Dolan Family Health Center, part of Huntington Hospital on Long Island in New York, is small, with seven physicians and two nurse practitioners. Despite not having much of an IT staff to speak of, the clinic has been able to customize its electronic health record to create better experiences for patients and staff members.
In a recent interview, William Gehrhardt, M.D., medical director at Dolan Family Health Center, began by describing some of the history of the clinic.
The Dolan Family Health Center practice was started in 1995. Community leaders expressed to Huntington Hospital that there was a need for healthcare for patients who didn't have primary care readily accessible and were using the emergency room for their primary care needs. “The CEO of Huntington Hospital liked the idea. He went to his CFO, who said this is the most ridiculous thing and would lose a ton of money,” Gehrhardt said. “In spite of that, he said we should do it anyway, and in 1995, the building opened with three distinct disciplines: pediatrics, adult medicine, and OB/GYN.” Many staff members are bilingual in either English and Spanish or English and French.
When Gehrhardt arrived at Dolan 20 years ago, they were still doing handwritten charts and handwritten prescriptions to patients. “Now we use the McKesson Practice Partner program. We're very proud of what we've done with this,” he said. “Five or six years ago, we decided that we should make sure that if our patients go to the hospital, we should follow up. So all our doctors, nurses, some of the medical assistants have gained access to the hospital's EMR. We know when our patients get admitted to the hospital. We watch them closely. The technology links the hospitalists at the hospital and our doctors here. We find out the list of the hospitalized patients every day. When our patients are on that and flow off the list, we say we better get a hold of them right away, and get them in for a visit.”
Dolan has a nurse in adult medicine call them to say “we heard you were discharged home. We want to know how you're doing. We want to know what plans they have for you from the discharge, how many subspecialists or appointments you have, we want to see how many meds you have.”
Gehrhardt says that starts a whole process to get them all set up to come in to the clinic. “We ask them to bring their meds with them; we find out what referrals they’ve got, and can they keep them or not? If they can't keep them for whatever reasons, we change them; if the meds were not attainable, because of cost, we change them. We've shown that we've brought the readmission rate on our patients down to an incredibly low level. We benchmark it to the Medicaid population across the country and we are lower than that, by a lot.”
Dolan has built templates for different types of visits into the EMR. “We built all the OB/GYN documentation and all the pediatric ones, Gehrhardt added. “We also built some of the forms we use for TB for the county into it. We've tweaked it, and continue to tweak the EMR to do what we need it to do. We want our doctors to have relationships with our patients. We want to know where they are, what they're doing, and what problems come up when they're outside of this building. We felt that was really important to maintain that and to keep this a very polished feel of a practice, which it really is. We needed to reach out to people using technology.”
“We made it that when you see a patient through our EMR, and you have to send that record to another provider for whatever reason, it is a really nice-looking document that reads like a story,” Gehrhardt said. “It tells you about the past medical history, family medical history, allergies, meds. It looks like a story. It's really easy to read. It has great continuity throughout it.”
Dolan also has partnered with DrFirst over the years. “As medicine has evolved, we had to try to keep up as best we could. For instance, initially our EMR was not compatible with writing for prescription narcotics, so we partnered with DrFirst to be able to allow us to do that, Gehrhardt said. “They also gave us a program that enabled patients to message us and us to message each other, and the hospital to message us.
Gehrhardt said the patients love the experience. These follow-up visits following hospitalizations are lengthy for the doctors to do, but the doctors feel that this is a worthwhile effort, because the patients don't go back to the hospital, he said. “Their health is maintained better. There's great communication between the hospital and us through the EMR. It was probably one of the best things we've done in the recent past.”
Dolan has always had a challenge with as many as 20 percent of patients being no-shows for appointments. Now they are working on the capability to text-message their patients reminders about visits. “If we leave a voice mail message, I know most people don't listen to our messages, Gehrhardt said, “but if it's a text, it is going to stay there for a few days, and it's going to help. I think that that is the most important thing that we should be doing technologically right now, as well as continuing to evolve our EMR to stay current all the time.”
