April 2011

Eastern Aleutian Tribes Leading the Way

Along the Aleutian Chain and Alaska Peninsula, extending far out into the frigid Bering Sea, the Unangan have had several thousands of years’ experience adapting to the rough, windy seas and the remote, rocky volcanic islands. They became skilled navigators of the sea and adept at hunting its bounty. As explorers from Russia and Scandinavia appeared, the Unangan, forced to call themselves “Aleut,” learned to adapt again, trading with the foreigners and even adopting some of their culture. Forbidden to dance their dances, sing the songs of their traditions or speak the language of their heritage, they became silent and they survived. What they could not adapt to was the new sickness introduced from faraway lands. Two hundred years ago, the Aleut population was decimated by disease, reduced to 20% of its former strength.

Today the Unangan (Aleut), through eight community health centers in the Aleutians East Borough and Whittier Alaska, have committed to an entirely different vision: to be the healthiest people in the nation. The small, isolated communities, without the connection of a road system among them or to the mainland, have clearly embraced the healthcare of the 21^st century. Under the fairly new leadership of Executive Director Michael Christensen, Eastern Aleutian Tribes, Inc. is leading the way in quality transformation, setting the pace through eight diverse clinics. It’s a new era for Eastern Aleutian Tribes, Inc. (EAT), celebrating its 20^th anniversary this year.

Leading the charge toward innovation, accreditation, meaningful use and much more is Tara Ferguson, EAT’s new Director of Quality Improvement and Quality Management. In part, Tara develops, implements, monitors and evaluates EAT’s organizational activities related to quality improvement, accreditation, patient satisfaction, safety and regulatory compliance, and adherence to state and federal regulations. As one of the state's few IHI Improvement Advisors, Tara does this via EAT’s Quality and Innovation Learning Network, part of the Improving Patient Care (IPC) program, an initiative of the Institute for HealthCare Improvement (IHI) and Indian Health Services (IHS). When the Institute announced EAT’s selection for IPC four years ago, its leaders noted that EAT’s “facility leadership and care teams remain at the forefront…in engaging excellence and improvements with our American Indian and Alaska Native patients, families and communities.” The Institute and IHS plan to keep EAT on the cutting edge of innovation and improvement.

The vision is a healthcare system Alaska Native people can call their own, and the first goal is improved patient care. Tara acknowledges IHI’s position that the greatest untapped resource for improving health care is the knowledge, wisdom and energy of the individuals, families and communities who face challenging health issues in their daily lives. Her efforts have already paid off with improved GPRA scores in both diabetes glycemic control and colorectal cancer screening along with improved patient experiences and outcomes, reduced costs and wait times. Using the Model for Improvement, which includes a method for rapidly testing process changes on a small scale, process mapping, redesigning practices and processes, and implementing and managing improvement initiatives, Tara is determined to bring EAT to the pinnacle of quality improvement.

One of Tara’s major responsibilities will be achieving Joint Commission Accreditation for EAT through HRSA. “Accreditation represents a visible demonstration to patients and the community that the health center or organization is committed to providing high quality health care services,” she explained.

In the meantime, EAT has made significant strides in the area of dental care by sponsoring two students, Eric Linduska and Chelsea Shoemaker, to a two-year training that resulted last December in their certification as Dental Health Aide Therapists (DHATs). The two new DHATs have returned to their communities on the Aleutian Chain, where Alaska Native children suffer rates of tooth decay 2.5 times the U.S. national average. They will work to change behavior through education, risk assessment and triage.

Determined to move forward on every front, EAT implemented Electronic Health Record (EHR) in 2010, improving provider decision support and workflow as well as quality assessment and planning. Tara said, “I’ll be working with clinics to help staff use the system effectively at the point of care to produce meaningful data that reveal our improvement efforts.” The EHR system EAT has adopted is Resource and Patient Management System (RPSM), a clinical information system developed by IHS.

