IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHRCOMMUNITY HEALTH NETWORK OF WEST VIRGINIA PAGE 2
Case Study for Primary Care Systems
Improving Patient Care Using an EHRBackground
A number of studies strongly suggest that health care services delivered in the United Statesoften do not meet patient needs. One of these studies indicates that only 50 percent of theindividuals studied received recommended preventive care and only 60 percent receivedrecommended chronic care. Equally troubling was the finding that, of those studied, twentypercent received chronic care that was contraindicated. See: Mark A. Schuster, Elizabeth A.McGlynn, Robert H. Brook (1998), “How Good Is the Quality of Health Care in the United States?” The Milbank Quarterly 76 (4), 517–563. These results were confirmed by a RAND Corporation study that found American adults receivedonly about half (54.9 percent) of recommended medical care in compliance with evidenced-basedguidelines. This study added to the mounting evidence of deficiencies in the U.S. health caresystem, which was highlighted in a 2001 Institute of Medicine report, “Crossing the QualityChasm”, documenting the chasm between the care Americans receive and the care Americansshould expect. There is emerging evidence that electronic health information systems (referred to genericallyherein as “EHR” for “Electronic Health Record”) can have a profound impact on quality of serviceand patient outcomes if implemented in concert with recommended health improvementprocesses. The use of EHR systems permits participants to measure and report externally on anumber of quality indicators and more importantly, to use these results internally to continuallyimprove care delivery by more readily conforming to evidence-based clinical best practices.Use of an EHR system facilitates measurement of outcomes and evaluation of interventions inreal-time rather than a retrospective environment, facilitating continuous improvement of theworkflow and processes of clinical activities. It also facilitates communication and coordination of care among care team participants and allows tracking of patient health indicators over time(facilitating health indicator trending through charts and graphs). This case study reviews how the implementation of a population-based EHR along with thechronic care model of care delivery and coordination (referred to herein as the “Care Model”indicating a system of care for chronic conditions based upon a model developed by Ed Wagner,MD, MPH, Director of the MacColl Institute for Healthcare Innovation and employed bycommunity health centers through the Health Disparities Collaborative efforts coordinated byHRSA, see: http://www.improvingchroniccare.org/) is improving the health outcomes for patientsof Primary Care Systems in the rural community of Clay, West Virginia.
Primary Care Systems
Primary Care Systems, Inc., is a Federally Qualified community health center (FQHC) serving theresidents of Clay County, West Virginia, and surrounding areas. Primary Care Systems has twoprimary clinical locations in Clay and Big Otter within Clay County, and three school-based healthcenters at Clay Elementary, Clay Middle and Clay High Schools (with a fourth center planned forthe new Big Otter Elementary School in 2008). Primary Care Systems serves approximately7,200 patients with approximately 30,000 patient encounters annually. Of the patients served,over seventy percent are covered by Medicare or Medicaid or are uninsured. The staff of PrimaryCare Systems currently includes 4 FTE physicians and 4 FTE mid-levels providing a range of primary care services, including laboratory, radiology, behavioral health and maternity and well-child services.