Clinica La Salud is a nurse practitioner-led primary care clinic serving a low-income community in the outer edge of Houston, Texas. The majority of the patients seen by the clinic staff are underserved minorities. The clinic primarily treats Medicaid patients; many of who are first-generation immigrants and their children.
Clinica La Salud had a failed electronic health record (EHR) implementation and needed to convert to a new EHR. The clinic started engaging with the Gulf Coast Regional Extension Center (GCREC) in February 2014 in the midst of its replacement EHR implementation. Alexa Poole was the GCREC consultant who worked with the site prior to the actual production use of the replacement EHR. She assisted the practice with Meaningful Use (MU) workflows to specifically help the practice optimize its use of the EHR for problem lists, clinical visit summaries, and patient access.
Most of the practices working under MU Stage 1 guidelines had difficulties with the clinical visit summary core measure. For this measure, a patient was provided a summary of their visit within three business days. The measure was particularly challenging for new EHR adaptors because clinicians often experienced delays in completing progress notes. With GCREC’s assistance on workflow modifications and MU training, Clinica La Salud was able to increase their threshold for this measure from zero to ninety one percent in four months.
A primary goal of the clinic has been to empower patients and their families with education. The practice treats a lot of Hispanic patients and perception, within their culture, is critical. “There is an expectation to use your hands with the patient or child. It is not ideal to go into the room with a computer,” notes Pamela Lombana RN CPNP, the owner and lead clinician for Clinica La Salud. Now they have nurse practitioners document outside the room and “this works for us and we have been able to use EHR tools for patient counseling and nutrition education,” noted Lombana. “Following MU guidelines has allowed us to raise standards by improving our providers’ documentation. We are now documenting the education we provide and printing summary reports - this has improved the quality of care we give and we even earned an award for it,” referring to the recognition the practice received from Community Health Choice, Inc.’s 2015 Provider Engagement Council.
Another win for the practice was the completion of the link with the state’s immunization registry, even though the requirement for the initial year was to perform a test. The site pushed onwards to connect with the registry and start sending data during the first year. GCREC assisted the practice to troubleshoot communication issues between the EHR and the registry. Transmitting immunization data has been extremely helpful to the practice since the staff primarily treat pediatric patients.
When GCREC first engaged with the practice, the clinicians were inundated with the amount of information they had to sift through to meet the Medicaid MU guidelines. Understanding MU program requirements while implementing an EHR was overwhelming. GCREC’s support guided the final stages of their system rollout as “we were able to mold workflows to meet practice needs and fulfill MU requirements. This is an amazing program,” states Lombana.
Prior to implementation, the practice received reports from other clinics on how the practice would slow down with EHR use. The clinic has functioned better with laboratory results feeding into the patient’s record as structured data and patient referrals are performed more quickly. “Once it is implemented, you are back to where you were before, you gain efficiencies in some areas and are able to move clinic staff around to pick up other work,” notes Lombana.
Lombana also notes that “the most important aspect of the implementation process was maintaining compassion and empathy throughout the entire process. Finding the time to make it personable is the biggest thing.” The clinic sees the EHR as a tool that has improved their practice by raising the bar on clinician documentation and competencies. The practice has been able to translate this into improved patient monitoring and education. For example, the practice found the integration of laboratory results to be extremely helpful. In four months, their lab interface measure was at 97%; this allowed clinicians to quickly review structured results at the patient level. The instant flow of data allowed the clinic’s nurse practitioners to address issues quickly; a significant change from when results would be queued in the fax printer to be manually filed to the patient’s chart. Lombana believes that following the MU guidelines has truly improved the quality of care they provide to patients.
The practice hopes to move forward with the Meaningful Use program, focusing on its remaining objectives: advanced clinical processes and improved outcomes. Implementing a new EHR while continuing to treat patients and provide the best care possible forced the practice to apply new workflows quickly, without much time for additional EHR training. The practice hopes to gain more knowledge of the software, using its tools to their full advantage. With customization of templates and enabling advanced functionality within the patient portal, Lombana wishes to further improve patient care by monitoring clinical quality measure reports and empowering patients to take a role in their personal health care.