reports on key clinical indicators, such as the number and percentage of patients with diabetes, by race, whose blood glucose levels are under control. Data are developed and can be reviewed by health center, by individual clinic location, and by provider.
Going forward
Our approach to bringing EMR capabilities to community health centers offers a practical and affordable model. Although the approach is incremental, it has proven successful.
Given the medical problems of the population served, care delivery in community health centers tends to be nursing-intensive. Developing support for nursing encounters in the EMR is important. Currently, the interface between MicroMD EMR and the practice management system deployed via CPH is unidirectional, from the practice management side to the clinical record. Demographic data from the practice management system is used by the EMR to eliminate duplicate data entry. Our goal is to have full integration of EMR and practice management functionality.
Doug Smith, serves as chief executive officer and chief information officer of Community Partners HealthNet, Inc. and is president and chief executive officer of Greene County Health Care, one of the participating community health centers. He can be reached at dsmith@greenecountyhealthcare.com.
You can contribute to HealthLeaders IT. Read our editorial guidelines to find out how.
Consequently, it is not surprising that health centers lag behind the private sector in adopting electronic medical record systems. According to a study by the National Association of Community Health Centers, only 8 percent of health centers are using EMRs, compared to 18 percent of private, office-based primary care physicians. Furthermore, 89 percent of surveyed health centers cited lack of capital as the biggest barrier to EMR implementation.
But the patients treated at these centers often have chronic and complex medical problems, so it becomes critical that we treat them with the most comprehensive, high-quality healthcare services available. In order to help physicians provide appropriate and effective care, we must find a way to implement and maintain EMRs.
A cooperative approach to EMR adoption
I helped undertake a broad review in 1999 of some 60 EMR vendors and systems for a presentation at an NACHC conference. One of my main conclusions was that unless a community health center is very large, it needs the economies of scale of a cooperative, network organization for group purchasing of an EMR as well as for the IT expertise and resources to manage and support the software. An EMR is just not otherwise affordable or practical for most health centers alone.
We developed just such an approach in North Carolina through Community Partners HealthNet, Inc. Founded in 1999, Community Partners HealthNet is a network of seven community health centers. These centers operate 43 medical and dental clinics with 105 providers (including 90 physicians and mid-level providers and 15 dentists). Together, we annually serve approximately 150,000 patients, more than half of whom are low-income and underinsured.
We established an EMR selection team that included the medical directors of the seven community health centers in our organization. The team worked for six months to choose a system. The physicians wanted an EMR that would be intuitive and easy to use. To ensure the required scalability and system performance, the three EMR systems selected for presentations and demonstrations had to be Windows-based, client/server systems using SQL as the database.
We chose MicroMD EMR from Henry Schein Medical Systems. The physicians were comfortable with its organization and presentation of patient information. We were also confident in the system’s performance and processing speed as well as with how straightforward it was for us to get data from MicroMD EMR into our data warehouse.
Cost was also a factor. Our contract with Henry Schein Medical Systems, which is based on a per provider license fee, helps make the EMR affordable because of our group purchasing power. The average purchase and implementation cost of an EMR system is $32,606 per full-time physician, according to a 2005 survey published by the Medical Group Management Association’s Center for Research and the University of Minnesota School of Public Health. For Community Partners HealthNet, the initial cost for MicroMD EMR was less than half of the MGMA estimate.
Sharing resources for implementation
Through shared resources, Community Partners HealthNet serves the participating community health centers through the operation of CPH, an application service provider for member health centers. CPH hosts MicroMD EMR, manages a data warehouse and tracks clinical outcomes for member organizations. We also host a practice management system for dental providers. Our centers are connected to CPH through secure firewall-to-firewall virtual private networks. Citrix clients are installed on PCs or thin clients, which are used to access the centrally managed EMR. CPH also provides access via the Web using the Citrix Secure Gateway. This gives our health centers’ providers secure access to the records from any PC with an Internet connection.
CPH has three full-time IT professionals on staff: a hardware specialist, a programmer/report writer, and a training and software specialist. Centralizing these positions has been critical to our success. Sharing centralized IT staff enables the health centers to benefit from IT professionals that they would otherwise not be able to afford individually.
Implementation status
The timeline of the MicroMD EMR adoption for the community health centers in Community Partners HealthNet stands as follows:
- 2000: Greene County Health Care
- 2000: Hudson River Health Care Corporation
- 2004: Tri-County Community Health Centers
- 2005: Stedman-Wade Health Services
EMR deployment at Kinston Community Health Center is in process now while Robeson Health Care Corporation is planned for 2008. Our other member, Goshen Medical Center, has no current plans for the EMR.
EMR uses and benefits
Implementing an EMR is a long-term process that involves fundamental changes in clinical workflow. In terms of lost productivity, it is less costly to implement an EMR gradually. This mitigates the problem of lost revenue. In addition, we maintain lean IT staffing to control costs. The trade-off--for instance, with just one trainer--is that it takes more time to bring the EMR to each health center.
For the participating health centers, the EMR has been instrumental in streamlining the collection and presentation of clinical data. A majority of the providers prefer access to patient charts via the EMR in exam rooms. Patients can view the same information that the provider sees. This makes patients feel that the chart is not “hidden” from them. Also, graphs and charts are viewable to assist the clinical staff with reviewing and discussing changes in patients’ blood pressure, weight and body mass index, and diabetes condition indicators.
The EMR helps our community health centers improve the quality of care. For example, medication interaction alerts are especially useful because our patient population includes so many people with multiple medical conditions and prescriptions.
Clinical tracking and outcomes measurement supported by EMR data have also proven to be vital to quality improvement. We undertake peer review and develop provider comparisons without tedious, time-consuming manual pulling of charts. For example, reducing racial disparities in health outcomes is a fundamental goal for community health centers. Community Partners HealthNet developed reports on key clinical indicators, such as the number and percentage of patients with diabetes, by race, whose blood glucose levels are under control. Data are developed and can be reviewed by health center, by individual clinic location, and by provider.
Going forward
Our approach to bringing EMR capabilities to community health centers offers a practical and affordable model. Although the approach is incremental, it has proven successful.
Given the medical problems of the population served, care delivery in community health centers tends to be nursing-intensive. Developing support for nursing encounters in the EMR is important. Currently, the interface between MicroMD EMR and the practice management system deployed via CPH is unidirectional, from the practice management side to the clinical record. Demographic data from the practice management system is used by the EMR to eliminate duplicate data entry. Our goal is to have full integration of EMR and practice management functionality.
Doug Smith, serves as chief executive officer and chief information officer of Community Partners HealthNet, Inc. and is president and chief executive officer of Greene County Health Care, one of the participating community health centers. He can be reached at dsmith@greenecountyhealthcare.com.
You can contribute to HealthLeaders IT. Read our editorial guidelines to find out how.
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