Debra: Community health centers are part of the safety net that provides health care to society’s most vulnerable: the poor, the uninsured, and the homeless. However, they sometimes lack access to cutting edge health information technology. But a partnership of community health centers on Chicago’s Near North Side has found a way to integrate this knowledge. With funding from AHRQ, the Health Resources and Services Administration, and other sources, the Alliance of Chicago Community Health Centers has deployed a customized electronic health record system that provides evidence-based decision support for clinicians and crucial data for managing chronic diseases. All four health centers in the Alliance partnership are using the system. Together, the centers have 29 sites that provide care to about 100,000 people a year. So far, 10 sites have implemented the new system, including a school-based health center that provides primary, mental and dental care services. Dr. Fred Rachman is the principal investigator for the project. Thank you for joining us, Dr. Rachman.

Dr. Rachman: Thank you for inviting me.

Debra: What makes your system different from other electronic record health systems?

Dr. Rachman: We decided early on that we wanted a system that would provide evidence-based clinical support, collect population health data, and manage chronic diseases. So we customized a vendor system to include the spectrum of health services provided in a community health center, as well as decision support and performance measures linked to evidence-based practice guidelines. We also developed a customized data warehouse that not only functions as a patient registry but also supports analysis of population health data and performance measurement.

Debra: What can you do with this system that you couldn’t do before?

Dr. Rachman: Well, with the new system, we have access to patient information at all times so that we can quickly review a patient’s status and make decisions that are fully informed. We can decide what a patient needs, whether we’re face-to-face in the exam room or whether we receive an emergency call late at night. The other exciting thing about this system is that now we can analyze health patterns among various patient populations so that we can do a better job with chronic disease management and understand and address health disparities.

Debra: How do you use the system to improve quality of care?

Dr. Rachman: We are refining our clinical decision support algorithms for a number of conditions, including basic preventive care, asthma, cardiovascular disease, depression, and HIV/AIDS. Improved workflow documentation is helping providers figure out how to do their jobs more efficiently. The centers have begun to work with monthly quality reports to help them manage their patients better. Trend data already indicate modest improvements in health status and adherence to practice guidelines.

Debra: What kind of challenges did you face while implementing this system?

Dr. Rachman: Our biggest challenge was to define the data elements and reporting specifications that we needed so that they worked in the new system. This involved a great deal of collaboration among the measure developers, users, and the software vendor. We also had to analyze and redesign hundreds of clinical workflow patterns in busy health centers and develop effective training strategies for our staff. It was a lot of work, but it was worth it.

Debra: So what would you say has been critical to your system’s success?

Dr. Rachman: Clinician involvement is critical. It comes down to planning, collaboration, and hard work. In the process, we learned a lot about workflow redesign, customization, building out decision support, and finally, implementation.

Debra: Dr. Rachman, thank you for joining us.

Dr. Rachman: My pleasure.

Debra: To find out more about AHRQ-funded health information technology projects, go online to healthit.ahrq.gov.