Federally Qualified Health Centers are the foundation of our healthcare safety net, providing care to people of all ages, regardless of their insurance status or ability to pay. Because they operate on tight budgets, they have traditionally struggled with health IT adoption. But one Texas nonprofit organization put a solid technology infrastructure and a transparent quality improvement effort at the heart of its expansion.
The 10-year-old Lone Star Circle of Care has grown to serve more than 80,000 patients in 25 clinics throughout Central Texas and has achieved patient-centered medical home status. In a few short years it has made impressive strides in using data for quality improvement initiatives. With grant funding in 2008, Lone Star implemented a NextGen electronic health records system for its clinics and other safety net clinics in the area. The consortium created an independent nonprofit organization, Centex System Support Services, to oversee the setup and maintenance of the NextGen system.
Speaking at a July 27 Health Resources and Services Administrationpresentation, Tamarah Duperval-Brownlee, M.D., MPH, Lone Star’s chief medical officer, said, “Early investment in technology infrastructure and having a vision for informed, evidence-based care is critical.” She said it’s important to have not just an EHR and practice management system in place, but also the staffing and support structure to take advantage of the data.
Beyond implementing an EHR, Lone Star officials knew they needed the capability to customize it and provide adequate training.“Our CEO comes from an IT background, so he gets it,” Duperval-Brownlee said. “We hired a dedicated chief medical information officer and set up quality councils. We spun off a whole organization focused on technology improvement to support our needs.”
The CMIO and quality councils have helped Lone Star develop valuable and transparent measures available on the intranet for everyone in the organization to study. “We wanted to avoid the trap of collecting data for data’s sake,” Duperval-Brownlee said. ‘We want everyone to have a good sense of what we’re measuring and why.” Providers are kept informed about how data leads to work flow improvements.
Lone Star made sure the quality councils have the time to look at data and plan changes. “They meet for at least two hours per month dedicated to this,” she added. “Strong leadership in clinical quality helps us push the envelope and empower service lines.” The real-time data in dashboards is integrated across practice teams. “It’s important not to get data into silos that isolate providers or operational staff.”
Just tracking certain measures leads to improvement, she said. For instance, before the meaningful use measures, Lone Star providers were doing okay on reviewing medications with patients, but once the organization started tracking medication reconciliation as part of meaningful use and made some improvements in its templates, medication reconciliation improved dramatically, she said.
Lone Star is not resting on its laurels. “Within our organization, quality is on everyone’s lips, but it is important for us to keep looking at the gaps we have,” Duperval-Brownlee said. “We have to challenge ourselves to make further improvements.” For instance, care coordination and chronic disease management need to be more robust, she said. “We also have to reinvest any gains into clinical improvement and rewarding our staff.”