1. IHS EHR Indian Health Service Electronic Health Record COMMUNITY HEALTH PROGRAMS Their Experience with EHR Marge Koepping, RN, MN, FNP IHS Model Diabetes Education Program

2. Community Health Programs  Diabetes Program  Public Health Nursing  Nutrition Program/WIC  Community Health Representatives  Maternal Child Health  Community Wellness Team

3. EHR & Community Health  Community Health visits may be different: Field /Home visits vs clinic visits Field /Home visits vs clinic visits Group Visits: in clinic and in community Group Visits: in clinic and in community Case management/chart review/preventative care. “Safety net” functions. Case management/chart review/preventative care. “Safety net” functions. Drop in visits vs scheduled encounters. Drop in visits vs scheduled encounters.

4. Process Changes:  All programs/providers needed computer access and needed to integrate the process changes.  Field visits sometimes required portability  Documenting group education/visits  Use of additional signer of notes increases communication  Consideration of scheduled visits vs drop in visits

5. Process Changes (cont.):  Case Management - Chart Reviews Registries still function as before in RPMS world.Registries still function as before in RPMS world.  Flow Sheets – finding creative solutions to tracking care Addendums to notes or consultsAddendums to notes or consults Templates for periodic reviews of care, education visits or complicated protocolsTemplates for periodic reviews of care, education visits or complicated protocols Worksheet function on labs tabWorksheet function on labs tab

6. Worksheet function on lab tab:

7.  Consult/Referral process Prepare for increased # of referrals Prepare for increased # of referrals Prepare for temporary increased avenues of referrals. Prepare for temporary increased avenues of referrals. It helps to keep a paper log of referrals to make sure things get completed while programs learning. It helps to keep a paper log of referrals to make sure things get completed while programs learning.

8. What we discovered with EHR…  Faster entry of case management chart reviews….  Increased visit documentation…  Increased communication…

9. Some challenges…  How to call attention to a special needs patient ?….  Drop in visit vs scheduled visit  Errant diagnoses triggering reminders that do not apply.