The Children's Clinic, serving children and their families serves a culturally and linguistically diverse, socioeconomically-challenged urban population of all ages. In many cases, TCC patients are children unable to find a primary-care home anywhere else because of barriers such as language and lack of insurance. For others, with special needs, TCC gives them the comprehensive care needed.
The Children's Clinic provides preventive, acute and chronic care for children and adults, selected specialty care, community outreach and chronic-disease management for diabetes, depression, obesity and asthma. Social workers connect families to additional resources like food, shelter, counseling and domestic violence services.
The ethnic composition of TCC's patients is 76% Latino, 12% African American, 2% Asian, 3% white, 1% American Indian or Alaskan Native, 1% Native Hawaiian or Pacific Islander, and 3% other. Nearly half of patients are uninsured and 99% live at or below 200% of the federal poverty level. This population faces significant barriers accessing quality affordable and linguistically appropriate healthcare and education. The Children's Clinic provided almost 56,000 patient visits to children and adults in the past year.
The Children's Clinic's implementation of myCare in December 2008 is an exemplary model of how health information technology can be used to maximize benefits to patients and their families and gain efficiencies in healthcare. The Children's Clinic is now able to truly provide a medical home for patients and their medical information. This information is available to other caregivers in the community in compliance with security and privacy requirements.
Description of the health information technology MemorialCare's ambulatory electronic medical record, known as myCare, is an intuitive system that MemorialCare makes available to physician partners. Physicians and their staff can use myCare for scheduling, registration, billing, ordering and clinical documentation. MyCare also provides:
- Lab interfaces
- Pharmacy interfaces
- Electronic claims processing
- Scanning technology
- Seamless access to visit history in the emergency rooms and inpatient hospitalizations within the MemorialCare system
MemorialCare, which includes Miller Children's Hospital, partnered with TCC so they could be among the first local practices to implement myCare. The Children's Clinic plays an essential role in the Long Beach and South Bay communities by providing comprehensive healthcare to medically underserved, low-income and high-risk populations.
The total start-up cost for TCC to implement myCare was $1,295,080. MemorialCare provided a subsidy and support to meet this cost. The California Network for Electronic Health Record Adoption, a joint program of the Community Clinics Initiative; the California Healthcare Foundation; and the Blue Shield of California Foundation, provided support for this project. Through the Network TCC will share its successes and lessons learned during EHR implementation with other community health centers and clinics. This project is funded in part by L.A. Care Health Plan's Robert E. Tranquada, M.D. Health Care Safety Net Award to address infrastructure improvement projects that will benefit low-income, uninsured residents of Los Angeles County. In addition, UnitedHealthcare/PacifiCare and the County of Los Angeles Department of Health Services are also partners in the collaborative effort. Full implementation of this project required participation of staff at all levels. The Children's Clinic's and MemorialCare's IT staff were available for support during the 3-4 month implementation period, at a ratio of one staff member to every two doctors. Front-office staff, nursing staff, managers and physicians received extensive training to use the system. More than 8.5 full-time equivalent IT employees worked for three months to successfully roll out the program. This intensive training and support is what made this implementation so successful.
MemorialCare was proud to partner with TCC creating access to a state-of-the-art EMR system. Within weeks after go-live, users at TCC were over the learning curve and starting to garner the full benefits of the system. Providers returned to pre-implementation productivity levels in just two months- an accomplishment that was estimated to take 6-8 months to achieve. In addition, the interoperability of myCare with inpatient EMR, pharmacies and labs means that TCC can maximize the benefits for their patients from health information technology.
The Children's Clinic physicians believe that using myCare has enabled them to provide a better quality of care for patients and to gain efficiencies. When myCare went live at TCC in December 2008, physicians were able to access patients' MemorialCare hospital records immediately. In addition, MemorialCare hospital caregivers could access TCC patients' ambulatory records—resulting in faster, improved collaborative care.
An integrated, interoperable electronic health record saves inpatient and outpatient caregivers from unnecessary duplication of tests and reduces administrative delays. It provides all caregivers with information about a patient's current medications and allergies. Most importantly, the system has enabled TCC to improve patient safety and quality of care by decreasing the risk of errors, cross-referencing medication orders, and generating templates for treatment for specific diseases.
Since implementing myCare, TCC physicians can assure patients that they have a secure and privacy-compliant system for the error-free creation, management and distribution of health records. The system has improved workflow, productivity and accuracy. It helps reduce overhead costs with more efficient billing practices. It has enabled TCC to move away from cumbersome paper records to an electronic record accessible by physicians from many locations through secure remote access.
The Children's Clinic EMR meets all standards currently defined within the “meaningful use” criteria of EMR. MemorialCare will provide all physician partners with the latest information on healthcare reform so they can apply for incentive funding for their interoperable community EMRs starting in 2011.
