David Gorchoff, MD MPH

1

Using Technology to Improve Care RCHCs
Experience Using MediTracks for Patient Care
Management

• David Gorchoff, MD MPH
• Medical Director, Redwood Community Health
  Coalition
• California Healthcare Foundation
• November 2005, San Francisco

2
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.

3
RCHC Clinical Data Networkusing MediTracks

• Currently RCHCs 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.

4
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 agencys administrative
leadership. Their task automate immunization
tracking using MediTracks.
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Clinic Ole' MediTracks Immunization Tracking
ProjectVision and Goals

• 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. 

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Clinic Ole' MediTracks Immunization Tracking
ProjectAccomplishments

• 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.

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Clinic Ole' MediTracks Immunization Tracking
ProjectMediTracks

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Clinic Ole' MediTracks Immunization Tracking
ProjectMediTracks

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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, Womens 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.

10
RCHC Clinical Data Networkusing MediTracks

• Functions as an upgrade from the automated
  Registry products used previously for RCHCs
  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.

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RCHCs 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.