Case Study

Financial gain with reduction of medical records staff
Ease of incentive program reporting
Improved quality and ability to proactively monitor patient care

Blackstone Valley Community Health Center’s (BVCHC) mission is to provide the highest quality, lowest cost healthcare to the Rhode Island residents of Central Falls and Pawtucket.  Health maintenance and disease management are particularly important, as leading diagnoses include chronic diseases such as obesity, diabetes, and asthma.  In an effort to increase quality, efficiency, and continuity of care, and to strengthen finances, BVCHC began exploring technology solutions. “We had to accelerate and improve the delivery of care, facilitate the acquisition of reports, and improve the execution of administrative tasks,” says Executive Director Ray Lavoie. “To accomplish this we envisioned a paperless environment where the information needed would be readily available to clinical and non-clinical staff with a few clicks of the mouse.”

Dr. Fingerut and Lavoie assembled a core group to lead the implementation effort, which included a Chief Information Officer, members of Human Resources, Finance, and of Clinical Operations. The group completed several financial analyses during the selection process, and monitored how patients moved through their system.  They sought to understand the workflow and answer questions such as: Who brings the patient to the exam room? Who completes which part of the medical record? What happens after the appointment? What happens when a patient calls the office with a question?  They realized that as a health center that provides pediatrics, family medicine, internal medicine, women’s health, dental and behavioral health services, they needed a range of templates with specialty content to serve all segments of their population.  Ultimately, the team deciding to implement NextGen’s integrated solution, including an enterprise practice management system (EPM), EHR, and an Electronic Dental Record (EDR) so says Fingerut, “dentists can see allergies, medical histories, and current medication lists—they have access to a comprehensive record at the time of the dental visit.”

To prepare for implementation, BVCHC chose to complete an initial manual data migration of medication lists, chronic conditions, immunization history, and allergies before the first electronic visit. After the first visit was complete, the chart was scanned so it would available electronically.  “Each of the six sections of the paper chart became a distinct category in the EHR, allowing clinicians to search through the scanned images of the paper chart in the EHR in the order they were used to.”

When implementation neared, “we decided the ‘big bang’ approach was best for us, and we worked hard to make the transition a positive experience through catered lunches and a positive atmosphere.” BVCHC invested in a comprehensive training plan that utilized e-learning modules and in-person trainings three weeks prior to go-live.  Each segment of the health center had a core group member assigned to train their staff and everyone was assigned learning modules based on role and responsibilities.  “We created a permanent training room so all staff could practice in a test database. We also tested the process by doing a mock go-live with real patients one week before we went into production.”

During go-live, each provider’s schedule was cut in half for the initial 3-4 days. Each clinician was then individually evaluated every 4 to 5 days and as skills permitted their schedules were incrementally increased. “We advise other physicians to do the same—you can’t put someone in a new environment on day one and expect them to do a 15 minute visit.”  Four weeks after go live, everyone was at full productivity.

Improved Productivity Utilizing an EHR has provided operational benefits in time savings and increased staff efficiency. “We were forced to look seriously at our workflow—it was an opportunity to examine why we do things or why we don’t do things. The whole organization became more efficient, says Dr. Fingerut: “Productivity has increased annually by 3.6% and administrative and clinical staff is less stressed because we eliminated paging, Post-Its, and paper chasing.”

Better Access to Data Immediately BVCHC enjoyed the benefit of instant access to patient information. “Typically practices find that 5-10% of paper charts are not available when providers need them.  Now all data is available at our fingertips.”  On-call providers can also access medical records remotely. The EHR’s real-time access to patient information has proven extremely valuable in emergency situations as well. Periodically the health center needs to transfer a patient to the hospital quickly. “When we have to call the ambulance, we just press a button and the EHR produces the patient’s vitals and everything recorded in the visit. We hand it to EMTs and we have saved the patient a half hour of questioning. Data can also be transmitted directly to the ER. We have been thanked profusely by ER doctors for this.”

Patient Appreciation BVCHC appreciates the benefits of more complete information and opportunities for patient involvement. “The EHR also supports our clinical decisions: providers have all relevant clinical information on hand when they make decisions. And because most of the system is point and click, doctors spend more face time with the patient.  Patients appreciate being able to see their data, like their blood sugar graph or growth chart—it really helps them to understand the meaning of these data.”

Increased Patient Safety BVCHC physicians utilize a system where virtually every piece of data is digitized and anything can be reported on.  “We have increased patient safety because we have significantly reduced the possibility of drug to drug interactions and can quickly generate drug recall lists when necessary. You can’t do that in 10 minutes with a paper record.”  They have also focused on improving chronic disease management, utilizing the EHR for individual performance reports, and proactively identifying patients due for preventative or follow-up care.