With the long-term outcome of national

Transcription

1 focus EHR Implemetatio i Ambulatory Care Settig A Health Ceter Cotrolled Network s Experiece i Ambulatory Care EHR Implemetatio Lessos Leared From Four Commuity Health Ceters. Nick Egleso; Jeifer H. Kag; David Collymore, MD, MBA; Warria Esmod, MD; Lydia Gozalez, MD; Perry Pog, MD; ad Ly Sherma, MBA KEYWORDS Electroic health record, implemetatio, health ceter cotrolled etwork, METCHIT, commuity health ceters, collaboratio. ABSTRACT Implemetig a full-featured EHR at a commuity health ceter is a dautig udertakig. Stakeholder buy-i, cotract egotiatio, workflow redesig, equipmet purchases, preloadig charts ad traiigs are just some of the ecessary tasks i maagig a implemetatio. METCHIT, a health ceter cotrolled etwork, used a collaborative approach to implemet electroic medical records. This article will cover the experiece, beefits ad lessos leared by a group of four FQHCs that took a cooperative, metorship approach to implemetatio. Sice 2005, the four commuity health ceters, Charles B. Wag Commuity Health Ceter, Morris Heights Health Ceter, Settlemet Health, ad Comprehesive Commuity Developmet Corporatio, have implemeted EHRs at four orgaizatios with multiple sites i diverse eighborhoods i New York City. The collaboratio bega ad grew durig this period, aided by a techology grat from HRSA. With the log-term outcome of atioal health reform still ucertai, oe thig is clear medical providers who have yet to implemet a electroic health record are feelig pressure. Sice February 2009, the time ARRA was passed, the iboxes of those i ambulatory care settigs have bee iudated with with such key words as health iformatio techology, EHR implemetatio, meaigful use, fiacial icetive ad, ultimately, implied fiacial pealty for failig to adopt. I respose to the pressure to implemet, orgaizatios have take their first steps oly to become overwhelmed by the complex reality of cotract egotiatios ad equipmet purchases coupled with techologically challeged providers ad resistace to chage are eormous barriers to overcome. Implemetig a full-featured EHR at a commuity health ceter is a dautig task for a sigle orgaizatio. I this article, the four commuity health ceters of METCHIT share the most sigificat lessos leared from their EHR implemetatio jourey: cliical leadership ad orgaizatioal collaboratio ope up the possibility of a successful implemetatio. By addressig these core priorities ad leveragig the kowledge that exists withi the etwork, orgaizatios ca overcome the challeges 28 jhim Sprig 2010 volume 24 / Number 2

2 ad achieve a operatioal electroic health record that serves patiets ad providers. I the pages that follow we are goig to cover: Who are these orgaizatios? What is the history of the collaboratio? What lessos ca be draw? METCHIT A Overview The Metropolita Collaborative of Health Iformatio Techology (METCHIT) is a techology focused health ceter cotrolled etwork (HCCN) i the greater New York metropolita area. METCHIT curretly icludes four member orgaizatios: Charles B. Wag Commuity Health Ceter (CBWCHC), Comprehesive Commuity Developmet Corporatio (CCDC), Morris Heights Health Ceter (MHHC), ad Settlemet Health ad Medical Services (Settlemet). The etwork delivers primary care i medically uderserved eighborhoods that are predomiatly Hispaic, Africa-America ad Asia-America. These ceters, with service sites i Mahatta, the Brox ad Quees, served over 100,000 patiets ad delivered more tha 600,000 ecouters i METCHIT s goal is to achieve improved health outcomes i the populatios served by the member orgaizatios. The HCCN is utilizig shared resources ad a commo platform to speed implemetatio, improve the quality of care, ad replicate HRSA s Chroic Care Model. METCHIT is govered by a Steerig Committee ad Cliical Leadership Committee, which covee regularly. History I 2003 oe of the future METCHIT Members, the Charles B. Wag Commuity Health Ceter, bega searchig for a Electroic Health Record. By the fall of 2006, CBWCHC had GE s Cetricity EHR operatig i all of its existig sites. I early 2007, CBWCHC s log-term collaboratio with three other health ceters i NYC bega to focus o EHRs. Each of the other ceters was early o i its implemetatio process. The four orgaizatios fouded METCHIT. I September 2007, the etwork was awarded a EHR Implemetatio grat by the Health Resources ad Services Admiistratio s Office of Health Iformatio Techology. METCHIT received $1.4 millio to implemet the EHR at 18 sites i the greater New York metropolita area. By Aug. 31, 2009, METCHIT implemeted the EHR. Lessos Leared The implemetatio of a EHR requires active participatio of members at all levels of a orgaizatio, but a system successfully istalled is useless uless it is accepted by the ed-users. Durig the etwork s implemetatio process, it was the ed-users, the cliicias, who selected the EHR vedor. They brought the issues of