To improve its data integrity, EAT has also hired a new senior data analyst, Maria Johnson, who will work closely with the EHR group and other data capturing programs, identifying trends to ultimately improve the quality of patient care. Maria is tasked with managing, developing and maintaining health information, trend information, providing basic audit guidance, and data flow to create useful tools for better business decision-making.

Spanning 6,985 square miles of land spread over 8,029 square miles of the Bering Sea and the Pacific Ocean requires a robust technology system and framework. EAT’s providers use teleradiology, telepharmacy, and a specially-designed telemedicine cart, made by the Alaska Federal Healthcare Access Network to capture patient information in digitized format for immediate transmittal to a specialist in a different location. Behavioral consultations in the smaller clinics are accomplished through confidential videoconferences with clinicians in Sand Point and King Cove.

According to Michael Christensen, “Quality Improvement will impact every goal and objective in EAT’s 2010-2015 Report to Our People.” He has acknowledged to his staff that this commitment will require that they think differently about how they provide care for patients, families, and communities, and about how the administration and leadership supports improvement and innovation in the health system.

Today the Unangan (Aleut) place their health and wellness in the capable hands of community health center staff who are leading the way in providing “reliable quality care everywhere, every time, for every person.” Most of us won’t get to visit the Aleutian Chain in our lifetime. Now we know that the resilient Aleuts have again adapted and are, in fact, out in front in making healthcare patient-centered, coordinated, and evidence-based. Congratulations to Michael Christensen, Tara Ferguson and the entire staff of EAT.

February 2011

SuccessEHS Leads Client to First HITECH Incentive Check!

The first Medicaid electronic health record (EHR) incentive has been paid out, and it was the client of an NWRPCA member who received that payment! SuccessEHS client Winn Community Health Center became the nation's first FQHC to receive such an incentive payment on January 12, 2011. Winn received the payment through the Louisiana Medicaid EHR Incentive Program, which is federally funded by the Health Information and Technology for Economic and Clinical Health (HITECH) Act, an ARRA program. HITECH promotes adoption of EHRs by health care providers through financial incentives under Medicare or Medicaid.

In a January 20, 2011 press release, SuccessEHS president and CEO W. Sanders Pitman said, "We are very proud to be partnered with one of the first providers in the nation to receive a Medicaid incentive payment. We are confident that many of our providers will follow and are proactively working to educate and assist our customers so they will be positioned to receive this needed funding as early as possible.

Headquartered in Birmingham, Alabama, SuccessEHS joined Northwest Regional PCA in 2010 after exhibiting at NWRPCA primary care conferences for several years. In addition, SuccessEHS, whose experienced management team has an average tenure of more than 12 years, regularly provides expert presenters for the primary care conferences and submits helpful articles to QuickNotes.

Founded in 1995, SuccessEHS has built a team of more than 200 professionals, allowing for the development of personal relationships with customers. The company quickly distinguished itself by providing an innovative blend of clinical, operational, and and financial software along with a suite of specialized integrated success services. The company's web site explains its product like this: "SuccessEHS is a combination of functionality-rich EHR and practice management systems that work together to provide a complete practice management solution."

NWRPCA is grateful for the support and expertise consistently offered by this for-profit associate member.

January 2011

OCHIN: Growing Well -- Mission Intact

Just a little over a year ago, Abby Sears, CEO of OCHIN, was waiting for word from The US Department of Health and Human Services (HHS): Would her 9-year-old Health Center Controlled Network (HCCN) be approved as the HIT Regional Extension Center (REC) for the state of Oregon? OCHIN had a lot of competition, but Sears knew they were a serious contender.

February 2010: Word arrived from HHS. Yes, indeed, OCHIN was the chosen consultant to help approximately 3000 “eligible professionals” (primary care providers, including community and migrant health center providers) select, adopt, launch and learn to meaningfully use federally certified electronic health records (EHR).

And then the waiting began again. OCHIN could not act without final guidance from HHS, which did not come until July 2010. Since then OCHIN has already consulted with approximately 500 eligible providers in Oregon, starting them on the road to “meaningful use” of federally certified EHR platforms. Oregon Health and Science University is OCHIN’s foundational partner on the grant. The new program is aptly named the Oregon Health Information Technology Extension Center (O-HITEC).

