Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Dennis Eberhardt is clinic director of Cow Creek Health & Wellness Center, which provides healthcare services to the Cow Creek Band of Umpqua Tribe of Indians at two locations in Oregon. Part of the US Indian Health Service, the center recently decided to replace its government-issued Resource and Patient Management System with Intergy software from Greenway Health.
Why did Cow Creek decide the time was right to move from its government-provided patient management software to a commercial product?
The need to move from RPMS has been present for a long time. RPMS, never developed as a true EHR but rather as an Indian Health Service-centric public health data collection device, has been obsolete for a couple of technological generations at least. From an operational vantage point, the decision was simple. Implementing a change of this magnitude, however, is difficult and can be more injurious to an operation than staying with a poor solution if not done correctly. Once the expertise to select and implement a new EHR was brought into the operation, along with the time resource to perform the selection and data conversion, the time was right to proceed. The pressure to bring the EHR technology into the current century is mounting as healthcare is rapidly evolving to a data-driven venture.
What adoption and implementation challenges are unique to organizations that are part of the Indian Health Service?
For a compacted facility there really are not that many. Of utmost importance are the Purchased and Referred Care functions, and accurate data collection and reporting for the National Data Warehouse – both of which are easily handled by Greenway Intergy.
Is Cow Creek participating in any federal value-based programs? If so, which ones, and how important is healthcare technology to your participation?
Unfortunately, RPMS makes participation in value-based programs difficult. Technologically, the reporting of the necessary data is resource intensive and, depending on how the report is formatted, the data can appear to be different for two queries. Greenway’s recording and reporting functions are made with value-based programs in mind, so it will be a natural progression for us once the EHR is fully implemented.
What other types of health IT is Cow Creek using at the moment? How have you seen these technologies improve patient access and care outcomes?
Part of the Intergy package is a patient portal, which will allow patients to communicate with the clinic electronically; and request appointments, refills, and information. The clinic can push out surveys and relevant information regarding current events or patient-specific education.
An optional program within Intergy is the Community Health module, which constantly scrubs the records and reports for actionable items for each patient, called “care gaps.” These can be reported according to established selection criterion, be that all patients or even the next day’s scheduled patients. This will increase our compliance with value-based initiatives, as well as help us deliver a more comprehensive primary care service to our patients.
We are investigating an add-on to Intergy that improves the patient experience. Allowing full electronic patient check-in and then delivery of (age/gender) relevant and branded interactive education for consumption during the waiting time.
Patient outcomes and safety are partially dependent on a well-trained staff. We just recently implemented a fully functional Learning Management System that houses all training and training records online, and is accessible 24-7.
Due to our two-clinic footprint and the fact that our PCP teams travel between locations, patients sometimes need to be seen by the resident team and not by their own PCP team. Although quality is good, it is less than optimal. We are instituting an in-house telemedicine program that will allow the PCP to be virtually present at the other clinic if one of their patients desires to be seen on a day when they are at the other location. This increases access as well as continuity of care.
After-hours care is always problematic. Placing providers on-call has been the go-to option in the past. This is suboptimal for a provider, and has not been shown to deliver better outcomes nor increase patient satisfaction when a provider who is not their PCP is answering the call. We have instituted a 24-7-365 After-Hours Nurse Triage line. RNs address the issues of the patient according to nationally accepted protocols. Patient satisfaction has been higher than on-call since the patient expectation is different. Emergency department visits for routine care are decreased as a result.
The next step is to institute a year-round after-hours, physician-staffed telemedicine service option for patients. Again, patient expectation is that this is equivalent to an urgent care visit. But this increases access to 24-7-365, and patient satisfaction with these services is high. Due to the high degree of communication between the telemedicine vendor and the clinic, as well as our practice of follow up for each after-hours call, outcomes are likely to improve.
What’s next for the clinic in terms of health IT adoption?
Telepsychiatry and tele-behavioral health augmented by in-person support personnel. We are investigating a vendor relationship to bring in service that we would not be able to staff due to rural location and patient loads. These would address true capacity gaps in the community.
Next year will see us fully embrace the outsourcing of claims management, payment posting, and patient statements functions. While this may not directly translate to better outcomes, it does release resources that can be used to deliver more services.
The other next big thing is health information exchange. We will be engaging with partners to share aggregated and specific PHI among various providers and entities to facilitate prior authorizations, insurance eligibility confirmation, referrals, and care coordination.
Finally, interactive online education. There is a large body of knowledge now about how brains function while learning – what sticks and what doesn’t work. Interactivity that is contextual, gamified, and meaningful is under development by our own content producers to be deployed via the patient portal as well as our revamped Web presence.