Electronic Health Records in Small Latino Practices Antonio Fernandez National Advisory Council Director, Ponce School of Medicine Regional Extension Center March 28 th, 2014

ARRA & HITECH “The National Coordinator shall assess and publish the impact of health information technology in communities with health disparities and in areas with a high proportion of individuals who are uninsured, underinsured, and medically underserved individuals (including urban and rural areas) and identify practices to increase the adoption of such technology by health care providers in such communities, and the use of health information technology to reduce and better manage chronic diseases.” American Recovery and Reinvestment Act of 2009, Public Law No , § 13101, 123 Stat (2009) (adding § 3001(c) (6)(C) of the Public Health Service Act).

Health Disparities & Meaningful Use Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information

PATIENT & FAMILY ENGAGEMENT/ COLLABORATIVE CARE ACCOUNTABLE CARE/ POPULATION HEALTH MANAGED CARE PROVIDER- DIRECTED CARE

National Quality Strategy The federal government’s approach to addressing the “three part aim” centers on developing a National Quality Strategy. Justification for pursuing this strategy includes the federal role in addressing health disparities, population health, and quality of care for underserved groups. Among other activities, the strategy calls for an alignment of quality measures that can be used to assess national progress, including those appropriate for monitoring progress related to reducing health disparities.

NQS & Three-Part Aim PATIENTSPROVIDERS HEALTH IT PAYERS

ONC: NORC Study “There is some work that suggests that Federally Qualified Health Centers (FQHCs) have relatively robust adoption of EHRs due to the Health Center Controlled Networks (HCCNs) program and other initiatives…On the other hand, stakeholders express growing concern that adoption of health IT among providers will cause a new form of the digital divide, as the populations served by providers adopting EHRs and exchanging health information experience benefits from improved convenience, coordination, and quality of care compared to populations whose providers have not adopted health IT.”

National Healthcare Disparities Reports AHRQ Access to Care Quality of Care Patient Engagement Healthcare Outcomes Management of Chronic Diseases

Elements for Practice Support Bilingual Trained Field Consultants Field Support to Practices Practice-Based Assessments Template Development Workflow Design Continuing Education for Physicians Certificate Training for Staff Integration with Payers Federal Incentives

Integrating consumer and provider engagement HITECH/HITOUCH Approach Understanding the dynamics of Consumer and Provider Relationship Early Engagement of Collaborative relationships with Physician Leaders who become Champions for promoting the value of the EHR among their peers, and assist in identifying other physicians who would be interested in the adoption Consumer engagement CANNOT be an afterthought. There is a need to be a coordinated approach with outreach to providers Safety Net Providers, Safety Net Provider Extenders- “Safety-Net RECs” Long-Term Sustainable Action

Puerto Rico REC Experience

Electronic Prescriptions

Good News Report Data presented in the report give reasons for hope: African American diabetic patients had improved health outcomes and better communication with their doctors when given access to patient portals, along with technical help and social networking support Three out of four minority patients receiving care from a San Francisco clinic would like to use an platform to communicate with medical staff. Among users of mobile technology, African Americans and Latinos are more likely to use health care applications than non-minority consumers. Latinos are more likely than any other patient group to research health information on their mobile phones and are also more likely to view health-related text messages as helpful as compared with their non-Latino counterparts.

NHIT Action Framework Adoption and Meaningful Use among Safety Net Providers & Extenders Expand Workforce Development andTraining for Safety-Net Provider Practices Clinical Quality and Population Health Analytics Use of mHealth to Engage Underserved Consumers, Patients and Families Patient-Centered Care for Underserved Communities

Contact Information Antonio I. Fernandez Ponce School of Medicine Regional Extension Center (787)

Q&A

Thank You! Antonio Fernandez National Advisory Council Contact Us: Luis Belen Chief Executive officer