HIT Adoption and Opportunity: Perspectives from the Primary Care Safety Net Presented by Greta J. Stewart, MPH, CAE Oklahoma Primary Care Association HRSA/BPHC State Liaison

Oklahoma Primary Care Association What are CHC / FQHCs? Private, 501(c)3s (primarily) with Federal grant support Private, 501(c)3s (primarily) with Federal grant support Of high need, Medically Underserved Areas Of high need, Medically Underserved Areas Services available to all people (of all payer types, income, age, location, etc.) Services available to all people (of all payer types, income, age, location, etc.) Offer sliding fee scale regardless of ability to pay (discounts apply for incomes <200% of poverty) Offer sliding fee scale regardless of ability to pay (discounts apply for incomes <200% of poverty) Provide comprehensive primary medical, dental, behavioral, enabling and health education services Provide comprehensive primary medical, dental, behavioral, enabling and health education services Directed by patient-majority boards of directors Directed by patient-majority boards of directors Federally Qualified Health Center -- reimbursement status for Medicaid and Medicare services Federally Qualified Health Center -- reimbursement status for Medicaid and Medicare services

Oklahoma Primary Care Association Oklahoma CHC Patients by Insurance Status, 2007 Uninsured 49.8% Medicaid/CHIP 26.2% Medicare 12.0% Private 12.1% Source: BPHC, HRSA, DHHS, 2007 Uniform Data System Range of Uninsured Rate: ~25% to 75% n= >107,000

1. Identify the Development/Training/Implementation Team Project Manager Project Manager Multi-disciplinary group to help with system development (Need Provider leader/champion) Multi-disciplinary group to help with system development (Need Provider leader/champion) Multi-Disciplinary Trainers Multi-Disciplinary Trainers IT Support Staff IT Support Staff 2. Design/Redesign Practice Protocols 3. Customize EMR for Clinical Documentation/Develop Encounter (Visit) Documentation Flow M odify templates to meet audit standards and/or practice protocols M odify templates to meet audit standards and/or practice protocols Build Interfaces Build Interfaces Decide how each template will be used and who will enter data; Determine the flow for documenting the encounter (visit) Decide how each template will be used and who will enter data; Determine the flow for documenting the encounter (visit) 4. Develop Implementation Plan 5. Develop Training Plans & Materials Implementation Planning

IT Centered Responsibilities Staff 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 (Staying on Track)

What worked well during planning and development process? What worked well during planning and development process? 1. Develop Project ORG chart 2. Include staff proficient in the appropriate tasks 3. Assess staff level of computer literacy 4. Institute fun, but effective learning opportunities 5. Document, Document, Document What worked well during transition to EMR? What worked well during transition to EMR? 1. Solidify practice management processes 2. Ensure generation of revenue 3. Closely monitor billing processes 4. Closely monitor denial management processes 5. Train, Train, Train Implementation Best Practices

Road Map To Success Workflow Review & Process Redesign & Adequate Training Implementation Best Practices

May 28, 2009 Draft description for establishment of RECs with comment period ended June 11 May 28, 2009 Draft description for establishment of RECs with comment period ended June 11 Meeting of partners Meeting of partners Late August 2009 guidance released Late August 2009 guidance released Planning underway for application (open to interested parties) Planning underway for application (open to interested parties) Regional Extension Center (REC) Collaboration

Purpose: Provide technical assistance; Consult using best practices; Communicate “Lessons Learned;” Support use of HIT Purpose: Provide technical assistance; Consult using best practices; Communicate “Lessons Learned;” Support use of HIT Goals: Goals: Encourage the adoption of electronic health records Encourage the adoption of electronic health records Assist clinicians, health centers, hospitals and clinics to become “meaningful users” Assist clinicians, health centers, hospitals and clinics to become “meaningful users” Increase probability for success Increase probability for success Priorities: Public or non-profit hospitals, CAHs, CHC/FQHCs, others entities that serve the underserved Priorities: Public or non-profit hospitals, CAHs, CHC/FQHCs, others entities that serve the underserved REC Opportunity

Design :Incorporate multiple stakeholders Leverage local resources Cooperation and collaboration Define : Geography and provider population Support levels and methods Describe :Structure of organization Staffing requirements Sustainability REC Opportunity

Oklahoma Primary Care Association For further information, contact Greta Stewart, MPH, CAE Brent Wilborn, MS Executive Director Director of Public Policy Jim Crawford Information Exchange Specialist Oklahoma Primary Care Association 4300 N. Lincoln Blvd., Ste. 203 Oklahoma City, OK (405) Fax (405)