Community Health Access Network: Kirsten Platte, Executive Director

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Community Health Access Network (CHAN) was founded in 1995 as one of the first Health Center Controlled Networks (HCCN) in the country. To this day, it remains the only Health Center Controlled Network (HCCN) in New Hampshire.

A non-profit entity, CHAN is a member organization of Federally Qualified Health Centers (FQHCs). It is comprised of 10 health-center members at 22 sites to include Full and Affiliate members.  Of its six Full members, five are located in New Hampshire and one in Texas. All use CHAN’s centralized electronic health records (EHR) infrastructure as well as its practice-management (PM) billing system. CHAN’s EHR and PM systems also support two Healthcare for the Homeless programs in New Hampshire.

CHAN’s EHR supports 65,000 active patient records. Two of CHAN’s Affiliate FQHC members, located in northern New Hampshire, host their own EMR database that supports approximately 21,000 patients.

Bridging socioeconomic factors

“Many of the health-center patients  are underserved and underinsured,” Kirsten Platte, executive director, said. “Approximately 26 percent of those patients are Medicaid patients; 32 percent of those are uninsured; and 19 percent of those are minority patients. Many health-center patients are very sick and have chronic disease and many of those have comorbidities, meaning they have more than one chronic disease.”

Many of CHAN’s members not only offer medical care, but also have to address socioeconomic issues when providing this care. These issues may include transportation, a factor that  oftentimes determines whether or not the patient can get to the health center for their appointment. Language barriers are also an issue.

The health centers are required by law to have a certified translator for those patients for whom English is a second language. This can consume a large part of a center’s budget depending on its location and the diversity of the area. One center in Manchester, N.H., Platte said, supports more than 60 different languages within its patient base. Its service area, though, consists of only 6,760 patients.

Being federally funded

“What’s unique about the FQHCs is their unique patient base,” Platte said. “Besides the under and uninsured, they also serve a substantial amount of insured patients. Because FQHCs are federally funded, there are certain standards of care that must be met and reported on. Quality, attention to detail, and utilization of clinical data to support improvements in patient care is really important for the health centers, whereas other providers may not have to meet the same quality criteria, as they’re not federally funded.”

The state of New Hampshire also supports the health centers with various funding, but recently, because of budget constraints, health-center funding has been  cut by up to 40 to 50 percent, depending on the center. New Hampshire is preparing to implement Medicaid Managed Care in July 2012. As one of the few states yet to implement Medicaid Managed Care, Platte said the implementation will help to improve patient outcomes, while bringing healthcare costs down.

Focused on data support

CHAN continues to focus on supporting the EHR and PM IT infrastructure for its members. Most recently, CHAN’s focus has included support of its members in meeting the requirements for the Centers for Medicare and Medicaid Services (CMS) meaningful-use program.  This program offers monetary incentives to eligible providers, such as doctors, dentists, nurse practitioners, and pediatricians for utilizing electronic medial records (EMRs) in a “meaningful way.”  Platte believes that the existing CHAN staff and infrastructure are the tools that will support meaningful use, offering a more efficient and effective providers/patient experience.

While many organizations are scrambling to catch up to EMR technology, CHAN implemented its first EMR in 2000, so Platte said they have had the luxury of time for developing their own EHR infrastructure to include electronic forms that support various types of patient visits and data collection.

CHAN has also compiled a robust data warehouse with an extensive assortment of historical clinical data. On a nightly basis, data from the PM billing system and the EHR are downloaded to the data warehouse. This allows for more robust reporting and enables reports to be posted on a report server that members can access independently.

CHAN’s next capital project is to develop an off-site Business Continuity/Data Recovery center. It will be a smaller version of the existing infrastructure and will serve as a back-up in the event of an emergency.

“If the system here were to go down due to some disaster or event, there should be a seamless transition over to the other site,” Platte said. “It won’t support all the users that we have, but will support the priority users, so the providers can continue to see patients and have access to their electronic charts.”

One of the core-system criteria for meaningful use is the generation and transmission of permissible prescriptions electronically, known as e-prescribing. The outlined measure demands that more than 40 percent of all the permissible prescriptions written by the eligible provider are transmitted electronically using a certified EHR technology.

CHAN has possessed this ability for the past two years. Platte said the organization is refining the process, running reports, and identifying which providers aren’t meeting the 40-percent criteria.

“We’re quite ahead of the curve,” she stated, “which is encouraging.”

CHAN has also spent a great deal of time over the past two years shoring up its infrastructure and making it more secure by installing security-oriented software and hardware. Federal funding from the Health Resources and Services Administration (HRSA) have made this possible.

“When you host protected patient health information (PHI), you are responsible to make sure that information is secure,” Platte said. “That’s been a big focus of ours over the last 18-24 months.”

Fostering “coopetition”

In 2008, CHAN received the Nicholas E. Davies Award from the Healthcare Information and Managements Systems Society (HIMSS) in the Community Health Organization category for improving healthcare through the use of IT. CHAN is still the only HCCN in the country to date to have received this award.

“There’s a certain amount of competition among our members, but the collaboration plus the competition (i.e., coopetition) is really what helps drive quality,” Platte said. “Our end goal is improved patient outcomes and enhanced patient care, and we support the IT tool and infrastructure which allow our health-center members to focus on that.”

-by Pete Fernbaugh

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