HealthNet records system enables quality care for the poor

A decade ago, HealthNet Community Health Centers was looking at an aging practice management system that no longer was delivering what the Indianapolis-based organization needed.

The journey to replace that system led to an electronic medical record implementation in 2009, and a HIMSS Davies award in 2015 for using EHR to both improve outcomes and reduce costs.

“We knew many of the payers and other organizations we worked with increasingly wanted us to be on an EMR, and we knew we really should be looking at a unified practice management and EMR system,” says Lauren Borgmann, HealthNet's clinical information systems/EMR program manager. “That sparked the conversation about what else we could get out of the technology—the goals.”

For an organization that serves the Indianapolis inner city, including homeless and at-risk populations, one of the chief goals was instant, 24-by-7 access to full medical records. Through 150 licensed providers, HealthNet provides affordable healthcare to more than 59,000 individuals each year, 65 percent of them Medicaid recipients. HealthNet's network includes eight primary care health centers, one OB/GYN care center, one pediatric and adolescent care center, a maternal fetal medicine center, five dental clinics, seven school-based clinics, a homeless program with eight shelter clinics, and additional support services.

“One of our goals was to be able to both collect and report more accurate, real-time data, standardize workflows across the organization,” Borgmann says. With a paper-based system, information about patients and outcomes might be done by surveying a representative sample of patient data, rather than the whole data set. “That was a huge challenge in the paper world.”

Since implementing the EMR, HealthNet has:

• Reduced low birth weights, initially increasing patients' entry to prenatal care in the first trimester by 71 percent, and reducing low-birth-weight deliveries by 16 percent from 2011 through 2014.
• Improved care outcomes for pediatric patients, including improving adherence to best practices on weight management counseling by 181 percent.
• Significantly increased patient satisfaction through IT-driven improvements. Patients receive lab results, Borgmann says, in barely over a day; before electronic records, patients used to wait a week for results. Even watching doctors actually enter data into a computer during an exam makes patients believe that they are receiving better care, she says, adding, “They feel like the provider is really listening.”
• Delivered a return on investment for its EHR initiative of 230 percent since 2009.

These results, and additional initiatives, are driven by the EMR system. Data is housed in a single proprietary eClinicalWorks database. Healthnet uses Gateway as its clearinghouse and EBO/Cognos for reporting. The data center uses EMC as its storage array and Cisco UCS servers.

Borgmann says that user engagement and change management were the leading challenges, both during the initial EMR rollout and today. During the rollout, a key strategy was to train two floating

primary care nurse practitioners as super users, and dispatch them to provide clinicians a combination of technical and clinical expertise.

These days, keeping users informed of new programs and features is important. One technique is a monthly newsletter, but everyone gets more personalized attention, as well.

“We have three EMR analysts and myself, and we've been assigned to work out of different clinics, each for a half day every week,” she says. “Every clinic gets to see an EMR analyst each week, and that's our opportunity to touch base.”