La Clinica de La Raza, EHRs and PHRs

This post is a continuation of my experience at La Clinica de La Raza in Oakland, California. As I mentioned previously, it was a great experience and I was welcomed by the staff and providers who serve this community.

I mentioned that most of the clinical work performed here uses a paper medical record. There is laboratory testing and medication look-up, as well as scheduling features. I asked both Steve Schiff, FNP, and Bina Patel, MD, their thoughts about going electronic, and even communicating with patients online. Because providers share a communal work space, I received additional perspectives. Patri Zayas, MD, the Medical Director, also stopped in to say hello and answer questions about the Medical Center.

Bina told me that when she looked to move to California, she interviewed at 7 safety-net medical organizations, and none of them had or were planning to get electronic health records. She hoped to use an EHR in her new clinical environment. I asked her about e-mailing with her patients. She said that she does some of this now, and would look forward to doing it more comprehensively. She trained in a location with an electronic health record and is very comfortable with the electronic tools she has access to here.

I also talked to Steve and his colleagues, and learned that many patients in this community don’t have good reading skills, and often, the individuals in the home that can read are children, and not at a level that is sufficient for translating health information. A real dilemma. It is not one PHR fits all. Many providers here do not have experience with electronic health records, except perhaps at patients at other systems, such as Kaiser Permanente. As I spoke with Patri, I understood that the clinicians here have a good sense of what the right clinical goals are for their patients, but it may be hard to conceptualize how to get there with an electronic health record right now. I felt the same way when we started our journey 5 years ago.

I was very kindly invited to the all staff meeting held on that day by Suzy Mejivar, the Manager of the Clinic, which was a celebration of a lot of hard work by the staff. La Clinica had passed a level of volume of encounters that had never been achieved before (and I recalled a comment made at another safety-net medcial centers that encounter numbers are essential in this environment to survival). Suzy individually thanked each staff group for all of their teamwork. She said, “Love each other, respect each other, and work together.” She even complimented one of her case managers when she said that she knew they were doing a good job because she was at her aunt’s house when her aunt received a call from La Clinica. This is a measure of the integration in the community that this organization has. Suzy did ask me to introduce myself to the group, which I did, and when I said, “Our practice has been fully electronic since 2004,” I got a sense of excitement from the staff present.

What next?

As I spent time at the practice level and a limited bit of time at the policy and leadership level, I don’t have a good understanding of the plans for technology adoption at La Clinica. It was very useful for me to see the flow here, and I mentioned to Dr. Zayas that I thought it would be important for providers and leaders to know what their patients and community needed and then begin the process of planning for an EHR and a PHR, rather than the other way around. For example, what do patients need to support their learning about their conditions, at the right level of literacy, and at what points in their care experience? What are their most pressing health needs or challenges, and which would be served best with technology?

In comparison to safety-net medical centers that I have visited in Boston, New York, and Washington, DC, I get the sense that California is a bit behind the rest in the adoption of health information technolgoy. I don’t know why this is and whether this is a statewide phenomena or just the two safety net providers that I visited – at this point I am planning to spend some more time where safety-net medical centers are adopting this technology and learning about the process that they used to get there.

I really enjoyed my time here and the energy that comes from a community health center supporting the population that it is a part of. With gratitude to Jane Garcia, the CEO, Patri Zayas, MD, Medical Director, Bina Patel, MD, Steve Schiff, FNP, and all of the staff and patients for allowing me to observe their hard work for the community they serve.

Ted Eytan, MD