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Self-Developing an Integrated EHR/Electronic Dental Record: La Clinica’s Bold Journey

November 4, 2014
by Mark Hagland
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Tina Buop of La Clinica in Oakland has been leading the self-development of a fully integrated EHR/EDR

Since its beginnings as a single storefront operation in Oakland, California, in 1971, La Clínica de la Raza has grown to become a network of 40 care locations across three counties  Contra Costa, Alameda, and Solano) in Northern California.  As a network of community health centers, La Clinica serves low-income residents with medical, dental, behavioral, vision, diagnostic imaging, laboratory, and pharmacy healthcare services. In 2013, La Clínica served over 91,000 patients and provided 427,867 patient visits. With over 43 years’ experience serving the community, La Clínica is one of the largest community health centers in California.

With such a comprehensive range of healthcare services provided across so many care sites, not surprisingly, IT management offers a considerable set of challenges to the leaders at La Clinica. What’s more, the organization, given its mission to serve poor and underserved, including uninsured, residents of Northern California, faces additional ongoing operating challenges.

Tina Buop, deputy CIO and CTO at La Clinica, has been in healthcare IT for two decades, and joined La Clinica two years ago. In a recent interview with HCI Editor-in-Chief Mark Hagland, she explained how she helped lead her colleagues forward to a first-ever, self-developed, fully integrated electronic health record/electronic dental record.  Below are excerpts from that interview.

Over the past year and a half, you’ve led your colleagues forward in self-developing a fully integrated electronic health record/electronic dental record. That’s very exciting.

Yes, thank you. As far as we know, we’re the only patient care organization in the U.S. to do this, meaning, to self-develop a truly fully integrated EHR/EDR. We’ve asked around to find out if anyone else has done this, and so far, we haven’t heard of anyone else who’s done this. If they’re out there, we’d love to know!

Tina Buop

What has been your strategy around self-developing an integrated EHR/EDR?

The initial strategy was to have a single patient record. People say all roads lead back to IT—but that’s not true; all roads lead back to the patient. And that was the premise for our strategy. Are we giving patients the best of care? In the community health world, our patients can quickly go from us as a medical provider, to a dental provider, to a lab, and having disparate systems isn’t good.

We’re in Contra Costa, Alameda, and Solano Counties. And we’re implemented this and have now gone live with the new system in Contra Costa and are still rolling it out in others. In our Concord facility, it’s been wonderful to see the system in action. The physician immediately sees the dental record, and here at La Clinica oral health is a part of the entire health record, in a holistic care environment, as it should be.

Here’s an example of why that’s important. Recently, when I was in our Concord facility, one of our patients, a man over 40, came in who was on Coumadin, and their primary language was Spanish. And the dentist was able to see that they were on Coumadin. And as a dentist, you want to know if your patient might have bleeding issues. And in this case, the dentist knew immediately about that patient being on that important medication.

That’s a perfect example of where an integrated record is beneficial, right?

Yes. And before we built this integrated system, all the products on the market required the clinician to shift from one record to another. It made the user interface look seamless, but it started the dentist out in the dental record. It’s important to understand this in context, too: La Clinica is the largest community health center-based provider in California that provides dental as well as medical care, so we’re talking about a significant volume of patient care. In fact, because we have dental sites within hospitals, we have a total of seven locations providing dental care, with a total of 56 chairs. We also serve patients from inside dental schools; we’ve got two dental school care locations, each with one chair.

What has been your path forward so far?

Two years ago, when I arrived at La Clinica, they were considering purchasing an electronic dental record, and were close to signing a contract. And I quickly pointed out that implementing a non-certified dental record and connecting it to a certified EHR would be non-compliant in terms of meaningful use. At the time, we were looking at implementing the EDR, and also implementing local dental bitewing x-ray care, and then also panoramic dental imaging via what’s called a Panorex (panoramic radiograph). The Panorex machine goes around your entire head, and has more robust diagnostic capabilities. And our dental director, who is phenomenal, had a vision of implementing an EDR, dental radiology, and the Panorex, in an integrated fashion. So I pitched a strategic vision to our board of directors to enable us to implement the EDR within the EHR. That was two years ago.

And the board asked whether we had done this before—integrated imaging and the EHR; and I said, I had, with different medical specialties; so they approved the plan. Among other things, we wanted to get away from film so that we could really give our dentists everything they needed to see those dental images immediately. We had imaging at one of our locations. We only had dental imaging at one location, on a standalone desktop machine that had stopped working. So we implemented the dental imaging system and the Panorex both at our local dental care sites and within the cloud, in our EHR. We started rolling out the system in October 2013, and are still rolling it out, but finished dental imaging in Contra Costa in March 2014, and the electronic health record with the electronic dental record, in June 2014.

The technology is phenomenal, because we have it all working in the cloud. We have the electronic health record sending the medical record number to the PACS [picture archiving and communications system] system. Most people who implement an EDR have the EDR, EHR, and imaging, all separate. We just have two, we have the EDR/EHR, with a single patient number, and imaging. And that means fewer errors. And we can compare data from within our PACS system to data within our EHR, in seconds.

What have the biggest lessons been learned in all this so far?

The first lesson learned was challenging the naysayers who said this was not achievable. The support within our board and within La Clinica more broadly was unwavering. Our senior management, our chief dental officer, and the board, were unwavering. The vendors were skeptical. You have 32 teeth, and we had to be able to develop all the images in the cloud. And many naysayers said, you can’t do this or that. Not only did we do it, but we did it very cost-effectively.

So you really did self-develop all of this, then?

Yes, we leveraged existing vendors solutions and our own resources and technology. And I want to give special credit to Jenny Stowe, our assistant dental director. She and others on our dental care team were essential to the success of this project. They’re phenomenal.

Do you have any specific advice for those who might follow in your path?

Yes: build your vision and your strategy, and closely adhere to it, being open to new technologies along the path, because technology develops so quickly. Because we were open to changes in technology, we were able to overcome the naysayers. And because we’re agile, we’re able to maintain our version control and our opportunities to control new portions of our electronic health record. So instead of being “one and done, “we’re eager to progress to what we’re calling Version 2 of this integrated system. And if someone is going to do this in the future, we need a rock-star implementation and training team, as I’ve had. My team has been amazing, and I’m grateful for them.


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