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Custom EHR helps safety net provider offer continuity of care

The Wright Center for Graduate Medical Education took an unusual route to its 2015 Ambulatory Davies Award. HIMSS gives the award to organizations that both improve patient outcomes and demonstrate a return on investment. Winners typically use a major EMR vendor's solution, but in the case of the Wright Center, their technology was grown almost entirely in-house.

TWC uses Medent, which it describes as a basic platform that required considerable in-house customization. “It's a canned EHR, we call it,” says EHR manager Tiffany Jaskulski. “We have to program to do what we want.”

TWC is a graduate medical education consortium and safety-net provider in northeastern Pennsylvania, with primary care practices providing high-quality, non-discriminatory and affordable care, regardless of ability to pay. It had more than 75,000 patient visits in the past year. It serves seven counties with 13 physicians, four nurse practitioners and three physician assistants.

TWC adopted Medent in 1998 for practice management. When it came time to transition to an electronic medical record system in 2005, prepackaged EHR solutions were too costly, so they built out their Medent capability.

“We build everything,” adds John Janosky, vice president of IT and innovation. “Front end, back end, so we can customize.”

Janosky says the do-it-yourself approach enables the organization to tailor the technology, and the reporting, as needed. “We take data mining from the EMR to import into the SQL relational database, and we can create any kind of report off of it,” he says.

The database is on SQL servers, with a web-based front end, Janosky says. Analytics are web-based and homegrown. Their data center, and the backup site, run entirely on Dell servers.

Dr. Linda Thomas-Hemak, CEO of the Wright Center, says that the initial EHR implementation didn't truly deliver results until the 2009 hiring of Dr. Jignesh Sheth, an “IT guru” and graduate of the Wright Center's program. “We really began to capitalize on the investment and value,” she says.

The specific achievements recognized by the Davies Award involved improving communication and collaboration:

Continuity of care. TWC patients often don’t see the same clinician from one visit to the next. Patients felt disconnected, and clinicians, many of them still learning the practice of medicine, couldn’t see how their treatment affected patient outcomes. An EMR-driven workflow for team-based care delivery ensured that patients consistently see familiar primary care providers.

Sheth says IT enabled the transformation in two ways. “First, IT [provided] a visual management tool, so someone making the appointment clearly knows who and where to schedule patient with, and second, they gave us tools to measure compliance.”

Workflow assessment: TWC implemented a performance assessment tool to draw team-level and individual performance data from the EHR, which more directly connects staff and provider work to the organization's goals. A key part of the IT mission, Thomas-Hemak says, has always been “helping all employees connect their work to higher purpose.”

Change management: TWC implemented a tracker tool that serves as an “idea pool” in which everyone in the organization is able—and expected—to contribute to quality improvement efforts and a learning culture. The effort has, over two years, launched 799 system improvements, with more 550 completed, including using the EHR to implement mammogram alerts, tracking diabetes self-management goals, automating prescription checking on electronic refill requests, and tracking smoking cessation counseling.

All three programs, and particularly the tracker tool, fuel the culture of learning and improvement that is central to the Wright Center's mission, Thomas-Hemak says. “If everyone rises and does stackable, iterative improvements, [we can create] rapid transformation.”

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