Tony Ryzinski is senior vice president of marketing for Sage Healthcare which develops electronic health records systems.
Located in a medically underserved area of rural north-central Wisconsin, Peter Christensen Health Center shows how the successful transition to an electronic health record system, or EHR, can fully support improved performance for patients—even amid the most challenging of circumstances.
From its founding in 1960 until 2010, Peter Christensen Health Center served only members of the Lac du Flambeau Tribe of the Chippewa Indians on the tribe's 144-square-mile reservation. During that time, the center relied on a combination of Indian Health Service funds and significant annual subsidies from the Lac du Flambeau Band of Lake Superior Chippewa to finance its operations. As the medical challenges faced by the center's patient population grew, so did the need for greater operating subsidies from the tribe. Seeing that it was not on a financially viable course, the center's leadership opted to seek more diverse sources of funding.
With an economy that leans heavily on seasonal tourism, small businesses, and agriculture, the area around the town of Lac de Flambeau is rich in natural resources, outdoor recreation opportunities, and scenery. The small population, however, does not provide the tax base or local industries that can allow the local and tribal governments to indefinitely subsidize the healthcare providers the community needed.
Responding to the challenge, the center became a Federally Qualified Health Center in 2010, opening its doors to the community at large. The center's leadership knew that its status as a community health center also introduced new challenges. As the center worked to collect information for proper FQHC billing, it soon realized that its old billing system was inadequate. Drawing patients from throughout the area, not just from the Lac du Flambeau tribe, meant serving more under-insured and uninsured patients, in addition to a mix of Medicare and Medicaid patients.
The shift in focus meant a dramatic expansion in the clinical areas of the Peter Christensen Health Center. In 2009, the clinic moved from its outdated and undersized 5,000-square-foot building into a 26,000-square-foot facility. In addition to providing significantly more space for health services and future expansion, the new facility helps promotes healing through design features that reflect the heritage of the tribe, such as outdoor-themed murals and rustic post-and-beam architectural details.
In a modern building that houses a family practice, urgent care, pharmacy, imaging center, lab, and staff areas, the clinic's three physicians handle about 25,000 patient visits annually. Supplementing them are clinicians who provide podiatry, oral surgery, mental and behavioral health, physical therapy nutrition, community health and dental services.
In leading this change, the center's leaders understood that along with FQHC status, there would have to be a transformation in managing clinical information.
Instead of taking baby steps toward automation, Peter Christensen Health Center jumped in with both feet by simultaneously implementing the practice management system and the EHR system Sage Intergy.
The result was a quick and substantial transformation in clinical and financial results. Sage Intergy's practice management system was key to what quickly became a complete financial turnaround. An early and favorable outcome was eliminating the need for the multimillion-dollar annual subsidy the center had been receiving from the Lac du Flambeau Tribe for years.
In addition to the remarkable financial results—the return on the EHR investment paid for the system in just six months—there were substantial improvements in efficiency and patient care.
With the paper record, preparing charts for patients with upcoming visits would entail sifting through pages and pages of flow sheets, labs, and progress notes to find all of the data related to the patient. Now, the EHR saves an estimated five to 10 minutes per patient in chart prepping, particularly for patients with chronic illnesses.
Diabetes is the No. 1 diagnosis for mortality and complications for the Native Americans who remain the vast majority of the clinic's patient population as well as many of its newer patients. Faced with those needs, the center required an EHR that enabled proactive management of patients.
A key feature of the system that clinicians value is the array of patient population management tools. One example is Sage Intergy's health management tab, which the center's staff uses extensively when patients call or present for appointments.
Personnel can easily query and review the health tab for patients at each of their appointments. The result, says Hope Williams, one of the center's certified diabetic educators, is a better educated and more empowered patient.
"We believe that the patient is the lead in the management of their diabetes. We are able to update this tool and then print it for them so they can understand what needs to be done to take best care of their diabetes," she says.
From a patient safety perspective, the Sage Intergy EHR has proven invaluable. In the past, patients who came to the clinic for "urgent" visits might call in a few days later for a medication renewal--and receive it without anyone conducting a thorough medical review. Frequently, this occurred because the record showed the patient requesting the renewal had been recently seen. However, the clinician approving the renewal could not see what type of visit it was. Most often, it was assumed that it was a routine follow-up visit for an existing condition. The potential for problems arose if the patient's visit had actually been for an acute problem, not a routine follow-up. As a result, no one was proactively managing the patient's chronic illness.
Nurse practitioner Dana Irmick sees a world of difference now with the EHR's ability to track patients over time. Instead of thumbing through the patient's file to compare heights and weights, for example, Irmick can easily call the information up electronically to review and share with parents.
Irmick also values the EHR as an aid in helping her to raise patients' awareness of their own health progress, or lack of it.
"It gives patients more ownership," Irmick says.
Williams also credits the EHR for an overall improvement in the continuity of care that the center provides, something that was always a challenge with its former system of tracking the care of patients with diabetes through flow charts maintained on paper.
Sage Intergy allows the center's providers and nurses to fully work as a team instead of spending time to track down a paper flow chart.
Today, Peter Christensen Health Center is truly a medical home for the 25,000 patients it serves each year. It presents a shining example of the integrated and responsive approach to health care, and it does so while meeting the financial and clinical challenges of serving a rural and disadvantaged patient population.