Title: Leveraging Health Information Technology (HIT ) in the Outpatient Arena to Actuate Authentic Medical Home Transformation and Accountable Care Delivery Organization: The Wright Center for Primary Care Topic: Converging Regional Extension Center (REC) coaching, EMR Meaningful Use implementation, and Medical Home transformation. Date of Success Story: 2011-2015 Care and Related Service Setting: Three Wright Centers for Primary Care Safety Net Ambulatory Clinics Meaningful Use Stage Attestation: Modified Stage 2 Alternative Payment Model Affiliation (If Any): Pennsylvania Chronic Care Initiative, a multi-payer value oriented learning collaborative. Overview: Quality Insights of Pennsylvania first approached The Wright Center (TWC) in 2008 to participate in the 9th Scope of Work related to clinical quality measure testing for flu and pneumonia vaccination rates. During the six year journey between 2008 and 2014, TWC gained immense value through its leading engagement within the learning action networks of Quality Insights 9th and 10th Scope of Work. The technical assistance and support for this work provided by Quality Insights of Pennsylvania yielded crucial coaching for the establishment of TWC s EHR integrated population health reporting infrastructure. This foundational Health IT outcomes reporting work dovetailed with the TWC s intentional care delivery redesign and medical home transformation efforts as a leading practice in the PA Chronic Care Initiative. The emerging EMR MU attestation program offered a timely framework for the convergence of transformation efforts at TWC. Regional Extension Centers (REC) were founded at this time to provide technical assistance for the engagement in the Federal MU program and Quality Insights of Pennsylvania was awarded the contract for both of Pennsylvania s RECs. Connected through prior work with the 9th and 10th scope, a PA-Reach team member reached out to TWC to see if the organization would be interested in participating in their Meaningful Use needs assessment. At this time it became very clear at TWC that medical home provider care teams needed entrenched coaching and advocacy for the EMR MU program to be authentically implemented in a value driven and outcomes oriented manner. As a result, TWC created a new full time position of an EMR Application Specialist whose role has been crucial and ever evolving to discover increasing value of EMR integration into daily workflow of care delivery to achieve the Triple Aim (JD as attached). The PAReach team worked closely with the TWC s EMR Application Specialist and visited all three Wright Center outpatient sites to observe EMR integrated clinical workflow directly. After a review of their findings, and based on the rapid advances made by TWC, PA-Reach and the Office of National Coordinator (ONC) recognized the Wright Center with the MUver award as a Meaningful Use Vanguard.
Today, The Wright Center and PA Reach continue to work together collaboratively on testing quality measures for future stages of the Federal Meaningful Use program. The organizations collaborate wholeheartedly around the vision of meaningful use of HIT because they recognize it as an essential catalyst of redesigning health care delivery to actuate The Triple Aim. Outcome: PA Reach conducted interviews with a physician lead from each Wright Center for Primary care clinic to gauge their individual understanding and collective vision of EMR Meaningful Use and its authentic integration into clinical workflow. Following their workflow assessment, PA Reach shared the observations and recommendations with the Wright Center in an EMR workflow template. Leadership at TWC was extremely impressed with the framework of PA Reach s workflow template and its capacity to promote accountability for high performing, team based care delivery enabled by EMR Meaningful Use. TWC adopted this template as the organization s living operational handbook and attached EMR screenshots as visual aids for workflow policy and procedures. This polished workflow document became the crucial Wright Center roadmap to certification as a NCQA Level 3 Patient Centered Medical Home. This was a powerful catalyst for TWC to capture fluid practice redesign innovations in a living document that became a core driver of a CQI culture. This web based document is still today updated on a regular basis when operations and processes are reconfigured. Role specific assignments of the components of team based care delivery generated in the workflow document now populated performance assessment competency evaluation tools PACE report cards for all employees. These individual report cards define team, clinic and departmental levels of a larger organizational Balanced Score Card, which is imperative for a performance based culture of accountability. Lessons Learned: PA Reach s direct assessment was valuable but required engaged leadership from TWC to make the workflow document a living meaningful roadmap for the organization. The Wright Center s now President and CEO, Dr. Linda Thomas-Hemak, a practicing primary care physician, engaged physician colleagues and staff to intently revise the original report to depict TWC s collective vision for high performing primary care delivery. This document was then shared across the organization for all clinic staff to review, with the understanding that some of the items mentioned were audacious and aspirational. This process overall provided awesome opportunity for the TWC to explore best practice and inspire individual team based and organization wide care delivery process and health outcome report cards. Taking the workflow document and editing it to echo the organization s mission and vision within the templated framework of medical home workflow and EMR MU was an undeniably generative process to authenticate practice and cultural transformation within TWC. Next-Steps/Future Vision: Our next steps would include continuing our strong partnership with PA-Reach as we transition into Stage 3 of Meaningful Use and to be valuable partners for them in any future opportunities that may arise. The Wright Center and PA Reach collaboration has delivered incredible impact for team based patient care delivery. TWC Primary care leadership is fully committed to leverage this partnership to inspire ONC attention to prompt America to the next frontier of meaningful use of HIT. TWC brings particular interest in the arenas of referral tracking, care coordination, patient engagement and interoperability and believes these focus points have the power to generate not only improvement in patient satisfaction but in professional satisfaction physician and care delivery team members.
Contact Information: Tiffany Jaskulski, EMR Specialist at The Wright Center for Primary Care. Email: elkinst@thewrightcenter.org Matthew Armstrong, Practice Transformation Specialist. Email: marmstrong@wvmi.org Rhonda Dodson, Project Director, Practice Transformation. Email: rdodson@wvmi.org
PA Reach shared the following template for EMR meaningful use guided clinical workflow. After their site visit to The Wright Center for Primary Care, they shared their observations and constructive recommendations with practice leadership. The Wright Center quickly recognized that this templated document converged with the practice s medical home redesign efforts and that the template integrated easily into their daily workflow. This strategic integration of the PA Reach EMR Meaningful Use template delivered incredible value to The Wright Center which has continued to utilize it as a living functional, adaptive document shared organization wide.
With the EMR Meaningful Use recommendations from PA Reach and inspiration for medical home driven workflow redesign, The Wright Center streamlined their team based rooming in process to ensure all steps along the way were lean and efficient. The workflow ensured all members of the team were working to the top of their license with whole team engagement to optimize patient s meaningful contributions to their care that can optimize care delivery and health outcomes while expanding provider capacity. EMR Meaningful Use Measure Outcomes On a monthly basis, The Wright Center internally circulates all of the meaningful use measures for individual providers. This gives each provider valuable feedback and an opportunity to inspire quality improvement projects to improve EMR Meaningful Use attestation metrics. The Wright Center leadership intentionally includes these EMR MU metrics in provider snapshots that report care delivery process and population health outcomes trackable to individual patients to give a clear and consistent message of organizational commitment to federal standards that promote meet public trust.
In conjunction with the monthly PACE card circulation, a related provider wide summative comparison report for individual EMR Meaningful Use metrics is emailed to all providers so they can see where they stand collectively and individually as an organization regarding Meaningful Use attestation. This organizational process intends to promote mindful engagement and healthy competition amongst the clinicians in the organization for value based initiatives like EMR Meaningful Use.