David Gorchoff, MD MPH Medical Director, Redwood Community Health Coalition California Healthcare Foundation November 2005, San Francisco Using Technology to Improve Care: RCHC’s Experience Using MediTracks for Patient Care Management

Redwood Community Health Coalition A network of independent community health care organizations in a four county area of Northern California: Sonoma, Napa, Marin and Yolo.

RCHC Clinical Data Network using MediTracks Currently RCHC’s network MediTracks project, funded by CCI/Tides, involves 10 member centers (including Clinic Ole). 10 independent RCHC clinics are coming together through a phased implementation process. The RCHC Clinical Data Network is buying together, using a single server, with potential availability of aggregated data for network Quality Improvement purposes.

Case Study: Napa Clinic Ole' Immunizations Napa Clinic Ole' has a well-established Quality Improvement Program with strong medical leadership, led by Dr. Robert Moore, which is supported by the agency’s administrative leadership. Their task: automate immunization tracking using MediTracks.

Maintain an automated and complete record of patients’ immunizations. Reduce vaccination errors, by building immunization standards into the system. Perform required annual vaccination audits (CASA audit) automatically. Use the system to track patients who are behind on vaccines. Develop a two way interface with the regional vaccine registry, to exchange vaccine data seamlessly and without extra data entry requirements. Clinic Ole' MediTracks Immunization Tracking Project Vision and Goals

Clinic Ole' MediTracks Immunization Tracking Project Accomplishments System now routinely finds errors in vaccination schedule missed by providers and nurses. Plan to do annual vaccination audit next year. Currently focusing on ensuring that all vaccines are entered in to the system (including vaccines given elsewhere). Beginning to use Meditracks to pull a list of children the system believes are behind on vaccinations, to review their charts and confirm and update Meditracks if needed, and then call patients to come in to catch up if needed. MediTracks also can generate and send letters, if desired.

. Clinic Ole' MediTracks Immunization Tracking Project MediTracks

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The Product: MediTracks Developed in partnership with Community Health Centers for Community Health Centers. User-friendly. Great training and support. Customizable to track anything. Current modules include Diabetes, Asthma, Women’s Health, Immunizations. Conceptualized and designed by interface specialists, to minimize duplicative data entry by seamlessly migrating data (from PMS, outside labs, etc.) into MediTracks. Fulfills the key quality improvement possibilities of an E.H.R., without the necessity of computerizing every aspect of the clinical record.

RCHC Clinical Data Network using MediTracks Functions as an upgrade from the automated Registry products used previously for RCHC’s network Diabetes Care Management project (CVDEMS, PECS). Earlier data can be (and has been successfully) imported into MediTracks, and required reports can be generated. Seen as a realistic first step toward ultimate goal of network Electronic Health Record More affordable than E.H.R. with functionality to track and manage common problems which is missing from most E.H.R. products Gives us time to improve our systems, and to learn to work together in new ways. Gives the E.H.R. market time to mature.

RCHC’s Clinical Data Network Caveats No product will take the place of clearly thought-out and implemented clinical systems, and introduction of MediTracks or any other automation product may magnify the problems caused by a lack of such systems. Customization is the enemy of standardization. The best products allow for a balance between the two. Most medical providers insist on the ability to customize their tools (“the Cowboy/Cowgirl phenomenon”), but Quality Improvement activities and Clinical Outcomes measurement require standardized data to be meaningful. Implementation nearly always occurs more slowly than expected. Expect delays and complications, which come with the territory.