Concurrent with planning around the EMR implementation, CHAN worked on a project to migrate most member health centers to a new practice management system: GE’s Millbrook Suite. Millbrook, a Windows-based application, is currently marketed as part of the Centricity EMR/practice management software package. Although Millbrook was selected by CHAN prior to being acquired by GE in December 2002, the acquisition gave them further confidence in their selection and its ability to effectively compliment Logician.
History and implementation of Millbrook. In the late 1990’s, most of the CHAN health centers used PCN for their practice management software. Respondents reported that PCN grew to be inadequate for their needs: the system was antiquated, difficult to use and extract data from, not HIPAA compliant, and integrated poorly with the Logician system that was already being used in some of the health centers. Initially, each center hosted PCN on its individual server, and the resulting coding differences made integrated data collection impossible. Upon the initiation of the SIMIS grant program, CHAN secured funds to plan and develop infrastructure to support a shared applications, including practice management and, as described above, EMR.
While the EMR system had been selected by virtue of the existing system in place at Lamprey, CHAN initiated a new evaluation process to select a practice management vendor and received a dedicated corporate private grant to purchase the system. The review process for a practice management vendor took place during 2001 and 2002, and included the development of an RFP and evaluation of proposals, site visits, product demonstrations, and an analysis of specific component criteria. CHAN staff stressed that the evaluation involved extensive collaboration with all member health centers. The network recognized that all health center staff would have to be fully supportive of the system for it to be beneficial in the long run. “You want a pull mentality, not CHAN pushing stuff on people. So we came up with a strategy to get non-IT staff to be enthusiastic about it…you have to back yourself up and feed from the bottom,” noted one CHAN respondent. In addition to leveraging SIMIS funding for evaluation and planning, CHAN managed to secure a large corporate donation to cover much of the cost of the application itself.
As with the EMR, the network planned the Millbrook implementation very methodically. Although CHAN worked with GE on customizations and new modules to support administration of CHCs in New Hampshire, there were some problems with early implementation. Manchester (MCHC) was the first site to go live with Millbrook (in March 2003), and experienced problems with the system’s billing component. MCHC staff reported that their accounts receivable grew tremendously during this period, partly due to their use of CHC- specific billing and claims modules that were relatively unfamiliar to the vendor and the major payers. In addition, the network encountered issues submitting claims to Medicare and the state Medicaid program. CHAN halted implementation in other health centers until these problems were resolved through additional customizations and testing. Once the system was operating smoothly at MCHC, the remaining centers began going live. The exhaustive troubleshooting and customization process conducted initially greatly streamlined implementation at the other sites. All but one of the member centers has now fully implemented Millbrook, and that one is planning to go live within the next few months.
Millbrook system functionalities. The Millbrook practice management system includes a full range of capabilities, including scheduling, billing, reporting, inventory control, scanning, accounts receivable and collections, and electronic claims and remittance. Overall, CHAN stakeholders described the software as “an exceptional product” that is cost effective and has already provided information benefits and operational efficiencies for the health centers.
Billing. Although MCHC experienced various problems with the billing component during the initial implementation, most of these issues have been resolved and health center respondents reported high satisfaction with the billing functionality. Claims are automatically pre-screened by the system before being sent electronically to the insurance companies, ensuring that errors are caught before the claim can be rejected. This capacity was custom-built by network staff during the implementation phase so that each center’s unique billing requirements were accommodated and smooth cash flow could be facilitated. Medicaid claims are now submitted electronically, and MCHC’s Executive Director noted that commercial payors have never reimbursed the center as quickly as they do with the Millbrook system.
Reporting. The Millbrook system has also improved the reporting capacities of the health centers, but some health centers still lack resources to take full advantage of this capacity. “We’ve got all this information,” noted one staff member, “but we need help developing the reports…we could use more staff to process what comes out. But the resources aren’t there.” Development of reports is coordinated both on the network and health center level with more complex reports are designed, produced, and distributed at the network using Crystal Report Writer software. These include custom reporting on care delivered to specific populations required to meet reporting requirements for specific funders. Simpler reports (e.g., quarterly financial reports for the state, monthly invoicing, immunization tracking, and clinical audits) are generated at each individual center but the format is standardized across the network.
Other functionalities. Respondents reported a high degree of satisfaction with Millbrook’s other components as well. The system is fully HIPAA compliant, user-friendly, and includes a scanning function that allows materials like patient identification cards and incoming paper forms to be scanned in and attached to the patient record. The potential for re-engineering and complex customizations has garnered the enthusiasm of the network IT staff. Finally, all functionalities are enhanced by interoperability between the Millbrook practice management system and the Logician EMR.