their orgaizatios to the etwork Steerig Committee table ad iitiated coversatio with outside etities collaboratively, to voice their perspective to EHR ad lab vedors, NYC DOHMH, ad peer etworks. Not to discout the cotributios of other staff, but havig cliical leaders be the trailblazers dow the path towards electroic health records proved successful i our etwork. The success did ot stem solely from commitmet to their idividual orgaizatios, but from their commitmet to the etwork to be ope, to share a visio ad to collaborate. METCHIT Cliical Leadership At the HCCN level, cliical leadership played a key role. From the first METCHIT Steerig Committee meetig, medical directors ad physicia champios from each orgaizatio were preset ad actively seekig out ad offerig advice. I additio to cotiued participatio i the Steerig Committee meetigs, the METCHIT cliical leadership met separately, coveig regular METCHIT Cliical Leadership meetigs for more i-depth coversatios o the pressig issues. Members at differet stages of implemetatio shared their experieces, difficulties, questios ad advice. The face-to-face meetigs ad commitmet to support each other through implemetatio built a rapport amog the cliicias ad cofidece to push ahead i their edeavors. The cliical leaders ivolved i these meetigs were key leaders i their ow orgaizatios. Medical directors ad chief medical officers i other words, the cliical decisio makers -- were the regular attedees ad cotributors to the etwork ad at the forefrot of the implemetatio process at their respective orgaizatios. Metorship Durig the course of EHR implemetatio, METCHIT employed a metorship strategy. The beefit of metorship is that the metor has a iheret uderstadig of the cotext of the questios. Therefore, the solutios are ofte more appropriate. Orgaizatios i later phases of implemetatio metored those i earlier phases. As the first orgaizatio to implemet, CBWCHC metored Settlemet, who metored CCDC ad MHHC. This sectio highlights ad provides examples of some areas of metorship: recommedatios for cosultats, preparatio strategies, techological advice, ad a ope door for site visits, shadowig ad traiigs. Recommedatios. Metees regarded cotract egotiatios ad orgaizatioal preparedess as two of the first issues related to implemetatio. The EHR vedor was a worldwide compay which had eormous legal ad fiacial resources, ad offered stadard cotracts that had bee carefully vetted by their staff. Commuity Health Ceters, o the other had, were ofte facig for the first time complex issues of support levels, performace guaratees, ad pricig models. The cost i time ad moey for a commuity health ceter to egotiate a cotract could be overwhelmig. Thus, CBWCHC shared its experiece egotiatig with the vedor, the pricig model it chose ad key poits that should be icluded i the cotract. Moreover, it recommeded its lawyer, oe who was experieced with this type of egotiatio for a EHR system ad for this type of customer -- a commuity health ceter. The goal of this suggestio was to shorte the egotiatio process for its peers. This saved time ad moey because the lawyer was familiar with both the vedor s boiler plate cotract as well as specific cocers of CHCs. The EHR vedor assigs its ow cliical cosultat to lead the EHR implemetatio. CBWCHC recommeded utilizig the same cliical cosultat. By isistig o a idividual who had specific commuity health ceter as well as New York experiece much time was saved. With each successive implemetatio the cosultat leared more about the specifics of commuity health ceters ad the regulatory ad reimbursemet eviromet i New York. Much hard-wo kowledge passed from implemetatio to volume 24 / umber 2 Sprig 2010 jhim 29

3 implemetatio. I the later implemetatios, MHHC ad CCDC collaborated so that they could both sychroize her services. The cosultat, who lived outside the New York regio, visited both sites i the same trips, ad cocurretly implemeted both orgaizatios. This lowered the travel costs that are the resposibility of each health ceter. Beig familiar with the type of orgaizatio, the cosultat could advise o the appropriate traiigs for the staff ad adjustmets to workflow. A few weeks ito Settlemet s implemetatio, for istace, providers were well-adjusted to the EHR from their traiigs. Preparatio Strategies. CBWCHC adopted the successful processes of its New York peers, who had previously implemeted the EHR. The orgaizatios it chose to visit were oes with similar structures. Its implemetatio timelie was modified from what it saw to fit its orgaizatio, rather tha beig reiveted from scratch. CBWCHC shared the successful tips of its implemetatio with its METCHIT peers, agai avoidig reivetio ad savig time ad moey for all. Oce a system is purchased, orgaizatios must develop a well-thought strategy to covert their patiet records from paper to electroic. The orgaizatio s roll-out strategy determies the order the departmets