Less than a decade ago, the Lynn Community Health Center (LCHC) employed a person full-time to drive paper health records around this sprawling city, a welcoming destination for immigrants. Based in the old Woolworth’s building on Union St., LCHC delivered care at six schools and other locations in what was once the shoe-making capital of the world.
“A good afternoon meant a provider might have ¾ of the patients’ charts,” said Bob Dempkowski, deputy director of the LCHC. Like a black market economy, people did what they needed to survive, sometimes stashing charts they might need the next day. Searching for those 'lost' charts became unworkable, and possibly dangerous for patients, so LCHC set out in 2004 to computerize records well in advance of the Meaningful Use mandate set forth by the American Reinvestment and Recovery Act of 2009.
Today, "charts no longer get lost,” Dembowski said. A large room in the basement has been freed from both "too much paper" and the servers that LCHC initially purchased to house electronic health records (EHR). The EHR software and patient data are now in a co-located data center that ensures patient privacy and business continuity.
From its auspicious beginnings in a storefront dedicated to mental health services, the LCHC has grown into a model of healthcare delivery and community development. On the same day that Dempkowski received an email to confirm delivery of the first dozen Meaningful Use payments for LCHC providers enrolled in the CMS program, he gave me a tour of the center's new facility and reflected on a meaningful journey.
Paying for EHR—and a Bigger Building
LCHC provides comprehensive, quality care to Lynn residents regardless of their ability to pay for it. As a non-profit, the center’s pockets weren’t deep enough to afford an EHR system, especially before cloud computing made it doable for a monthly fee—so they asked a larger neighbor for help. Joining a collaborative or partnering with a nearby hospital, as LCHC did with nearby North Shore Medical Center (NSMC) in Salem, Mass., has proven to be a successful way to fund EHR.
The Health Center’s senior management team worked with a consultant to wade through available offerings and selected NextGen because “it was a major vendor in a rapidly changing field. We wanted a product that would survive,” Dembowski said. “It was a huge investment in time and money.” Initially, the NextGen system ran on servers that replaced the paper files in the basement, but a couple of years ago, it became clear that privately maintained servers were ancient technology. In addition to security issues, the servers were vulnerable to occasional outages due to electrical or air-conditioning issues. With a limited IT staff, LCHC partnered with Platform Solutions in Boston, which manages the LCHC’s applications and data within a secure and redundant data center that offers a scalable environment based on virtualized servers.
Along with the funding from NSMC and its parent company, Partners Healthcare, LCHC launched a capital campaign to expand its footprint by connecting the old Woolworth space with a new, state-of-the-art facility. Last fall, the Center dedicated the calm and efficient Steven D. Hayes building, which connects to the old space via an atrium adorned with the words of the late Senator Edward Kennedy. At the building's dedication, his widow, Victoria Reggie Kennedy, was visibly moved by the recitation of Senator Kennedy’s words in multiple languages by LCHC staffers:
“Healthcare…is above all a moral issue…at stake are not just the details of policy…but fundamental principles of social justice and the character of our country. We will – yes, we will – fulfill the promise of healthcare in America as a right, and not a privilege.”
Community Effort Rewarded
Indeed, the LCHC appears to be fulfilling the promise of health centers as hubs of the community. It serves 34,000 people a year, delivering healthcare services including behavioral health, dental care, eye care, pharmacy service, WIC, nutrition, addiction/recovery counseling, smoking cessation, HIV/AIDS counseling, testing and case management, a pediatric literacy program and domestic violence counseling. In a collaboration with LCHC, the Massachusetts Coalition for the Homeless opened a HomeLink Help Desk in the lobby to provide information on housing, material needs, and food assistance services. The Health Center is one of the largest employers in the city, with 420 people on staff, and recently won the Lynn Area Chamber of Commerce’s Multicultural Business Leadership Award.
On the tour, I was impressed by the well-equipped training rooms, where staffers can learn how to use the EHR system and patients can learn how to cook healthy meals. Breaking ground online as well, the LCHC’s Facebook page is a great example of using social media to post news and congratulations to those who are making a meaningful contribution, including Board Member Magnolia Contreras, recognized by El Planeta as one of the 100 most influential people in the Massachusetts Hispanic Community.
Meaningful Use Madness
All that done, it was time to enroll in the Meaningful Use (MU) program, which really delivered some growing pains, Dempkowski said. The health center chose to enroll in the Medicaid MU program, because the number of its Medicaid patients was more than double the volume required to receive the higher payouts than the Medicare MU program. Of the 400 new patients walking through the LCHC doors each month, roughly 62% rely on Medicaid for health insurance.
The enrollment process was a tough nut to crack. The providers employed by LCHC had to do the registration and designate the health center, rather than the other way around. Chasing down practitioners proved arduous but profitable, as the center now stands to gain $22,000 in Meaningful Use funds for each of the 40 providers now enrolled.
Moving forward, Dempkowski has his sights set on security policies, particularly for mobile devices. Currently, providers can access records remotely using terminal services, rather than a more secure virtual private network (VPN). LCHC recently brought in a consultant to do a security assessment. “We know we won’t come out of it in perfect shape. It’s going to be an eye opener, but a good eye opener.”
The Center is also part of the Massachusetts League of Community Health Centers, and is taking part in a combined data repository to run nightly Meaningful Use reports. The process will really become meaningful when documentation for clinical criteria becomes standardized, Dempkowski said, rather than the random notes and phrases providers use to express their findings. “It needs to be in a check-box; it’s very different from the old paper-record world.”
LCHC treats the whole patient, and its EHR systems reflect that. Behavioral health records are integrated with medical records, although Dempkowski admits that integration beyond the LCHC to partners including NSMC is limited. There’s always tomorrow to address the changing landscape of mobile devices and connectivity through Health Information Exchanges (HIEs). For now, it’s worth celebrating the Meaningful Use of electronic records. “Providers can access the record 24 X 7, so they don’t have to wing it,” he said, like in the old days, less than a decade ago.