Patient-Centered EHR Journey at the Community Health Level

How one of the nation’s largest federally qualified health centers is transforming its model of care

Implementing an electronic health record is a major undertaking at any provider organization, but is especially challenging in an environment without any IT infrastructure or an information services (IS) department. Yet that’s the goal the Access Community Health Network (ACCESS) set for itself, and met in a short timeframe, to better serve patients in underserved areas of Chicago. ACCESS, which is one of the nation’s largest networks of federally qualified health centers (FQHCs), provides ambulatory services to more than 200,000 patients at nearly 40 health centers across greater Chicago.

ACCESS met its goal in just four years, using an HIT strategy based on the patient-centered medical home (PCMH) model. According to Julie Bonello, CIO of ACCESS, who oversaw the implementation process, the PCMH model provided a simple and unifying vehicle that was understandable organization-wide. She recently spoke with Healthcare Informatics about the implementation process and how it has helped to transform patient care in the ambulatory setting.

PCMH as a Unifying Principle

Bonello explains that ACCESS has implemented a three-prong HIT strategy: first, an electronic health record (EHR) to document patient information and align it with PCMH patient population standards; second, a patient portal that aligns with the patient engagement standards in PCMH; and third, a community portal that aligns with PCMH care-coordination standards. That approach has allowed ACCESS to meet its patient-care goals, Bonello says. It aligns the patient record to chronic care conditions and also the normal preventative wellbeing of different age groups, she says.

To increase access for its patients, it also set up a call center and follow-up work queues for all of its patients who need appointments, based on preventative maintenance. It fully documents every patient in the electronic record, according to clinical guidelines for its most prevalent chronic care conditions, including diabetes, hypertension and asthma. To enable patient engagement, it implemented a patient portal. “We have utilized many different methods to assess a patient’s readiness to use a portal, and we have also built out the capabilities of our portal to align with the chronic conditions,” she says. This has allowed providers to speak with their diabetic patients to discuss their patient care goals, how to communicate with each other, based on their diabetic care plan, she says.

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