- HealthNet, the largest Federally Qualified Health Center (FQHC) in Indiana, is a recipient of this year’s HIMSS Ambulatory Davies Award of Excellence, a program that recognizes outstanding improvement in patient care, outcomes, EHR adoption, and population health management.
With two-thirds of its 60,000 patients covered by Medicaid, HealthNet’s challenging urban environment requires the 150-provider organization to rely heavily on health IT tools to deliver a broad array of services. The organization provides everything from dental care to maternal services to school-based clinics and care programs for the homeless.
In its award application documents, HealthNet provides valuable details about its successful EHR implementation process and the care strategies it employed to become a deeply integrated, community-based resource for high quality care.
“As a federally qualified community health center, HealthNet has a large pediatric population with significant social determinants that contribute to the development of chronic disease,” said Jonathan French, director of quality and patient safety at HIMSS.
“HealthNet has leveraged health IT to standardize and improve care for children and newborns within its delivery system. The Davies Committee and HIMSS congratulate the team members of HealthNet on improving the health outcomes of their patient population through the effective use of health IT.”
HealthNet is the only FQHC in Indiana to be accredited by the Joint Commission as an Ambulatory Practice, and has been an accredited patient-centered medical home (PCMH) since 2012. Ninety-eight percent of its providers have successfully attested to the Medicaid meaningful use program.
Participation in these programs, coupled with a robust and well-integrated EHR infrastructure, has produced measurable improvements in maternal care, pediatric care, and patient satisfaction.
“HealthNet is honored and pleased to receive the 2015 HIMSS Ambulatory Davies Award,” said HealthNet President and CEO J. Cornelius Brown, CHE. “A few short years ago, HealthNet was among only a handful of community health centers across the country focused on becoming wired for better patient care.”
“That dream became a reality in 2009, thanks to a [$2.5 million] grant from the Richard M. Fairbanks Foundation that enabled HealthNet to implement an electronic health record system across all our locations.” The organization also received a $1 million grant from the State of Indiana to fund its first two years of EHR implementation.
“Besides improving efficiency, the system continues to help our health care providers to better monitor and manage patients’ health risks and to significantly improve outcomes,” Brown added. “This award is a testament to the dedication of our providers and staff to keep families healthy and provide a true medical home for patients we serve.”
HealthNet took a careful and measured approach to its four-year-long EHR implementation process. In addition to training two nurse practitioners as super-users of its eClinicalWorks system to facilitate training and ensure continued patient access to quality care, the organization paid close attention to reworking its workflow processes to maintain high levels of efficiency.
Initially, HealthNet reduced physician schedules to compensate for the learning curve, using their NP super-users to cover appointments for approximately half of their patients. While physicians cut their patient workload by 50 percent to allow them time to get familiar with their new electronic tools, HealthNet still saw between 90 and 95 percent of its usual patient volume thanks to the efforts of its nurse practitioners.
“We believe this time given to [providers] during go-lives decreased frustration with learning the new electronic way of charting and allowed them to more quickly remove blocks in their schedule and get close to pre-EMR productivity,” say organizational leaders.
“We also benefitted by pausing early in the EMR implementation process and reworking our internal patient flow processes (including updating our nursing standing orders to mirror these new processes) and improving our training and support services,” HealthNet continues.
As a result of this, providers in some of the system’s health centers were able to approach pre-EHR productivity levels within three to four months, compared to almost 12 months for the initial implementation sites.
HealthNet also paid close attention to integrating its behavioral health services with its primary care delivery. Behavioral health providers and primary care providers are located in the same buildings, facilitating access to care, and the two divisions can easily share data using the integrated EHR platform.
“Regardless of specialty, all of our providers can now meaningfully contribute to the patients’ medical record as well as utilize the combined information to optimize the medical care provided,” HealthNet says. The provider developed a series of new policies and guidelines to support clinicians as they navigated the transition, and continues to refine its strategies as new challenges arise.
The EHR system also provides clinical decision support reminders, including flagging opportunities to bring comprehensive prenatal care to expectant mothers. Using a standardized template, the organization was able to increase early entry into prenatal care programs from 58 percent in 2011 to 71 percent in 2014. Low birth weight deliveries decreased accordingly, from 8.1 percent in 2011 to 6.6 percent in the first half of 2015.
As a result of these efforts, HealthNet has significantly increased its patient satisfaction scores. While the health system started off with a respectable 4.2 out of 5.0 rating in 2009, its patient experience marks skyrocketed to between 4.5 and 4.6 after EHR implementation.
Performance on clinical quality measure sets also improved, bringing financial gains as well as clinical ones. In addition to payments for services rendered, HealthNet has earned more than $1.5 million in pay-for-performance bonuses due to improvements on their HEDIS scores.
Quality improvements include increasing adult tobacco cessation counseling rates from 77 percent to 100 percent, boosting pediatric weight assessments from 26 percent to 73 percent, and nearly doubling the rate of well-child checks for infants and teenagers.
“As health plans are a couple of years behind in paying out these bonuses, HealthNet stands to earn more in the next 2 years for improved performance reported in 2013 and 2014,” they added. “We anticipate earning at least another $100,000 for performance on these measures in 2013 and 2014.”
HealthNet limited provider frustration with these myriad efforts by focusing on a few critical mission objectives, and developing a staff incentive plan to motivate clinicians into meeting their quality goals. Front-line staff were deeply involved in designing workflows and templates, while a multi-disciplinary leadership team made sure that staff members achieved an optimal balance between clinic time and involvement in the quality improvement process.
HealthNet will be honored for its achievements at the 2016 HIMSS Conference and Exposition in Las Vegas, Nevada between February 29 and March 4, 2016.