Waiting is not exactly comfortable for OCHIN. In its ten-year history, the network has progressed from serving 3400 patients through electronic practice management to serving 100 times that many! In just the past four years this Portland-based network, which specializes in Epic System’s EHR modified for community health clinics, and supports a range of HIT products, has increased its quota of patients served through EHR seven-fold.

Board president (and now an NWRPCA employee) Bob Marsalli credits OCHIN, on whose board he has served for four years, as a shining example of “how to grow well and not forget your mission.” Growth has been the operative word for this health information technology network that has proven to be dramatically innovative while remaining practical.

Founded in 2000 with two employees, the network’s original name was “Oregon Community Health Information Network.” When prospective clients beyond Oregon came calling, the name was changed to “Our Community Health Information Network.” Now, serving seven states across the nation (Oregon, Washington, California, Alaska, Ohio, South Carolina and Wisconsin) and employing over 100 staff members, the organization’s legal name is simply OCHIN. In 2011 OCHIN, a 501 (c) (3) nonprofit, will support more than 2 million outpatient visits with a budget exceeding $20M.

A very active member of Northwest Regional PCA since 2007, OCHIN was already offering a host of technical services to its members before this latest HHS grant:

A Practice Based Research Network (PBRN) that provides original research on the safety net population
An advanced health information exchange with nearly 200 interfaces and an operational exchange of information with EHRs at external organizations
A respected business services division that provides billing services to clinics and health centers
Consultants offering expert advice on implementation and optimization of EHR systems, HIPPA, contract negotiations, and system selection and planning
A data aggregation and benchmarking tool set that offers normalized quality metrics and benchmarks for ambulatory clinics and critical access hospitals, encouraging quality improvement across multiple platforms
An education center for IT and health care professionals on practical methods and techniques for performance improvement

Today, it’s the new O-HITEC project the OCHIN staff is excited to talk about. According to Ruby Haughton-Pitts, _communications and outreach consultant, a Regional Extension Center is subscription-based and “vendor agnostic.” That is, O-HITEC does not prescribe a specific EHR but is mandated by HHS to help providers find the certified EHR that best fits their needs.

The vision of O-HITEC is “to use HIT as a catalyst to transform the delivery of primary care services to patients across the State of Oregon.” Its stated three overarching goals are as follows:

Bringing EHR technology to providers in small clinics still using paper charts
Helping those who have “adopted” EHR systems achieve true meaningful use
Transforming the delivery of primary care

The OCHIN staff plans to continue to provide education, outreach and technical assistance to Oregon subscribers through O-HITEC. There is probably no geographic limit to OCHIN’s ability to expand. Will the network remain mission-focused? Probably. According to Marsalli, OCHIN has remained true to its original HRSA-mandated governance structure of a 51-percent community health center dominated board of directors. What started as part of the local safety net has found a way to help transform the delivery of primary care services on a national scale and still remember its way home.

We salute OCHIN as an associate member that has learned to grow well, and we are grateful for the technical expertise and national prestige it has brought to Region X.

December 2010

Celebrating our Rural Workforce Development Grantees

Four NWRPCA members were awarded HRSA grants to develop the clinical workforce serving rural areas by collaborating with medical schools, residencies, AHECs and other resources to bring medical practitioners in training into their health centers: Iliuliuk Family Health Services, Unalaska, AK; Kodiak Community Health Center, Kodiak, AK; Columbia Basin Health Association, Othello, WA; Yakima Valley Farmworkers Clinic, Toppenish, WA)

Because the two Alaska grantees will be providing clerkships for our A.T. Still SOMA/NWRPCA students, Trisha Bustos, NWRPCA Workforce Development Manager and Lisa Watts, DO, our Regional Campus Director, traveled to Alaska to visit our two Alaska grantees. Here we present a series of congratulatory reports:

