Our EHR Journey: A Good to Great Analysis

It's 3:30 p.m. and a 35-year-old Chicago resident is waiting for the bus. He has just finished his shift at a local manufacturing plant and is exhausted from a long day on his feet. He also is feeling a bit shaky and experiencing blurred vision.

When he gets home, he takes a blood glucose test and then logs onto his computer. He has diabetes and the low sugar levels from his test confirm why he feels shaky and has blurred vision.

He logs into his electronic health record patient portal and sends his primary care physician a message with his glucose level. The EHR patient portal allows him to track and graph his blood sugar levels and all other lab results, schedule appointments, review medications and request refills, review his healthcare problem list and goals, and — most importantly — communicate directly with his primary care physician. His primary care physician, who has been working closely with him to stabilize his glucose level, responds immediately with follow-up instructions.

This is a typical Access Community Health Network EHR success story of how our patients can now interact with their physicians beyond the health center walls. Many of our patients struggle to control their chronic conditions. By leveraging the right technology, we are now able to help patients better manage their health.

As one of the nation's largest federally-qualified health center networks, ACCESS is always looking for ways to empower our patients to be actively engaged in their healthcare.  While many of our health centers are located in underserved communities, we strive to ensure that they receive access to high-quality care and the best tools to manage their health.

In four short years, ACCESS — in collaboration with our EHR partner, Epic — created a robust, patient-centered EHR system that achieved Stage 6 ambulatory EHR recognition through the HIMSS Ambulatory EMR Adoption Model, which has been attained by only 2.4 percent of ambulatory health centers nationwide. The achievement is even more remarkable because our information technology department created a full organizational IT systems strategy while concurrently implementing the EHR in those four years. 

Many other healthcare organizations are going to start — or have started — a similar technological transformation. Here are some of the top takeaways from our experience, modeled after sections in a classic business book about transformational change — "Good to Great" by Jim Collins.

1. Level 5 leadership. The ACCESS leadership had a fierce resolve to do whatever was needed to implement EHR successfully.  We understood an EHR strategy was the foundation for future success and pursued it with fearless humility.  We knew we would make mistakes, but we would learn from them and not let them deter us from our goals.

2. First who, then what. One of our most important accomplishments was hiring and developing the right people for our new IT department. With a great deal to accomplish in little time, every position was instrumental to our success. ACCESS IT developed a recruiting and retention strategy focused on cultural fit, passion, aptitude and commitment to our organization's mission, vision and values. In a competitive HIT marketplace, ACCESS' recruiting, training and retaining strategy continues to be one of the most important keys to success.

3. Confront the brutal facts. Before the Patient Protection and Accountable Care Act was enacted in 2010, ACCESS had decided the patient-centered medical home care delivery model would be our strategy to serve our patients across the continuum of care.  We knew the model would reduce costs and increase quality if we successfully implemented a three-pronged EHR strategy: the record, the patient portal and the community partner portal. Healthcare information technology is a strategic advantage, allowing us to quickly react successfully to changes. 

4. The hedgehog concept. We defined a simple and unifying HIT vision to support a very complex and changing healthcare environment.  We drew up the three-pronged HIT platform strategy on a napkin during a 2009 lunch, and it has framed all HIT decisions since then. We took the complex and made it simple, which has fostered an organization-wide understanding of where we are going and how important HIT is in our strategic plans. As the healthcare industry transforms to support the PPACA, our strategy continues to stand the test of time.  One of our principles was to partner with one vendor, one integrated product line and one patient record to coordinate a patient's care across the continuum to support the PCMH.

5. A culture of discipline. We defined a structured methodology to successfully implement systems but, more importantly, developed disciplined teams to work across the entire organization. An essential aspect of our strategy involved adjusting new organizational and governance structures to maximize ACCESS' ability to implement and use technology. With that foundation in place, optimizing our systems to support care is now part of our organizational thought process. 

6. Technology accelerators. Our vision and strategy for providing patient-centered care across the continuum drives our pragmatic use of HIT.  Our greatest accomplishment has been to create a simplified HIT framework to support a very complex and changing healthcare environment. We use technology to accelerate our business.

By using HIT in a transformational manner, we've developed a sustainable model that will support our future care delivery system and evolve as our organization continues to respond to the changing healthcare landscape. For example, we plan to use our EHR for telehealth, care coordination, after-hours support and more robust patient portal capabilities.

The journey to be a patient-centered medical home is worth it, not only for our organization but also for the patients and communities we are honored to serve.

Julie Bonello, B.S.N., M.S., is CIO for ACCESS, with 30 years of leadership experience in healthcare information systems, consulting, operations, research and nursing. During her past four years at ACCESS, Julie has transformed the organization’s Information Systems from the ground up to build a robust infrastructure that now not only has the capabilities to maintain all-new administrative systems (including payroll and financial), but also the ability to launch and support ACCESS’ own electronic health record (EHR) across its health center network. She has held senior positions in health care IT consulting with First Consulting Group and Price Waterhouse, as well as CIO positions at Children’s Memorial Hospital and Cook County Health and Hospitals System. She earned her CHCIO accreditation this year.

Donna Thompson, R.N., M.S., is CEOof Access Community Health Network. In her nine years as CEO, Donna has led ACCESS to become one of the largest federally qualified health center organizations in the country. ACCESS serves nearly 200,000 patients annually, 45,000 of whom are uninsured, in nearly 40 health center locations across the greater Chicago area including suburban Cook and DuPage counties. Under Donna’s leadership, ACCESS has developed a model of healthcare that helps patients navigate the gap between community based care and other resources, both those in hospitals and in other community agencies. She also organized the Stand Against Cancer program in 2002, which led to nearly $4 million in annual state funding, and Pin-A-Sister™/Examinate Comadre™, a cancer awareness program which has reached more than 700,000 people in the African American and Hispanic communities.

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New Bill Aims to Boost mHealth Use in Government Healthcare Programs 

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