HIT Adoption and Opportunity: Perspectives from the Primary Care Safety Net

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

2. What are CHC / FQHCs? • Private, 501(c)3s (primarily) with Federal grant support • Of high need, Medically Underserved Areas • 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) • Provide comprehensive primary medical, dental, behavioral, enabling and health education services • Directed by patient-majority boards of directors • Federally Qualified Health Center -- reimbursement status for Medicaid and Medicare services Oklahoma Primary Care Association

3. Oklahoma CHC Patientsby Insurance Status, 2007 Private12.1% Range of Uninsured Rate: ~25% to 75% n= >107,000 Medicare12.0% Uninsured49.8% Medicaid/CHIP26.2% Source: BPHC, HRSA, DHHS, 2007 Uniform Data System Oklahoma Primary Care Association

4. Implementation Planning 1. Identify the Development/Training/Implementation Team • Project Manager • Multi-disciplinary group to help with system development (Need Provider leader/champion) • Multi-Disciplinary Trainers • IT Support Staff 2. Design/Redesign Practice Protocols 3. Customize EMR for Clinical Documentation/Develop Encounter (Visit) Documentation Flow • Modify templates to meet audit standards and/or practice protocols • Build Interfaces • 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

5. Implementation Process (Staying on Track)

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

7. Implementation Best Practices

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

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

10. 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

11. For further information, contactGreta Stewart, MPH, CAE Brent Wilborn, MSExecutive Director Director of Public Policygshepherd@okpca.org bwilborn@okpca.org Jim Crawford Information Exchange Specialist jcrawford@okpca.org Oklahoma Primary Care Association4300 N. Lincoln Blvd., Ste. 203Oklahoma City, OK 73105(405) 424-2282 • Fax (405) 424-1111www.okpca.org Oklahoma Primary Care Association