implemet, which affects the order paper charts are uploaded ito the system. CBWCHC s roll-out strategy was to implemet the EHR by specialty. Notig the success of their roll-out strategy, Settlemet Health also had a rollig implemetatio of its mai site. It started with Pediatrics, followed by other specialties i subsequet moths. MHHC ad CCDC had satellite sites, which were ot a factor i CBWCHC or Settlemet s strategy, but adapted by rollig out satellite sites first ad the by specialty i their mai sites. Before go-live, patiet iformatio must be uploaded i to the EHR. This pre-load process ca cosume precious time ad resources, especially if providers feel it is ecessary to trasfer all documets from each patiet s paper chart to the EHR. A more effective strategy is for the cliical leader, with the iput of their specialty providers, to select documets to be preloaded. CBW- CHC metored its etwork peers i this process, sharig which documets it selected to preload before go-live of each specialty ad how the iitial visits were coducted based o the ew, limited electroic iformatio. CBWCHC also oted that a very importat part of pre-loadig was to have the providers do it. It is the oly way they ca get traiig prior to go-live. They will uderstad how the system flows by iputtig charts. The preload strategy became more sophisticated as it evolved through the METCHIT etwork. Template Customizatio. Though template packages sometimes come budled with the EHR system, modificatios are ecessary, especially for those i commuity health ceter settigs who have madatory ad diverse reportig requiremets. Modifyig templates requires attetio to the desig of the template, to where the data will be iputted ad stored, ad lastly, to how it will evetually be reported. It is best for these templates to be ready o the date of go-live so that data ca be captured appropriately from the first patiet visit. If modificatios to templates occur after implemetatio, providers will have to be retraied o the ew templates, a tedious ad time-cosumig process cosiderig the substatiality of adjustig to the EHR i the first place. Oe goal durig this process should be to gai as much provider acceptace of the techology as possible, ad this area is oe where potetial protest could be avoided. Durig implemetatio, etwork members shared modified templates, sparig precious resources, moey ad time. These modificatios allowed for populatio ad disease specificity, providig the ecessary data for FQHC required reportig. Which templates were modified? Cliical leaders chose to modify templates oly whe there was eed. Some eeds that were addressed by modified templates were applicable to other health ceters, so it was oly appropriate to share. This avoided Though template packages sometimes come budled with the EHR system, modificatios are ecessary, especially for those i commuity health ceter settigs who have madatory ad diverse reportig requiremets. reivetig the wheel amog four collaborators. For istace, the curret EHR system does ot collect race ad ethicity i a maer sufficiet for reports required by CHCs or for actual cliical uses. CBWCHC had to make its ow forms ad observatio terms, which was readily shared with other METCHIT members, who had similar reportig eeds. OB-GYN templates were desiged so that CHCs could sed reports from the EHR to hospitals that were performig their patiets deliveries. As it was, the EHR did ot collect the proper iformatio or prit it out i a format acceptable to the hospitals. Settlemet spearheaded the collaborative iitiative to create templates that would collect ad report the ecessary data, agai, to avoid repetitive work amog the ceters. Lab Iterfaces. I additio to sharig a commo EHR system, three of the METCHIT members also share the same primary laboratory vedor. As the fial implemeter CCDC was the beeficiary of may of the efforts of CBWCHC ad MHHC. May of the commo laboratory tests were cosistet throughout the members of METCHIT, therefore may of the preparatory tables eeded to build the iterface were also very similar. Techological Support: Implemetig the EHR requires immese techological support, a area also willigly provided by METCHIT. Advice o equipmet decisios, for istace, preveted uecessary purchases ad processes. Durig their early search for a EHR, Settlemet Health Ceter did ot kow whether it was ecessary to upgrade their practice maagemet system alog with the implemetatio of their EHR. Settlemet assumed it would be ecessary to purchase a practice maagemet system from the same EHR vedor to esure compatibility. However, the orgaizatio was cotet with its curret practice maagemet system ad preferred to keep it. By presetig this issue to its metor, CBWCHC, Settlemet discovered that CBWCHC had the same practice maagemet system ad had bee able to iterface it with the ew EHR. This discovery spared Settlemet the chal- 30 jhim Sprig 2010 volume 24 / Number 2

