America’s Voice for Community Health Care The National Association of Community Health Centers (NACHC) represents Community and Migrant Health Centers, as well as Health Care for the Homeless and Public Housing Primary Care Programs and other community-based health centers. Founded in 1971, NACHC is a nonprofit advocacy organization providing education, training and technical assistance to health centers in support of their mission to provide quality health care to medically underserved populations.

The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved populations.

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A National Community Health Center Perspective Issues & Challenges for Medicaid Eligible Providers From AIU to Stage 1 Meaningful Use Shane C. Hickey, MBA, MS Director, Information Technology Assistance National Association of Community Health Centers 3/16/2012

Health Center Strategic Priorities ACCESS QUALITY COST Meaningful Use Patient Centered Medical Home Healthy People 2020 Uniform Data System

EHR Adoption Among Health Centers Source: 2010 HRSA BPHC UDS Data

Outreach to 35% of Non-Adopters Primary Goals & Objectives Where they are How we can serve you better Challenges & Barriers Steer to the right resources & tools Invitations to join Communities of Practice

Issues and Challenges from Prior Non- Adopters 89% have high functioning EHRsFocused on implementation and trainingGrappling with next layer of functions Issues with e-Rx, patient portals, secure messaging, HIE and quality reporting, typically at additional $$ 78% applied for AIU, but only 35% have received $$

Issues and Challenges from Prior Non- Adopters Clinics believe they will all have what they need to meet Meaningful Use When asked to rate satisfaction levels of various elements of their EHR, reporting and analytics ranked markedly lower than other functions A stark desire for more robust reporting and analytic functionality Of the 11% without an EHR, 89% cited reasons other than funding as the cause: lack of staff resources, organizational leadership, bureaucracy, etc.

Health Center Issues & Barriers from a National Regional Extension Center Perspective Courtesy of:

REC Sites By Barrier Type Reported Data Source: ONC CRM Database (March 3, 2012).

Top Five Barriers for CHCs (Proportion of Providers Impacted) Rank CHCs 1 Administrative 2 MU Measures 3 Certification 4 Medicaid 5 Vendor Selection # providers with barrier reports 2921 Data Source: ONC CRM Database (March 3, 2012). Non-priority hospitals did not report any barriers. Attestation Process Practice Issue Vendor Issue MU Measure

Top Five MU Measure-Specific Barriers for CHCs (Proportion of Providers Impacted) Rank CHCs 1 Core 12: Electronic copy (17%) 2 Menu 5: Electronic Access (17%) 3 Menu 7: Medication Reconciliation (16%) 4 Core 15: Security Review (14%) 5 Menu 9: Immunization (14%) Data Source: ONC CRM Database (March 3, 2012). Rural Hospitals and non-priority hospitals did not report any MU Measure Barriers. Users may select multiple measure-specific issues as barriers within one report, therefore, these numbers may overestimate the total number of Barrier reports for Measure- specific issues.

Proportion of Providers at CHCs that Reported MU Measure Barriers: Core CHCs Core 1: CPOE Core 2: Drug Interactions Core 3: Problem List Core 4: eRx 1.10 Core 5: Active Medication List Core 6: Active Medication Allergy List Core 7: Demographics Core 8: Vital Signs Core 9: Smoking Status 1.32 Core 10: Reporting Ambulatory CQMs Core 11: Implement CDS 1.98 Core 12: Electronic Copy Core 13: Clinical Summary 5.71 Core 14: Electronic Exchange 3.52 Core 15: Security Review Data Source: ONC CRM Database (March 3, 2012). Rural Hospitals and non-priority hospitals did not report any MU Measure Barriers. Users may select multiple measure-specific issues as barriers within one report, therefore, these numbers may overestimate the total number of Barrier reports for Measure- specific issues.

Proportion of Providers at CHCs that Reported MU Measure Barriers: Menu CHCs Menu 1: Drug Formulary Check Menu 2: Laboratory Tests Menu 3: Patient Lists Menu 4: Patient Reminders Menu 5: Electronic Access Menu 6: Educational Resources Menu 7: Medication Reconciliation Menu 8: Summary Care Record Menu 9: Immunization Menu 10: Syndromic Surveillance 2.86 Data Source: ONC CRM Database (March 3, 2012). Private Practices with 11+ providers, Public Hospitals, Rural Hospitals, and non-priority hospitals did not report any MU Measure Barriers. Specialty Practices did not report any Menu-set specific Barrier Issues. Users may select multiple measure-specific issues as barriers within one report, therefore, these numbers may overestimate the total number of Barrier reports for Measure-specific issues.

Implications for Overcoming Challenges and Barriers Moving Forward Health centers will require assistance with more sophisticated and costly functionalities such as e- Rx, Patient Portals, HIE, etc. Patient Centered Medical Home intersects with Meaningful Use work and it will be beneficial to work on these goals together in lieu of silos Stage 2 MU brings new requirements and criteria that require development of new tools and education materials to assist CHCs (e.g. patient portal and interoperability requirements)

Questions? Shane C. Hickey, MBA, MS Director, Information Technology Assistance National Association of Community Health Centers or