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For South Cove Community Health Center, caring for 29,000 primarily non-English speaking patients in Boston and Quincy is a considerable challenge, and the organization discovered that effectively delivering and coordinating care for these patients using paper medical charts was preventing it from significantly improving care.
In 2009 the center, which largely serves greater Boston’s Asian-American community, took a bold leap into electronic medical records (EMRs) when it implemented a system from Westborough – based eClinicalWorks® (eCW). This meant sailing into uncharted waters for South Cove’s four locations, but the transition has proven to be a successful one, as South Cove has improved on several patient outcomes and operational efficiencies. It has also earned the distinction as one of the first Federally Qualified Health Centers (FQHC) in Massachusetts to achieve Meaningful Use Stage 1.
“In the next month we are going to retire all of our paper charts,” said Brook Hailu, quality improvement program manger at South Cove. “So, we’re pretty much 100 percent paperless.”
Besides the technical challenges attached to complex, computerized systems, the center also needed to get buy in from its physicians, nurses and clinical staff, many of whom had only used paper files. Intensive training, planning, and patience paved the way for implementing a system that today is embraced by all of the center’s providers, staff, and leadership alike.
“The number one quality measure that any organization can introduce is the electronic medical record,” said Eugene Welch, executive director at South Cove. “You cannot begin to think about Meaningful Use or patient centered medical homes, or having 24/7/365 availability at all locations, without physician access to the patient medical record through the EMR. Now South Cove care providers are on an iPad or an iPhone and dealing with patients when the health center is closed."
For Brook and the medical and administrative staff, much of the EMR’s benefit lies in its ability to transport information immediately, regardless of where it is coming from or where it needs to go.
“What’s really great is if you have a patient in Quincy and you need something at the Washington Street [Boston] location, everything is updated in real-time right to the central server,” he said. “It’s instantaneous. Any changes are automatic.”
Founded more than 40 years ago in Boston’s Chinatown neighborhood, South Cove operates two centers in Boston and two others in the nearby city of Quincy. While its mission is to help all medically underserved Massachusetts residents, the center fills a specific need within Boston’s Asian-American community, as 90 percent of its patients do not read, write, or speak English. Many are also low-income and face cultural barriers that often impede receiving care elsewhere. More than 90 percent of the non-English speaking patients speak Chinese (63 percent Cantonese, 29 percent Mandarin) and about seven percent speak Vietnamese.
To address the language issues, virtually all of South Cove’s staff, both medical and administrative, is bi-lingual. In fact, only eight staff members are not fluent in a Chinese dialect.
With 29,000 patients accounting for more than 165,000 annual visits, South Cove is using its EMR to keep track of its patient population and better coordinate the care it provides. Brook said he easily prints out lists of patients who received specific services and lists of those who are due for follow-ups. For example, well-being visits for children between the ages of ‘newborn to two,’ or those ages ‘three to six’, can be specifically extracted. Nurses at each location are trained to pull the lists monthly and call patents to ensure their children are brought in for necessary visits.
“We use a lot of that data to see where we can better manage the patient,” said Brook. “It’s much more difficult with a paper-based system. There’s no way you could do this without an EMR. It’s our number one quality measure.”
By implementing a lab interface within its EMR, which allows for entering and extracting numeric lab results, South Cove has also dramatically increased colorectal cancer screenings. From 2012-2013, the percentage of patients ages 51 to 75 that received a screening increased from 58 to 73 percent. In another measure, the center was able to increase diabetes control in certain patients from 73 to 78 percent over the same period.
“The EMR has made it much easier to label and track high-risk patients, as well as to quickly identify which patients need which care,” said Brook. “The best part, however, about being able to pull data from the EMR is a more realistic understanding of where our organization stands in terms of metrics. Instead of pulling 70 charts to represent a sample of 29,000 patients, we have accurate representation of all our patients and use the data to craft our strategic goals and strategies every year.”
Since online patient engagement is a key component of Meaningful Use Stage 2, South Cove is aiming to boost usage of its patient portal. The center launched a pilot program with a portal offered by eCW, but to date the center has only convinced about 260 of its 29,000 patients to sign up.
A key barrier is that the portal is only available in English, a language in which few of the patients are fluent. The lack of patient portals offered in languages other than English is a problem common for many health centers, and most EMR vendors have yet to expand the portals to additional languages. Until that happens, usage will likely continue to remain low among non-English speaking populations. However, Brook said South Cove plans to push for higher enrollment in 2014.
South Cove is also keeping an eye on a future connection to the state’s health information exchange (HIE), the Mass HIway, which will link all Massachusetts health care providers together through a secure electronic network.
“[The] HIE should make it much easier to collaborate with other agencies in terms of receiving results, imaging, screenings, and progress notes electronically into our EMR,” he said. “This would really complete the journey of going paperless and allow our providers to have access to important information that might change the way they treat the patient.”
To date, 23 of South Cove’s 25 physicians have achieved Meaningful Use Stage 1 (90 Day) and are working toward the full year attestation. As noted earlier, the center is one of the first FQHC in Massachusetts to reach Stage 1.
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