Trisha's report on the Alaska collaborative and its plans to apply the HRSA grant (directly below)
Photos taken at Kodiak Island
Photos taken at Unalaska
An in-depth look at two of the grantees: Iliuliuk Family Health Services and Columbia Basin Health Association (below)
Photos of the Columbia Basin Health Association Sites

Alaska Rural Workforce Network Receives $ ½ M From HRSA to  Combat Shortages

Trisha Bustos, Workforce Development Manager

Beginning in September 2010, the Rural Health Workforce Consortium, led by the Kodiak Island Health Care Foundation, established a rural health immersion clerkship for 3^rd and 4^th year Osteopathic Medical Students from the A.T. Still SOMA/NWRPCA Regional Campus.

"Kodiak and Iliuliuk clinics have both provided exceptional training experiences for our students. In both areas, access to specialists often requires extensive travel, so their family practitioners really "do it all", and they include the students in all aspects of care. This grant will enable more students to train in these clinics, igniting their passion for rural primary care within these unique communities."

– Dr. Watts, Regional Director, A.T. Still SOMA/NWRPCA Regional Campus

The Department of Health and Human Services has awarded the Kodiak Island Health Care Foundation a three-year grant to encourage health professional students to select health center careers in rural family practice settings. The clerkship partners include Kodiak Community Health Center, Iliuliuk Family Health Service, Inc, in Unalaska, Providence Hospital/Kodiak, Brother Francis Homeless Shelter and the Kodiak Senior Center.

As a result of these clerkships 24-36 3^rd year and 4^th year osteopathic medical students will receive the rich experience of working in a rural community health center setting. Alaska faces unmet health and professional workforce needs, and research shows that this exposure impacts clinician decisions about where to practice, bringing some of these professionals back to Alaskan communities.

This clerkship program is the first step in providing research leading to a concise sustainability plan for recruitment and retention of family physicians in Alaskan areas where they are needed most. Congratulations on receipt of this innovative grant!

Iliuliuk and Columbia Basin develop collaborations to win Rural Workforce Development Grant funding through HRSA

Four NWRPCA members recently won HRSA funding to create, with local collaborators, innovative ways to develop the clinical workforce serving rural communities. Iliuliuk Family Health Services and Columbia Basin Health Association were among the grantees and have shared their stories with us.

Recipients of the Rural Workforce Development Grant use the funds to provide medical students with opportunities for training within culturally competent, community-focused rural community/migrant health centers; to provide meaningful service learning that reinforces ties to local communities; to enhance recruitment and retention of needed healthcare professionals; and to develop innovative approaches to training medical students in rural community and migrant health centers.

Columbia Basin Health Association (CBHA), Othello, WA, will collaborate with Pacific Northwest University, Yakima Valley Farmworkers Clinic (YVFWC) and its Area Health Education Center to implement the WALD model. WALD, developed by Kansas Public Health Workforce and Leadership Development, implements health education and training projects through a collaborative process of health needs identification, program conceptualization, research, and program evaluation.

According to Gina Bullis, Director of Workforce Development and Communication, this collaborative was fostered through AEGD, Advanced Education in General Dentistry. “YVFWC had an established partnership with the University of Washington for the NW Dental Residency Program,” said Bullis. “Three years ago CHBA partnered with YVFWC to bring dental students to CBHA for a yearlong residency through AEGD. This new Rural Health Workforce Development grant opportunity allowed us to enhance that established partnership.”

Iliuliuk Family Health Services, Unalaska, AK, is part of the Rural Health Workforce Consortium, led by Kodiak Island Health Care Foundation, and including Providence Hospital/Kodiak, Brother Francis Homeless Shelter and the Kodiak Senior Center. Sonia Handforth-Kome, Executive Director of Iliuliuk, explained how her health center entered the consortium. “ Brenda Friend [Kodiak CHC Executive Director] and I have worked together on various projects over the years, and we know each other through NWRPCA. This was a natural partnership for us. The project made sense for us, because we know the presence of medical practitioners in training (MPITs) tends to raise staff morale. They are energetic and excited about learning, which is contagious. While we work to create a valuable learning experience for them, they add value for us.”