4 leges of practice maagemet implemetatio. It allowed them to keep a practice maagemet system they liked ad focus their efforts o EHR implemetatio, which was their origial goal. I aother istace, a metee beefits from a metor who udertook the implemetatio of a practice maagemet system. MHHC did implemet the practice maagemet portio of the EHR prior to implemetig the medical record, which CCDC also plas to implemet. The orgaizatios have already begu discussios for site visits of key staff members as a early step i this implemetatio process. Techological support was also exemplified through site visits of IT staff. A shared METCHIT IT cosultat ad CBWCHC s IT Maager, two people who were ivolved i CBWCHC s implemetatio, visited members preparig their implemetatios to review their equipmet specificatios. I additio, they provided opportuities to share a commo equipmet ad techological lessos leared from previous experieces. Iter-Orgaizatioal Expertise. As sites bega to implemet, orgaizatios bega to develop iteral staff to focus o the ew reportig ad data collectio eeds that accompay a EHR. METCHIT members shared job descriptios, table of orgaizatios ad other ideas to facilitate recruitmet of staff. CBWCHC, havig developed its ow Cliical Iformatics (CI) departmet, arraged to trai oe of the CI staff at Settlemet. Over a period of several weeks, she came oe day a week to receive practical, o-the-job traiig o the system she will evetually be usig. The etwork believes cross traiig is a method to recruit ad retai staff. Ope Doors ad Ope Phoe Lies. Alog with opeig doors to other orgaizatios visitig their sites, metors also kept ope phoe lies, deliverig o-the-spot solutios geerated from their experieces for metees i crisis. New York State has a very specific prescriptio protocol ad o the go-live day at its first implemetatio site CCDC ecoutered a problem with pritig prescriptios from the EHR. CCDC was able to immediately call its parters at MHHC whose go-live day was oe week prior. The problem was resolved withi miutes ad did ot cause ay sigificat issues. The metorship model provided structure to the HCCN s goal of implemetig the EHR at four differet orgaizatios. It allowed members the opportuity to avoid mistakes ad preveted reivetig the wheel. Members achieved cofidece at each step of implemetatio from their ehaced kowledge. Despite commo issues, implemetatio is hardly a cookie cutter process. It is uique to each orgaizatio, which has its ow differet culture, techological startig poit ad idividual goals. For this reaso, later implemeters were facig issues that the more experieced implemeters had ot ecoutered. I the ed, all orgaizatios, o matter their order i the implemetatio sequece, were costatly learig from each other. Lab iterfaces, for istace, was a area of importace for the etwork but still a ew area durig the implemetatio process. I sprig 2009, Settlemet received otice that its primary lab provider, which was iterfacig with the EHR, was beig elimiated from the preferred labs list of oe of its isurace compaies. It discovered that istallig ad maitaiig a secod lab iterface would require more iformatio techology ad back office support tha the orgaizatio could maitai. This issue was shared at the METCHIT cliical meetig. Other members were ever preseted with the same situatio ad were ot aware of the difficulties of supportig two fuctioig lab iterfaces with the EHR. As a result of the shared of kowledge, Settlemet iformed both its more experieced ad less-experieced EHR peers of a potetial occurrece that could have affected ay of the etwork members. Some of the greatest challeges associated with later implemetatios were i areas i which there were o prior kowledge to share. For example, CBWCHC could oly offer advice o its versio of the EHR, which was compatible with its curret practice maagemet system. Whe Settlemet tried to implemet a ewer versio of the EHR system, it could oly trust the vedor, who assumed that the ewer versio would also be compatible with its practice maagemet system. A few weeks before istallatio, the EHR vedor discovered the ewer versio was ot iterfaceable with other practice maagemet systems. Settlemet s implemetatio date was delayed, ad i the ed, they implemeted the same versio as CBWCHC. The implemetatio of this versio was successful, sice much of groudwork for iterfacig with the practice maagemet system was already completed. The success of Settlemet s implemetatio with the same EHR versio as CBWCHC compared to the difficulty of attemptig to implemet a ew versio highlights ot oly the value of metorship, but also the fact that some areas were ew for all members. I the ed, metors were able to offer recommedatios, advice ad solutios for some issues, but for other issues, collaborative braistormig sessios were more helpful. At times, the better solutio was produced from poolig all idividual experieces together, ad at