From Humble Roots, Brockton Neighborhood Health Center Embraces EHR Built for Bold Future

For Ben Lightfoot, M.D., medical director at Brockton Neighborhood Health Center (BNHC), it's hard to pick one electronic health record (EHR) success story that trumps all others.

"At the health center, pretty much every day has a success story with our EHR. There are a million little successes,"  he said during a recent Regional Health IT Meeting in Taunton, an event organized for area health care executives and providers by the Massachusetts eHealth Institute at MassTech (MeHI).

Since BNHC's EHR went live seven years ago, it has helped the center improve efficiency, patient safety, care coordination, and reporting requirements. It has also led to thousands of dollars in federal Meaningful Use incentive payments.

The non-profit, independent federally qualified health center (FQHC) is well onboard with health IT,  and the EHR is just a part of the effort. This summer, BNHC was among the Bay State healthcare outfits to receive funding from MeHI to connect to the state's health information exchange (HIE), the Mass Hlway. The funds will allow BNHC to better collaborate with its trading partner, Network Health, enabling the electronic exchange of care plans for high-risk patients. The goal is to improve care team effectiveness and reduce the rate of emergency department visits  by  'low-acuity'  patients - those  not requiring emergency care.

The Hlway  Implementation Grant is the first step in a collaboration that Lightfoot and his team plan to grow into a broader initiative which includes developing integrated care plans within the EHR that can be shared with Network Health.

BNHC has come a long way since starting 20 years ago as a fledgling health care provider with one physician working in a mobile unit parked outside a church. Since those humble origins, the center constructed a $17 million facility that serves roughly 26,000 patients a year, many of whom are low-income. The facility handled about 150,000  patient visits in 2012 alone.

At about the same time BNHC was opening the doors to its sparkling new home, it went live with its first EHR. The experience has brought both rewards and challenges.

It has been an interesting trip down the paperless path," said Lightfoot.

That trip began in 2004 when Brockton was among three Massachusetts communities to share a $50 million grant from Blue Cross Blue Shield to adopt EHRs.

For its EHR system, BNHC chose NextGen Healthcare, which works with several community health centers. The implementation included a considerable learning curve, as BNHC adjusted to an environment that moved away from paper charts in favor of electronic data. Adjusting workflow procedures was key to the implementation.

We did a lot of training," Lightfoot said. "You can't under train.

Another key to the  implementation was  assembling a comprehensive group of staff from the center to discuss what lay ahead when the system went live. Lightfoot brought in staff from all relevant departments to foster communication and gather input.

One of the big things was to pick an EHR champion, and I was it," he said. "You really need someone who's enthusiastic about the system going live, who is tech savvy, and can communicate well with the other providers.

Some of the challenges BNHC faced included ensuring that providers are properly and consistently entering data into the EHR,  so that records and measures across the system are complete. BNHC also has a backup paper system and protocols in place should the EHR go offline or experience other technical problems.

Lightfoot encourages other organizations to keep EHR modifications  to a minimum. While it can be tempting to tweak a system to meet personal needs and preferences, it will likely make it difficult to upgrade the system when the time comes, he said.

Meeting  Meaningful  Use  standards  has  accounted  for much of the center's EHR activity.

Stage 1 has been a little challenging, basically getting all the reports to work properly, but it has resulted in some really impressive things for patients," he said.

For example, as part of BNHC's Stage 1 accomplishments, each  patient  receives  a  patient  plan.  Additionally,  the center has improved its focus on quality measures.

Lightfoot said the center is in the midst of preparing for Stage  2 and could begin to attest early next year. This next stage includes connecting to a health information exchange (HIE).

As  part  of  the  patient-focused   measures  in  Stage  2, BNHC's plans call for implementing a patient portal, which will allow patients to access their health information via the Internet. Since many of the center 's patients lack access to a computer, Lightfoot and his team are exploring whether the patient portal can be accessed through smartphones, which many of the center's patients own.

Plenty of other health IT initiatives are brewing at BNHC, including its participation in Medicare's Electronic Prescribing  (eRX)  Program,  which  offers  an additional 0.5 percent payment on total Medicare billing to providers using an eRX system. There is a 2 percent penalty for providers who do not e-prescribe. The health center has  also  gone live  with an electronic  dental  record  system which is tied to the NextGen EHR. The connection allows for sharing important data, including a patient's medication. An impending  upgrade to the NextGen system will help BNHC improve the OB/GYN and pediatric templates with the EHR.

Twenty years after its founding and nearly a decade since its EHR journey began, BNHC continues to push forward with new technologies that offer the reward of smoother operational efficiencies, improved patient care and lower costs. Its collaboration with Network Health on the Mass Hlway is a first step toward a broader commitment to HIE.

Lightfoot said the health IT path is not without its challenges. Bringing the EHR system and other IT technologies  to their current  capacity requires  a steady diet of education, training and communication between multiple departments in a fast-moving environment.

"The systems are powerful and can do a lot of amazing things, but you have to be careful," he said.

"At the health center, pretty much every day has a success story with our EHR. There are a million little successes" -Ben Lightfoot, M.D., Medical Director, BNHC


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