Inside An FQHC’s Epic EHR Implementation Tailored to Patient Experience

Howard Brown Health used to have a fragmented patient communication strategy that included a patient portal, several text messaging solutions, and a direct scheduling tool. But that strategy is anathema to what experts know about a unified patient experience, one that needs to be centralized in a unified EHR.

To optimize the patient experience, the Chicago-based federally qualified health center (FQHC) recently decided to implement an Epic EHR system which includes an updated patient portal, MyChart. 

“It was very Frankenstein-ed together and we really wanted it to be a cohesive experience for our patients,” Lauren Sullivan, Howard Brown Health’s CIO, told EHRIntelligence in an interview. “The capabilities of what we had weren't in line with how we wanted to enable our community to be able to manage their own care.”

As one of the country’s largest providers for LGBTQ+ individuals, Howard Brown Health focuses on meeting folks where they are at and delivering gender-affirming care.

The new patient portal is set to help “level the playing field” and support these often-marginalized patients by allowing them to easily communicate with their providers, Sullivan said.

She also said that the portal will help patients keep track of their test results.

“We do a very robust STI walk-in clinic at different sides of the city, and the idea is that the fewer barriers that you have to going and getting tested and then receiving those results in a way that's respectful to your privacy and to your preferences is really important,” Sullivan explained.  

She said that while patients were able to access their test results through the legacy patient portal, the Epic technology delivers a more seamless patient experience.

Similarly, the implementation is set to improve the provider experience.

Physicians employed at FQHCs report the highest levels of physician burnout, according to survey data from athenahealth.

“There was a fairly well-appreciated sense across the organization that there's technology out there that can help our providers reduce their administrative burden and provide some of the clinical decision-making tools that you don't see in more legacy-type EHRs,” Sullivan said.

For instance, it was common for information to get buried in the chart in Howard Brown’s legacy EHR. Providers would have to click through the chart four or five times to find simple information, such as who was on a patient’s care team.

“Once you're four or five clicks in, that becomes a barrier in the clinic,” Sullivan explained. “Epic does a really nice job of surfacing information that was oftentimes hard to find. At the end of the day, this is so exciting for us, knowing that our workflows are going to improve.”

She also said that the interoperability Epic brings was a major selling point for Howard Brown.

“In the Chicagoland area, there's such a prevalence of large academic medical centers where everyone seems to be using Epic,” Sullivan said.  

Now, Howard Brown providers will be able to easily share patient information with those organizations to streamline transitions of care.

Another component that drove the organization’s decision to implement the Epic system was its advanced analytics to support Howard Brown’s Education, Research, and Advocacy (ERA) Center.

“We have great epidemiologists, but we have struggled with really coalescing data in a meaningful way,” Sullivan said.

The Epic implementation will allow researchers to run inline analytics on patient populations. Additionally, it supports the collection of sexual orientation and gender identity (SOGI) data and other social determinants of health (SDOH).

With these capabilities, Howard Brown will be able to extract data more easily to formulate quality improvement plans that address the needs of different patient populations.

Sullivan noted that Chicago neighborhoods can be starkly different; clinical strategies that work on the south side of Chicago don't work on the north side of Chicago, and vice versa.

“There are also far different outcomes on the north side of Chicago than there are on the south side of Chicago,” Sullivan said.

According to Rush University System for Health, a five-mile difference between neighborhoods in Chicago could adversely affect an individual’s life expectancy by up to 12 years.

“We are really excited about the advanced analytics capability to be able to do more targeted outreach and work with communities,” she noted.

Sullivan explained that Howard Brown selected Epic through a collective RFP process.

“I really made sure from the get-go is that it was a collaborative activity, even in the creation of the RFP,” she said. “It involved everyone that's in our executive leadership team plus our director of practice operations, patient access, social services, and dental.”

“I don't have to use the EMR every day, so in many ways, my opinion is not necessarily terribly important,” Sullivan continued. “The folks that use the system every day should have a much louder voice than I do. My job was to partner with operations and clinical folks to make sure that their needs and wants were encapsulated in that RFP that got sent out to a handful of vendors to quote.”

Howard Brown then invited EHR vendors in for demonstrations over the course of three months.

“This gave folks an opportunity to ask their questions and make sure that they felt comfortable because, at the end of the day, no EHR implementation is an IT project,” Sullivan said. “Arguably, we at IT are just there to support the agency. My colleagues, our leadership team, and our managers had sessions before-clinic and after-clinic so folks could be able to see it.”

“We really wanted the agency to feel like they own the project, that they own the system, that they own the data quality that's going to go into it, and that they really can leverage it to provide high-quality care,” she added.

After being on its legacy system for some time, Howard Brown opted to tap a consultancy to leverage best practices for project management and subject matter expertise.

“We've known about Pivot Point Consulting for a little while,” Sullivan said. “We've been able to leverage Pivot Point's experience and the depth and breadth of their consultants to kind of guide us through best practices.”

Sullivan noted that Pivot Point recently worked on a project with another FQHC in Chicago, Erie Family Health Center.

“They have a very recent line of sight implementing another OCHIN Epic client in the Chicagoland area,” Sullivan said.

The consultancy was able to flag things to look out for and pitfalls to avoid during the implementation.

For instance, due to supply chain issues, Sullivan said that Pivot Point advised Howard Brown to get lab label printers early, as well as ribbons for the lab label printers because they are sold separately.

“It seems so silly, but if you can't print out labels for your specimens at go-live, it's going to be pandemonium,” she noted.

Sullivan noted that as a growing agency, Howard Brown was looking to make strategic partnerships with organizations that could grow with them, too.

“When I joined, we had 550 employees, and now we're up to about 740,” she said. “We're building a new, state-of-the-art center in North Halsted and we just opened up a new Broadway youth center.”

Sullivan noted that becoming a member of OCHIN’s health center-controlled network and having access to Pivot Point consultants puts Howard Brown in a good position to continue to grow.

“As much effort as gets put into an implementation, it's really just the start,” she said. “We want to have long-lasting relationships where we can all build each other up. We're happy with where we're at.”