others, the collaboratio was walkig through a ew issue together. This accets the sigificace of etwork level collaboratio, elaborated further i the ext sectio. NETWORK LEVEL COLLABORATION Problem Solvig ad Emotioal Support. At METCHIT meetigs, members would ot oly update o their project status, but preset their curret challege or questios. Almost immediately, there would be a ethusiastic respose from others, offerig their experieces ad advice. The dyamism was ivigoratig. The kowledge pooled together at these meetigs iformed the process, ofte providig a multitude of optios. Moreover, alog with active cotributios came emotioal support. New implemeters would go back to their respective orgaizatios with cofidece, ot because they had all the aswers, but because they kew if they did t, they could call o their support etwork. Oe of the factors i the successful operatio of these meetigs ad support provided was METCHIT s uderlyig structure. Oe perso was desigated to be the first poit of cotact for health ceters related to admiistrative matters. If she could ot aswer their questios, she would direct them to others i the etwork who could. She was aware of all METCHIT activities, ad all iformatio set out to the etwork was fueled through her. Reportig to the govermet ad iitiatig coversatios with other outside etities would be orgaized ad facilitated by this same perso, who ivolved parties as ecessary. Havig volume 24 / umber 2 Sprig 2010 jhim 31

5 a desigated METCHIT facilitator ad liaiso esured follow up ad that the priorities of each meetig stemmed from combied kowledge of the eeds of each participat. The Project Maager was desigated to be the poit of cotact related to techological ad fiacial matters. He was familiar with the uique culture ad history of each of the orgaizatios, ad was a key role i the techological eeds as they implemeted. Also, with his idividual relatioships with the health ceters, he had a overarchig view of the etwork s progress as a whole. The Project Maager ad METCHIT liaiso worked closely together to make sure METCHIT members felt the support of their etwork. Braistormig ad Strategy It s a commo sayig that two heads are better tha oe. Similarly, four heads, or orgaizatios, are eve better. There were situatios where all orgaizatios were at the same level i kowledge ad experiece, ad etwork meetigs became braistormig sessios for collaborative solutios. Each orgaizatio brought a list of priorities it wated to address, ad together, METCHIT agreed upo a joit list of techological priorities. Discussios focused aroud these priorities, resultig i solutios ad plas of actios. Oe priority was beig able to maage relatioships with vedors. Others were quality reportig ad usig the EHR for the HRSA Chroic Care Model. METCHIT came up with two collaborative solutios: first, to leverage its stregth i umbers with vedors ad secod, to host a joit techical assistace visit of a more experieced etwork to gai kowledge i its other priority areas. Commo Frot with Vedors. Although implemeted for several years, the etwork did ot feel that the EHR vedor had modified its system to best suit the eeds of the CHC customer. Certai programmed buttos did ot perform expected fuctios, ad the orgaizatio desired for traiig o how providers could better avigate the system. I additio, as the etwork implemeted more sites, it bega discussig other techological goals, such as istallig bi-directioal lab iterfaces. Oly oe member was i discussio with a lab for a iterface, but the process was fairly early, ad the etwork members kew collaboratig o this effort may prove as successful as collaboratig o EHR implemetatio. This prompted the etwork to use its stregth i umbers to attract the attetio of the lab ad EHR vedors. The uified voice was strog. Upper level executives of the EHR ad lab vedors were motivated to travel to the etwork s table ad hear METCHIT s opiios ad provide their best cosultats for demostratios. While chage has bee a process, the iitial meetigs opeed a door for coversatio betwee the HCCN ad the vedors. It also made vedors more sesitive to the eeds of its CHC customers. Joit TA. At a coferece of the Healthcare Iformatio ad Maagemet Systems Society, oe of the METCHIT members got acquaited with aother etwork. This secod etwork, loger established ad more practiced i EHR implemetatio, was a deep source of iformatio. Moreover, this secod etwork shared the same values regardig collaboratio ad was ope to visitig to bestow its experiece ad advice. Sice all members were facig similar orgaizatioal priorities, METCHIT decided to host the etwork joitly. With the aid of HRSA fudig, the Alliace of Chicago Commuity Health Services, Ic. staff traveled from Chicago to New York ad coducted a two-day formal techical assistace visit. The first day bega with itroductios, where each etwork articulated its story from iceptio to their curret model for collaboratio. Hearig the