Urban Health Plan
Despite signs of urban renewal in recent years, the Mott Haven section of the South Bronx in New York City remains one of the poorest communities in America. More than half of the population, primarily Latinos and African-Americans, live below the poverty line and receive public assistance.
The South Bronx unemployment rate is in the highest percentile among all U.S. counties. At the same time, its residents suffer from high rates of diabetes, asthma, obesity, HIV/AIDS, and mental health when compared to the rest of New York City.
Despite signs of urban renewal in recent years, the Mott Haven section of the South Bronx in New York City remains one of the poorest communities in America. More than half of the population, primarily Latinos and African-Americans, live below the poverty line is in the highest percentile among all U.S. counties. At the same time, its residents suffer from high rates of diabetes, asthma, obesity, HIV/AIDS, and mental health when compared to the rest of New York City.
Mott Haven and the rest of the South Bronx provide a stark picture of disparities in health care, where the economically disadvantaged and certain population groups do not have access to quality clinical care. Today, a myriad of federal, state, and local agencies’ programs are underway to remove these disparities. All agree that tracking community health needs to develop evidence-based programs is vital for evaluation of health outcomes. An essential tool to track these needs is the electronic health record (EHR), which can be used by the local health care providers that serve these underserved communities.
City health facilities, which provide clinical care to the underserved and are exploring the feasibility of adopting an EHR for their patients, need to look no further than the Urban Health Plan (UHP) as a model for implementation. Located in the South Bronx, UHP was established as a community health center in 1974 by a local physician. Since then, it has grown to be one of the largest providers of ambulatory care services in New York. Serving the South Bronx and the Corona section of Queens, UHP is a Federally Qualified Health Center and receives funding to provide comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay.
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UHP first implemented an EHR in its integrated health care and practice management system in 2006 to manage care for 31,000 patients at UHP's sites in the Bronx and Queens. With that implementation, UHP's appointment scheduling and tracking has become more efficient. Providers now schedule patient appointments right in their examination rooms. This allows for individual tailoring of appointment dates and times, which in turn leads to improved attendance or "show" rates to appointments. "No-show" reports are generated daily to improve care management, which helps in contacting "no-shows" to make new appointments, accommodating walk-in patients, and improving UHP's ability to construct provider schedules. Patient access has been enhanced because they can receive care at any one of UHP's network of service sites since they are all connected to a single patient database. This assures that a patient's information will be available to all sites immediately and securely.
UHP preventive medicine services, essential to overall community health, have also been enhanced by adoption of an electronic health record. The EHR supports targeted mailings and reminders to patients alerting them of upcoming health maintenance appointments. An added feature is the ability to collect data on patients’ cycle time (movement of a patient from entry into the facility through discharge). The cycle time was an area identified for improvement and, through the use of the EHR, UHP can easily track this. The results have been impressive -- a 42 percent decrease in cycle time in its busiest clinic, according to UHP.
In addition, UHP has worked with its software vendor to improve care coordination through enhancement of the EHR’s features. For example, the UHP Referrals Department is responsible for scheduling and re-scheduling referral appointments and tracking consults to ensure patients received their specialty care. With vendor's upgrades, the department can now track how many referrals are made, how many specialist appointments are made, the percentage of appointments kept, and how many specialist consult reports have not yet been received by UHP. Specific documents, e.g., labs and diagnostic imaging, can now be attached to each referral so the specialists have the required information to treat patients.
This capability enables follow up on all patients sent to the emergency room. A referral is printed along with all other relevant clinical information including a medical summary and given to the Emergency Medical Service to take to the hospital with the patient. The referral is electronically assigned to the staff member designated as the ER Tracker, enabling them to follow-up on the patient’s disposition and course of treatment as well as schedule necessary appointments.
UHP’s goals for an EHR system are that implementation lead to improved access to care, reduction of health disparities, and improvements that permeate throughout the culture of the organization. Enhanced care coordination, new public health functionality and biosurveillance capabilities were other anticipated benefits. All these benefits were realized, and the decision support tools embedded in the EHR have further served to improve health outcomes. Providers are now reminded on a real time basis of evidence based guidelines that assist in assuring patient needs are properly addressed, such as aspirin for diabetics with ischemic vascular disease.
EHR implementation at UHP was led by a core project team consisting of the Chief Executive Officer (CEO), the Chief Medical Officer (CMO), the Chief Technology Officer (CTO), and the Project Manager (PM). The composition of the team was critical to the success of the project because it assured the support and buy-in of the most senior level staff in the organization. To advance implementation, the team selected a group of providers to assist with vendor and EHR selection, and constructed the following vendor requirements based upon the initial EHR experience:
- Compliant with industry standards features;
- Outstanding customer service;
- Financially viable;
- Strong support capabilities;
- Strong commitment to Community Health Centers; and
- Integrated Practice Management
In 2009, Paloma Hernandez, President and CEO of Urban Health Plan, Inc. accepted the Healthcare Information and Management Systems Society (HIMSS) Davies Award, a recognition of the organization’s excellence in implementing health IT and deriving value from the use of electronic health records. In her remarks she stated, “We at Urban Health Plan are honored to receive the distinguished Davies Award. Since 2006, when we successfully implemented our EHR system, we have been able to transform our health care delivery system in how we treat our patients, track their health care outcomes and more importantly, continuously work towards improving the health of the communities we serve, namely the South Bronx and Corona, Queens. Our work will go a long way in aiding the elimination of health care disparities in these communities."
Urban Health Plan has created a template on how other urban health facilities can adopt health information technology for the benefit of their patients. For this, New York City has led the applause for their accomplishments.