Iliuliuk, with a 38-year history, serves Unalaska and the Aleutian Chain, employing a full-time staff of over 30 individuals, with a provider staff of 3.75 doctors, 2.75 mid-levels, 1 dentist, and 2 behavioral health counselors, on a budget of approximately $5.5 million. The health service hopes to host 15-18 MPITs per year. They plan to use the new funding to pay for the high cost of student airfare, housing and vehicle availability. Their ultimate goal, of course, is to introduce promising primary care providers to Alaska’s frontier and encourage them to fall in love with it.

CBHA, which considers itself a “pioneering organization,” aims at being “the employer of choice in the Columbia Basin.” Gina Bullis explained, “This grant contributes to our efforts to recruit and retain the most talented staff, providers and leaders from across the nation and the world.” The health center, which operates The Family Clinic in Othello and three satellite clinics, plans to use the new HRSA grant to achieve three specific goals:

Secure a Network Coordinator who will monitor project goals and objectives, oversee the budget, and supervise the Medical Student Placement Coordinator
Fund a part-time position for a Medical Student Placement Coordinator to coordinate PNWU student rotations and serve as a liaison between students and providers
Make possible a Rural Health Workforce Development Annual Meeting

Both member health centers were eager to enter into such a collaboration and apply for this particular grant based on insight from previous experience. Handforth-Kome said that approximately half her provider staff is hired from among MPITs who have rotated with Iliuliuk. “Those who don’t come to work for us sometimes return to the area to work for another provider service,” she said, “so we know the rotation experience is likely to draw them back to the area.”

CBHA’s CEO, Greg Brandenburg, agrees with this assessment, having also signed contracts with previously rotating students. Without the geographic/distance/travel challenges faced by Iliuliuk, though, CBHA has established partnerships with University of Washington, Washington State, and A.T. Still University, building for itself the reputation of a “choice site” for student rotations. CBHA became a supporting partner of Pacific Northwest University of Health Sciences as soon as it was established in 2005, recognizing another opportunity for future recruitment and retention through the MPIT pipeline.

NWRPCA salutes all four members who had the foresight to collaborate with neighbors in order to take advantage of this excellent new funding source.

October 2010

Seven Health Centers in Eight Days -- a Great Trip to Oregon!

Last month I had the opportunity to take a road trip down the Oregon coast, from top to bottom, and then all the way back up via Interstate - 5. Along the way I visited seven of our member health centers, collecting valuable data about their needs in training, workforce development, and IT support. I also took a lot of pictures.

On my return, I shared the photos and information with our staff, hoping to give them data to help drive their programming decisions in the next year.

The member health centers I visited included Coastal Family Health Center, The Rinehart Clinic, Tillamook County Health Department, Waterfall Community Health Center, Siskiyou Community Health Center, Umpqua Community Health Center, and Community Health Centers of Lane County.

Click here to see my photo journal and story about my seven wonderful visits.

Lynn Gerlach, Member Services Coordinator

August 2010

National Health Center Week 2010

This is how five of our members planned to celebrate National Health Center Week (and earned a $50 gift certificate from NWRPCA for any Learning Connections event in the next year):

Columbia River Community Health Services planned its Sixth Annual Community Barbeque, with free food and drink served by the health center staff, a raffle, and entertainment.
Cowlitz Family Health Center sponsored a Health, Wellness and Prevention Fair on Saturday, August 14, with free food, games and prizes, a maze and a Velcro wall. This special day was planned in conjunction with other community events, including a fundraiser for kids’ athletics, a park remodel with new walking trails, and a movie in the park.
Seldovia Village Tribe focused on school children for NHCW, sponsoring a back-to-school day that included medical and oral health examinations, healthy snacks, and wellness information. On the following day, SVT hosted a continental breakfast for patients and staff to meet each other. The menu included free blood pressure checks and promotion of the tobacco cessation program.
Community Health Care and Peninsula Health Services together invited Congressman Norm Dicks to help them celebrate National Health Center Week on Monday, August 9.
Tri-Cities Community Health, aka Community Health Center La Clinica, offered special events on each week day of National Health Center Week, including a stress management program, advice for the uninsured, a parenting session, an oral health day, and a day devoted specifically to the back-to-school crowd.