Alliace s experiece, accomplishmets ad challeges i collaboratio provided a model for compariso for METCHIT, especially as it looked to develop its structure further. The core of the visit cosisted of sessios o relevat EHR topics, icludig: lab-iterfaces, reportig, usig the EHR for chroic disease Collaboratio is a key factor for efficiet ad successful implemetatio of a EHR. The value is i replicatig rather tha reivetig, ad choosig to replicate with orgaizatios who share similar struggles ad eed. maagemet ad quality assurace. I each area, participats shared their experieces ad progress. The two etworks discussed their experiece with a particular lab vedor ad progress i developig a bi-directioal lab iterface with the EHR. It was evidet those similar issues were priorities for both etworks, ad that the idividual coversatios of each etwork with the lab provider were parallel. It suggested aveues for collaboratio o bi-directioal lab iterfaces, ad provided both orgaizatios isight ad help i dealig with EHR ad third-party vedors. The evet exceeded expectatios. It fully explored how a HCCN ca use EHRs to promote the care model, ad helped METCHIT see the ext steps i implemetig chroic care collaboratives. Also, ot oly did it itroduce ad reacquait members of the orgaizatios, it laid the basis for a active, o-goig collaboratio. Havig a joit techical assistace visit from aother etwork stemmed from each etwork member s ackowledgemet that commo issues should be addressed together. Guidace ad solutios were gaied i specific areas, but oe of greater achievemets of the visit was to make clear that there is a fruitful path to log-term collaboratio amog HCCNs. NEXT STEPS I hidsight, METCHIT members would agree it is better to be part of a health ceter cotrolled etwork tha a sigle etity. Outside the scope of implemetatio, workig together has allowed for more efficiet sharig of resources. For example, evaluatig ew techologies, ew versios of software, scaig ad idexig, eve evaluatig ew grat opportuities were divided amogst health ceters istead of all ivestig time ad effort ito the same evaluatio. Idividual members also represeted the etwork i atioal meetigs or i buildig relatioships with city, state, ad govermets. As METCHIT cotiues, it looks towards its ext steps ad is curretly prioritizig goals 32 jhim Sprig 2010 volume 24 / Number 2

6 for the future, such as: commo template desigs, commo data ad reportig platforms, ad sharig staff resources. It also looks to pool etwork data for research ad collaborate with other etworks. All these future activities stemmed from the positive experiece of collaboratig o EHR implemetatio. CONCLUSION Collaboratio is a key factor for efficiet ad successful implemetatio of a EHR. The value is i replicatig rather tha reivetig, ad choosig to replicate with orgaizatios who share similar struggles ad eed. Through metorship ad regular meetigs of the etwork s cliical leadership, each orgaizatio had a less steep learig curve tha those i previous phases ad avoided repeatig mistakes of its peers. Cliical meetigs provided a collegial eviromet where members could share their experieces, questios ad advice. Moreover, the positive rapport formed amog the cliicias through implemetatio prompted further collaboratio o subsequet health iformatio techology edeavors, such as: bi-directioal iterfaces, relatioships with vedors ad other outside parties, reportig ad template desig, ad policy. All i all, collaboratio through a etwork ca greatly icrease a idividual health ceter s wealth of kowledge ad voice (i umbers), while reducig time, stress ad fiaces. JHIM Jeifer H. Kag, is Plaig Associate at the Charles B. Wag Commuity Health Ceter. She provides admiistrative support for METCHIT ad liaisos amog the commuity health ceters, govermet officials ad outside parters ad vedors. David Collymore, MD, MBA, is Medical Director of CCDC, member of the Cliical Affairs Committee of Affiity Health Pla, ad a practicig pediatricia. He oversees all cliical ad quality iitiatives. Warria Esmod, MD, is Medical Director of Settlemet Health Ceter i New York, NY. She champios EHR activities while maagig the cliical operatios of the Health Ceter. Lydia Gozalez, MD, is a pediatricia ad EHR physicia lead at Morris Heights Health Ceter i the Brox, NY. She has maaged the orgaizatio through EHR implemetatio. Perry Pog, MD, is Chief Medical Officer of Charles B. Wag Commuity Health Ceter. He is a practicig iterist ad oversees cliical iformatics ad medical admiistratio. Ly Sherma, MBA, CFO, of CBWCHC, is istrumetal i obtaiig fudig ad grat support for EHR projects, ad has worked atioally ad locally to foster collaboratio amogst commuity health ceters. Nick Egleso has bee the Project Maager for the Metropolita Collaborative of Health Iformatio Techology sice its iceptio. He is also Presidet ad Fouder of Paladi Cosultig ad Programmig. volume 24 / umber 2 Sprig 2010 jhim 33