Populating EHR Patient Charts

Open Door Community Health Centers (ODCHC)
Pre-Populating the EHR Patient Chart

ODCHC began its hefty abstraction process (pre-populating EHR patient charts) by forming a Provider Champion Team. This team is composed of a provider champion from each of the ODCHC sites, led by the Corporate Medical Director. The team meets every other week to discuss and establish EHR best practices as it relates to clinical procedures, policies, protocols, and work flow processes.

Initially, the challenge was to establish which information would make it into the digital world of EHR. At first, providers desired ALL paper chart information to be either entered or scanned into the EHR. However, of course, this massive amount of information would overwhelm and bog down the system, and, ultimately, the provider would still have the paper chart available to them for reference. After much deliberation, the Provider Champions established that all sites would abstract only allergies, immunizations, medication lists, and master problem lists from the paper charts into the EHR charts. After Del Norte Community Health Center, the first clinic to go-live, implemented EHR, the Provider Champions added birth history and medical and surgery history to the list of abstracted information to be transferred to the EHR chart. Prior to each site going live with Epic EHR, the Provider Champions informed the medical staff at their respective clinics to “clean-up” the items on the abstraction list in preparation for the EHR. Then, for each site, a two hour abstraction training is held for providers, RNs, and MAs. During these trainings, medical staff begins to abstract all items for all patients actively seen in the last 3 years.

It is important to note that ODCHC has 7 medical sites and 2 dental sites. So, only a portion of all charts were able to be abstracted during the initial trainings, and each of the sites is scheduled to “go-live” at stages since August of 2008 and through the summer of 2009. Thus, the process of abstraction begins at the time of the abstraction training but then becomes the responsibility of each clinic at their clinic site. So, some clinics like Del Norte Community Health Center had only several weeks before “go-live” to abstract, while others like North Country Clinic have a good 4-5 months to abstract patient information.

Moreover, since each clinic has its own culture, each site has determined different approaches to chart abstraction. For instance, Del Norte Community Health Center, due to limited time before “go-live”, blocked provider schedules for one hour in the morning for about two months for chart abstraction. On the other hand, Humboldt Open Door Clinic developed an incentive program whereby each clinic team (medical provider, MA, and RN) had a goal of abstracting 10 charts per week pre- and post- EHR implementation. If a clinic team reaches its goal of 10 charts, they add an image of their chose to a board in the clinic. The board lists all clinic teams, and each team can see their progress through the growing images that are forming a quite beautiful collage. Although it may seem a simplistic incentive, the staff is inspired and a positive, healthy competition is occurring, creating a sense of excitement and motivation to keep the task of abstraction moving forward. Clinics have also had Saturday workdays wherein staff members, usually RNs and MAs, are paid over-time to come in for 2-3 hours to abstract charts.

The process of transferring approximately 40,000 patients from the paper to digital world is time consuming and costly with the key objective of keeping everyone content and calm—quite the endeavor to say the least. However, one outcome that has been quite inspiring is the teamwork and cooperation that is occurring within and across sites—nothing like chaos to bring communities together.