Member Reports on NHCW 2010 (with photos)

Community Health Care
HealthPoint CHC
Columbia River Community Health Services
Terry Reilly Health Services
Columbia Basin Health Association
Valley View Community Health Center
Family Health Services, Inc.
Tri-Cities Community Health

July 2010

ICHS Improves Wayfinding Thanks to Universal Symbols

When International Community Health Services (ICHS) in Seattle, WA, opened its newly remodeled International District clinic in fall 2009, patients were greeted with bigger exams rooms, more dental chairs, an expanded acupuncture room and bright, bold icons in the place of standard directional signage.

ICHS was the test site for Hablamos Juntos, a nationwide effort to develop universal icons to help patients navigate through medical facilities. Robert Wood Johnson Foundation, which originated the Hablamos Juntos program, wanted to develop a way of improving wayfinding in large medical facilities. The inability for non-English speaking patients to find their way through hospitals and large medical centers that offer navigation signs only in English is a barrier to providing culturally competent medical care. The project began to develop a series of symbols that could be meaningful across a number of ethnicities and languages.

ICHS operates 2 clinics in Seattle and primarily serves Asian, Native Hawaiian, and Pacific Islander communities, as well as other underserved communities. According to Vajra Allan, Planning, Development and Evaluation Manager for ICHS, 60% of patients served speak English as a second language. Says Allan, “our patients speak up to 50 languages,” and some cannot read their native language. She says, “It was very difficult to translate all of our signs into all the needed languages.”

In 2008, ICHS applied and was selected to be a test site for Hablamos Juntos universal icons. ICHS was the only health center chosen and joined with three other medical facilities, all of which served very diverse patient populations. According to Allan, ICHS was looking for a wayfinding “system that could work at both clinic sites.”

With the remodeling of ICHS’ International District clinic, the health center used the 2009 re-opening to unveil the new signage. Today, patients seeking the dental center at the International District clinic simply need to follow the picture of the large white molar against a black background. Medical patients follow the sign with a doc in the foreground (sporting a stethoscope); a nuclear family of father, mother, and child appear in the upper left corner. Pharmacy is simply a bottle with the letters “RX” on the outside while women’s health is pictured as a female form with the universal female symbol. Labaratory is identified by a microscope and test tubes, and the acupuncture clinic has the most complex sign – an acupuncturist applying needles to a prone patient while a lotus hovers in the upper corner.

Of the 54 symbols developed, ICHS uses only 7, since the clinic is not as complex as a hospital or medical center. Signage for medical, dental, pharmacy, women’s health, nutrition (or WIC), acupuncture and laboratories are prominent throughout the clinic. The entrance is marked by a directory introducing each symbol along with its English language label. ICHS has replaced the original Hablamos Juntos symbol for nutrition with a simple apple, which reflects the symbols used by the Washington state WIC program.

Before ICHS rolled out the actual signs, though, it used staff and patient newsletters to educate constituents about the new tools. Staff were also reminded of the new signs at meetings and had to memorize the meaning of the news symbols.

Patients have learned to navigate by using the new icons, though the picture is accompanied by English language labels. Allan says that when the symbols were first rolled out, those patients familiar with the clinic paid little attention to the new signs, but the new patients learned to navigate the clinic using just the symbols. Hablamos Juntos staff tested the symbols’ usefulness by quizzing patients on the meaning and shadowing individuals as they navigated the clinic using just the symbols.

Allan says ICHS would like to implement the same signage in its second clinic, in South Seattle. She says the current signs are simply on laminated board, and the health center is seeking funding to cover the costs of installing more permanent signs.

Written by Leah LaCivita