Community EHR Models
A community based EHR is a way of adopting an electronic health records (EHRs). In 2009, the American Recovery and Reinvestment Act (ARRA) has urged the adoption of electronic medical recods by all providers.
Each organization begins conceptualization often unaware that they need not go at it alone. In addition to recently established Regional Extension Centers whom provide a wide array of guidance, their are community organizations (many years to decades old) that may be available, or serve as a model for developing one in your own community. The focus of this article is to provide examples of organized Community EHR models. One is not better than the other; only one fits better than another given the environment it is or will be operating in.
The first organization is Oregon Community Health Information Network (OCHIN). OCHIN was established in 2000 following a State of Oregon sponsored study recommending enhanced use of information systems to improve organization, coordination, financial stability and management of safety net health centers . OCHIN, a consortium of Integrated Practice Management (IPM) Partners and a larger group of non-IPM collaboration partners, began during an era in which safety net clinics where failing due to adverse business conditions created under Oregon Health Plan (OHP) Medicaid waiver 1115 program . OCHIN, under the organization of CareOregon, received initial funding through a federal Health Resources and Services Administration (HRSA) Community Access Program (CAP) over a four year period amounting to $2.4 million. With the funding OCHIN hired its first staff of two, then grew to about a dozen .
OCHIN’s initial focus driven by the HRSA CAP funding was two fold: (1) drive improvements in safety net health center administrative systems and (2) collect and distribute high quality information on the health status and health care experience of vulnerable populations through a coordinated central data warehouse . To reach the first goal, in 2001 OCHIN procured a sophisticated practice management (PM) system known as EPIC, which also included an electronic medical record (EMR) system . The first PM system was installed 2002 with 3 more to follow that year . As of October 2005, OCHIN continued work toward the second focus, however it has not yet been achieved .
A review of OCHIN operations in 2005 found that although the various partners where dissimilar in infrastructure, they had similar motivations for partnering in OCHIN: Billing – OCHIN provides access to the reliable billing component of EPIC PM; Reporting – OCHIN provided EPIC capabilities enabled administrative reporting for the various grantors; Local training, support, and collaboration – OCHIN provided more responsive technical staff than experienced with other national practice management vendors; EMR – OCHIN’s plan to implement EPIC EMR .
OCHIN’s 2010 Annual Report  provides a snapshot of a decade of operations. In 2002 4 IPM’s had installed PM, whereas by 2010, there where a total of 37; In 2005 1 IPM had installed OCHIN’s billing services (OBS) as compared to 7 by 2010; and in 2006 3 IPM’s installed EHR's and by 2010 31 had been installed. Funding also grew to a 2010 operating budget of $14.4 million. OCHIN’s 2009 Annual Report  alluded to new challenges in 2010. In preparation, OCHIN changed it’s mission for a third time to read: We pioneer the best and most innovative use of information and information technology for the medically underserved. In addition OCHIN has established 2 operational Divisions to meet the new challenges: Practice-Based Research Network (PBRN) named Safety Net West established in 2007 a Community Health Applied Research Network (CHARN) ;and Oregon Health Information Technology Extension Center (O-HITEC) an Office of the National Coordinator for Health Information Technology approved extension center .
The second organization is MVP Health Authority (formerly known as Mid Valley Independent Physicians Association). MVP Health Authority (MVPHA) was founded in 1991 as a contract services organization negotiating on behalf of the members with Health Maintenance and Managed Care Organizations. MVPHA membership makeup is approximately 510 independent minded physician members; with 420 members in private provider practice. Of the 150 practices, 3 have 10 or more physicians; 17 have 5-9 physicians; and the balance include 4 or less providers in the practice .
MVIPA EHR project vision was to measurably improve both the quality and efficiency of health care in our service area through the use of information systems at the place and time of care. These systems will securely and reliably provide the clinician community with information in all of its forms, support decision making, and minimize risk. MVPHA’s initial focus of the EHR project was to improve quality of care; improve efficiency with which care is delivered including reduced costs; improve reimbursement through improved charge captures; and improve patient safety. In addition to the initial focus, MVPHA strived to provide a service that would assist the members with barriers they faced to adoption of EHR's: evaluation of EHR solutions; seek out a single vendor platform; negotiate vendor contracts for software and data repository; provide assistance with funding the EHR acquisition; and implement technical support. In terms of acquisition, MVPHA provides NextGen licenses, data center hosting service, implementation support, training, and a help desk. The member pays for internal office hardware and support, software maintenance after 2 years, and monthly connection fee for connection to the private network data center .
A recent operation review of MVPHA provides a snapshot of the two decades of operations. MVPHA began the project with 8 staff and have grown to 13. Project planning began in 2003, with the first go live implementation completed in January of 2006. Since that time 45 independent practice implementations representing 207 providers have been completed .
In conclusion, the focus of this article was to provide examples of organized Community EHR models. The two provided, OCHIN and MVPHA are two Community EHR organizations that are offered as completed models for use in replication in other locations. Although the models are similar, the models are distinctly different primarily in the customers they serve. OCHIN's external customers are public funded sourced clinics requiring reporting for fiscal and programmatic transparency, whereas MVPHA external customers are independent private practice providers with disparate membership reporting requirements. Both models operate successfully in the environment they were designed for.
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Submitted by (Barry Camarillo)