In this section we describe applications typically used at IPM partner health centers to collect, manage, and use clinical and practice management data. Discussion includes both software maintained through OCHIN and software developed or procured independently by IPM partner health centers.
Practice Management Application Functionality.All of OCHIN’s IPM partner health centers use the Epic practice management application, which is tailored to meet practice management needs of the health care safety net as recommended by the Bureau of Primary Health Care (BPHC). Especially useful functions included billing and claims management, scheduling, reporting, and the MPI described above. As the Epic practice management system was not designed to address clinical data acquisition or management functions such as immunization tracking, additional technology solutions will be necessary to meet these goals.Many IPM partners have been able to use different applications to track encounter results, send lab orders and receive lab results, and maintain disease registries.
Health Center Custom-Developed Applications.Many Oregon health centers create custom applications to meet their individual needs, either by programming entirely new software, as in the case of Multnomah County, or by creating custom versions of databases using widely available software. Smaller consolidated health centers reported using Microsoft Access to create applications that manage discrete clinical data items such as obstetrics care, screening interventions, or to track inventory of donated pharmaceuticals dispensed to uninsured clients. Also, health centers in Oregon often develop interfaces (described below) to integrate data from Epic and their custom-developed databases to produce reports that combine clinical and practice management data.
Federal and State-based Software Applications.A number of health centers reported that they manage clinical data items as part of the BPHC’s Health Disparities Collaborative, using the Patient Electronic Care System (PECS) and Cardio Vascular & Diabetes Electronic Management System (CVDEMS) software provided by the BPHC. These systems allow each health center to create and maintain registries of patients with specific chronic illnesses; the data is used for monitoring and informing the care of individual patients, supporting continuous quality improvement efforts at the health center level and for reporting purposes to the Collaborative.
Several centers also use state-based tracking programs that are unaffiliated with the Epic practice management suite. Two of the most common were the Immunization and Record Information System (IRIS), which is used to record immunization services provided by health departments across the state; and The Women, Infants and Children Information System Tracker (TWIST), which offers scheduling, paperless charts, and case management modules in order to collect data and coordinate services provided to clients in the Women, Infants and Children (WIC) Program.
Epic interfaces.A significant area of application development is the building of interfaces from Epic to other systems, whether they are in-house systems or third-party systems. For example, health centers may use an interface to transfer billing data into specific formats for electronic claims that are not handled via Epic/McKesson. Other health centers required interfaces to be built for reporting to local health departments or other funding sources. Multnomah County has developed software that interfaces with Epic in part to replace functionality that was lost when the county discontinued use of a mainframe-based application that integrated management and clinical data that they had developed in house. Part of this effort was to develop an interface to Epic that allows for data exchange between Epic, a nursing triage system, and a reporting system.
Other applications. While the applications and data management processes described above are those most relevant to the current project and site visit, respondents also reported use of certain applications to aid in general management. Particularly, a number of the health centers are using Micro Information Processing (MIP) accounting software as their primary financial package. Sites also generally use Microsoft Office applications such as Word or Excel (or equivalent applications) for general productivity purposes.
Overall, we find that health centers in Oregon engaged in significant application development to support various clinical and administrative data needs. Much of the relevant data resides in disparate systems where integration with Epic is not possible without significant effort; and it is clear that the existing applications do not contain all of the clinical data being managed with paper records. Many informants expressed a strong desire to have an EMR integrated with the practice management system which would give them greater support with their clinical data needs and quality improvements needs.