Giving the Uninsured a Home Base Through Technology
In the early 2000’s, a sluggish US economy forced low-income families to continually chase the best apartment deal and affordable housing vacancies, so multiple moves a year were commonplace. Moving from place to place across Central Texas, families rarely returned to a previous home, whether for lack of transportation or lack of desire.
It was safe to assume that low-income, highly-mobile families who couldn’t list a permanent residential address typically had no medical home to receive consistent, quality care. Any ailment, illness or injury among these families would result in a trip to the closest emergency room. If any of them happened to take advantage of the local health clinics, once a family moved from one housing complex to another, they wouldn’t return to the previous clinic because it was too difficult to reach without reliable transportation or other complications. So without any continuity of care, every move meant entering the health system as a new patient at another emergency room or clinic. Families who moved frequently had no history the next time a medical need arose. Mobility and the lack of a medical home for low-income families were issues hospitals and clinics recognized, but had no easy way to address.
EMR: Medical Home that Moves With Patients
New technologies are constantly introduced in the healthcare industry to improve patient care and cut costs. Implementation of robust electronic medical records (EMR) and electronic practice management (EPM) systems to make patients’ detailed health records available to each health provider who might possibly interact with patients at clinics in the network has meant that highly-mobile families in Central Texas now have access to a medical home that moves with them.
In 2008, the Michael & Susan Dell Foundation partnered with Centex System Support Services (CSSS), the non-profit technology arm of the Integrated Care Collaboration (ICC), a non-profit alliance of safety-net health care providers in Central Texas, to implement a common, integrated electronic medical record (EMR) and/or electronic practice management (EPM) system. While EMR is not a new concept, in Central Texas, the complexity of implementing EMR was overwhelming for the health community serving the uninsured. To begin, we tapped our long-standing relationships with local non-profit clinics serving the underinsured. The success of those efforts created momentum for additional participation. The EMR system is now available at 167 providers, covering more than 25 percent of all children treated in Central Texas.
While EMR allows health practitioners in Central Texas to see trends in patient data with minimal effort and helps to prompt best practice care, its benefits for families are significant. A family’s health history is clear and visible, so diagnoses are more accurate and care more consistent. Ultimately, patients learn how their health histories affect their future health. The patient and physician experiences are better. Though mobility continues to be a challenge for families struggling to find suitable housing, quality of health care has improved. Patient data can be tracked over time, so practitioners can focus on quality metrics and be proactive about reaching out to patients regarding wellness screenings and disease prevention. Unnecessary visits to the emergency room are alleviated because patients can be educated on the benefits of the EMR system and advised to visit any of the three networks’ clinic locations in Central Texas for minor medical issues.
One year after EMR launched at one of the original partners, the clinic opened an Optimization Center through which it proactively reaches out to patients about medical care. Today, hospitals and clinics continue to build on the innovative electronic medical record system to connect clinics and emergency rooms across the city for holistic patient care.
Innovate and Spark Systemic Change
For systemic change to occur, people and systems must evolve. If we are to truly change all parts of a community, we must choose solutions that are relevant. You’ll find that an innovative approach to addressing a family’s needs must take into consideration all of the factors at play—the family’s entire ecosystem. The innovation was not electronic medical records. The innovation was in using electronic medical records to solve a very real problem for families and their health care providers. We have to think creatively about the way innovation can ignite systemic change, and about the ways that an improved process or a program at a larger scale—or new behaviors—can transform lives. If you can spark systemic change, you’ll be an innovator, too.