Electronic Health Reporter

The Hill Country Health and Wellness Center is a small clinic located in the rural community of Round Mountain in Northern California. California is home to Hollywood and startups that enjoy incentives to start an LLC in California. The Center, which opened in a trailer in the 1980s, continues to reflect its founder’s passion for helping the area’s rural, largely underserved population. From that humble beginning, with one doctor and one nurse working without pay, the clinic today is housed in a modern building, with 90 employees.

The Center’s provider staff, consisting of two MDs, three mid-levels and three dentists sees about 3,700 patients per year — most of whom drive 30 miles or more for care.

All of the Center’s providers are in different stages of earning meaningful use incentive payments. The physician and nurse practitioners have each attested to Medi-Cal’s Adopt, Implement, Upgrade (AIU) incentive program.

The Center, which has been live on its EHR since June 2012, uses GE Centricity.

The Rewards Of Earning EHR Incentive Payments

Like most clinics, Hill Country Health and Wellness Center uses incentive payments to help offset the costs of buying EHR software and ongoing consulting. But according to Bridget Schafer, Chief Information Officer/EMR Project Manager, there are important rewards other than financial.

“One of the primary pay-offs is that initiating use of the EHR software engages providers in good quality of care guidelines,” says Schafer. “These guidelines line up directly with Patient Certified Medical Home (PCMH) guidelines, thereby accelerating our ability to become certified as a PCMH.

“Meeting MU requirements to qualify for incentive payments was a great morale booster for our staff,” continues Schafer. “We developed dashboards that enabled us to compare our performance with respect to requirements. Being able to see our performance and progress has provided staff with a great sense of satisfaction.”

MU Attestation Challenges

According to Schafer, the process of adopting an EHR and attesting to MU presented a number of challenges, among them: 

•Compensating for Scarce Resources

Because the Center is small and remote, resources are understandably scarce. To compensate, the Center early on became part of a network of 32 different clinics called the Alliance of Chicago, which hosts Centricity and all relevant data. The mission of the Alliance is to share resources and integrate services in order to help community health centers more efficiently and effectively deliver accessible quality health care to the communities they serve.

“The Alliance has been a great resource throughout our journey, guiding us and directing us in the use of software,” said Schafer. “Some of the incentive money helps offset these costs.”

Schafer notes that while the incentive money is great, it doesn’t nearly cover the cost of EHR adoption and the MU attestation process. The Center started its EHR adoption effort with a grant from Health Resources and Services Administration (HRSA). CalHIPSO also gave the Center money to help with the cost of consulting services related to implementation.

•Fear of Letting Go

“Getting the paper chart out of provider hands was a big challenge at first,” said Schafer. “It’s taken a year, but they’re now using the electronic record. Part of this equation was an underlying fear about the concept — there was a high level of discomfort. We met that challenge with training and education about the long-term value of using an EHR.”

•Time, Productivity Challenges

According to Schafer, at the beginning of the process, the time needed for implementation, and reduced productivity were big challenges.

The Center went live with its EHR in June 2012. “We initially took a big hit on productivity, cutting our visit times in half so that providers could become proficient using the EHR,” noted Schafer. “During the month of July providers took an hour for each visit, so that they could become comfortable with the software.”

Now, a year later, they’re back to 20-minute time slots. “We got lots of help from the Alliance, during this whole process,” added Schafer.

Tactical solutions 

Schafer attributes the Center’s successful journey to MU attestation to four key activities: planning, workflow re-engineering, pre-loading data — and lots of training. 

•Planning, Planning, Planning

“We did this right,” said Schafer, looking back on the past year with some well-deserved satisfaction. “We started preparing early, in January of 2012, and spent the first six months doing a tremendous amount of planning and preparation.”

•Workflow Re-Engineering

“We spent a lot of time and effort re-engineering workflow to integrate with best practices of the software,” Schafer recalled. “We didn’t try to make our paper workflows fit the new electronic platform. We let the software guide us.”

•Pre-Loading Data

“We pre-loaded data related to about 20 patient visit items we wanted to have in the EHR before going live,” said Schafer. “We pre-loaded charts of about half our patient population — the patients we see most frequently, many of whom have chronic illnesses.”

•Lots Of Training

During the entire month after going live with their EHR, Center providers took an hour per patient visit to allow them to get comfortable using the software. “It was time consuming, but it was critical that we do this, and paid off going forward,” said Schafer.

Bigger Picture MU Pay-off:Standardized Provider Behavior, Improved Efficiency and Outcomes Reporting, Better Continuity of Care

Schafer said the Center has experienced a remarkable change in the way it delivers healthcare. “With the software guiding providers through best practices, we’ve standardized provider behavior, and improved continuity of care. The fact that all of our providers are striving to meet the same objectives leads to improved outcomes — and much better reporting on how our patients are doing. This is all made possible because we have access to data. That’s so important. That’s where the value comes from.”

“Would We Do It Again? Absolutely!”

When asked if the Center would undertake the process all over again, despite the expense, time and implementation challenges, Schafer doesn’t hesitate.

“Yes, absolutely!” she said. “In the end it has all paid off. We’re happy with our outcome: quality improvement, reporting, and executing core benchmarks. Our EHR makes everything much easier. Just look at us, we’re up here in the middle of nowhere, and we’re doing it.”

Content provided by CalHIPSO, the largest of 62 federally designated Regional Extension Centers, and the largest in California, serving 56 of California’s 58 counties.