1. Elizabeth Markona, Health Promotion Programs Manager, and Amanda Guay, Director of Community Health Programs EHR & Systems Change Adventures in a CHC

2. 20 Existing Clinics Ash Fork Bullhead City Flagstaff Grand Canyon Holbrook Kingman Lake Havasu City Round Valley Seligman Show Low St. Johns 4 North Country HealthCare Connect Integration Clinics in BH Centers Virtual Clinic Payson Williams Winslow Mobile Medical Unit:  School Based Health Services  Employer based health services

3.  Primary Care Medical Services (Family Practice, Internal Medicine, OB/Gyn, Pediatrics)  Dental Care  Behavioral Health Counseling  Prenatal Care  Preventive Screening  Diabetes Management Program  Integrative Medicine  Pharmacy  Telemedicine  Outreach Programs  School-Based Health  Employee Health  Care Coordination

4.  Well Woman/FIT at Fifty HealthChecks  Maternal & Child Health  Diabetes Program  RESEP  HIV/AIDS Ryan White  NACASA  Domestic Violence  Hermosa Vida  SBIRT Prenatal Program Well Woman Program Nuclear Blast, Nevada 1952

6.  Assess CHC Readiness  Leadership Buy-In  Data Collection and Reporting Capacity  Create a Measurable Aim  Illustrate the Value  Go Beyond the Numbers  Be Specific  Don’t Go it Alone

7. Leadership Buy-In  Establish clinical indicator as a priority for the organization  Agreement that the change is important Data Collection and Reporting Capacity  EHR enables comprehensive monitoring and reporting

8. Develop a specific, measurable, achievable, realistic and time related goal  Establish baseline  Inform by UDS and Meaningful Use  Consider resources and low hanging fruit  Communicate the goal and monitor progress Build the infrastructure to collect the data and provide feedback to the system on progress toward the goal  Share the data and receive feedback to improve the quality/utility of the data  Getting credit for care provided - Document

9.  Meeting care opportunities for patients  Positions the CHC to meet expectations  Communicate the business case

10.  Share patient stories  Demonstrate missed opportunities  Identify provider champions  Provide links to screening for uninsured patients/resources

11. Provider Specific Reminders  Use available reports/manual audits  Pilot provider specific feedback  Develop new reports (free text)  Create clear referral system within EHR  Establish specific steps in workflow

12. Evidence-Based Programs Leverage Other Contributing Efforts  EHR Network  PCMH efforts  Affordable Care Act provisions  UDS reporting requirements

13.  Recommitment of leadership  FFHP report - Provider specific feedback on patients they will see  Provider initiated clinic successes (Lake Havasu City and Kingman)  Enhanced capacity with EHR EHR enables comprehensive screening rate reporting (patient universe) expedited audits by location, provider, insurance status, etc. “term” searchable charts (Hysterectomy) Provider reminders and communication from a distance (satellites)

14.  Exemption considerations in reporting  Provider preferences and ability to customize EHR: modifiable views of EHR, provider-specific visit-flows  Documentation location and frequency of documentation when to document (patient reported) control of forms and options for documentation within EHR (Alliance EHRS Network)  Resistance to flags, accuracy of flags, flag fatigue  Patient empanelment

15. There is an, “incredibly important, and largely unnoticed, role that health centers play in improving the health of not just their individual patients, but their communities.”  David Fukuzawa, Kresge’s Program Director for Health