FQHCs Thrive Thanks to Federal Dollars, Policy

2013 Survey Shows EHR Gains, Documents Need to Expand Capacity

May 21, 2014 01:33 pm News Staff

An infusion of federal dollars into the nation's system of federally qualified health centers (FQHCs) has paid off in substantial gains in the centers' use of health information technology and pushed FQHCs' adoption rate ahead of that of office-based physicians. That's according to survey results recently published in a data brief titled "Trends in Health Information Technology Adoption Among Federally Qualified Health Centers, 2009-2013."(www.commonwealthfund.org)

[Doctor looking at computer, nurse measuring blood pressure of older patient in office. ]

According to a May 16 press release(www.commonwealthfund.org) from The Commonwealth Fund, which developed the brief, use of electronic health records (EHRs) by FQHCs increased 133 percent between 2009 and 2013. Additionally, EHR users learned to increase the functionality of their systems.

Specifically, in 2009, just 30 percent of FQHCs responding to a Commonwealth Fund survey reported having achieved advanced health IT capabilities, which the report defined as the ability to perform at least nine of 13 vital functions, such as electronic prescribing.

Results from the follow-up survey conducted in 2013 showed that 85 percent of the 679 FQHC clinical directors who responded said their centers were advanced health IT users.

In 2011, the federal Bureau of Primary Health Care listed a total of 1,128 FQHCs with at least one community-based primary care clinic nationwide. In 2012, the centers collectively treated 21 million people, nearly 80 percent of whom were uninsured or had public insurance.

Story highlights
  • The Commonwealth Fund recently released two issue briefs based on 2013 survey results from 679 federally qualified health centers (FQHCs).
  • One brief details responses about the adoption and use of electronic health records, and the second covers how FQHCs plan to prepare for an influx of newly insured patients.
  • An infusion of federal dollars has boosted FQHCs' EHR adoption rate above that of office-based physicians, including those in large practices and integrated health care systems.

According to the Commonwealth Fund, since 2009, the federal government has provided FQHCs, sometimes referred to as community health centers, with "unprecedented funding" to help them build strong health IT infrastructures. Specifically, health IT funds were made available to FQHCs through the Health Information Technology for Economic and Clinical Health Act of 2009 and the Patient Protection and Affordable Care Act (ACA).

"It's encouraging to see how far community health centers have come in their health information technology use," said Commonwealth Fund President David Blumenthal, M.D., in the press release.

"Their progress demonstrates that with concerted investment and support, substantial change is possible. It makes the case for continued investment to make sure these clinics can continue caring for some of our nation's most vulnerable patients," said Blumenthal.

Survey Charts Health IT Successes, Challenges

A vast majority of responders to the 2013 survey said they used their EHR systems to track patient information and manage patient care. For instance, 98 percent of FQHCs said they could list patients by disease diagnosis, 90 percent by lab results and 86 percent by patient medications. In addition, 82 percent could generate a list of patients overdue for tests or preventive care.

Computerized order entry also was widespread, with a large number of FQHCs reporting they had the ability to

  • utilize electronic prescribing (90 percent),
  • enter clinical notes (91 percent),
  • order lab tests (87 percent),
  • access lab test results (86 percent) and
  • track test results until they reach clinicians (77 percent).

The brief also revealed a big jump in the number of EHR systems that could provide alerts about potential problems with medication doses or drug interactions, with that figure rising from just 38 percent in 2009 to 83 percent in 2013.

Although FQHCs overall reported great progress in creating health IT efficiencies, some areas remain challenging. For example, just 55 percent of FQHCs said their systems provided physicians with electronic reminders to give patients their test results. And only 35 percent of health centers could send electronic reminders to patients about preventive and follow-up care.

In addition, survey findings showed low rates of interoperability between EHR systems, as well as low levels of patient access to their electronic records. FQHCs reported that inadequate staff training and loss of productivity during EHR implementation were the two biggest barriers to health IT adoption.

On a positive financial note, 76 percent of FQHCs reported that their physicians and other health care professionals had received bonus payments since 2011 through the federal EHR incentive programs.

Overall, said the authors, "Health centers' impressive adoption of this technology bodes well for meeting not only the needs of their existing patients but also those of the millions of new patients expected as a result of national health reform."

Newly Insured Patients Boost Demand

A second brief, titled "Ready or Not? How Community Health Centers View Their Preparedness to Care for Newly Insured Patients,"(www.commonwealthfund.org) focuses on survey findings related to FQHCs' preparations for a flood of newly insured patients related to passage of the ACA.

According to the brief's authors, "An estimated 4 million uninsured health center patients are expected to gain insurance coverage in 2014."

The 2013 survey found that of FQHC respondents,

  • nearly 75 percent anticipated problems related to the influx of new patients,
  • 83 percent expected a physician shortage,
  • 73 percent foresaw a shortage of nurse practitioners and physician assistants, and
  • 66 percent predicted challenges in staff retention.

In addition, although "Patients receive better care from providers who can communicate in (the patient's) primary language," the authors noted, FQHCs surveyed reported difficulty in hiring bilingual physicians and clinical staff.

The authors offered several recommendations that, if implemented, would help ensure that FQHCs could meet patient demand for health care services. Among them are the following:

  • Pursue a targeted outreach approach to attracting appropriate clinical personnel to FQHCs that goes beyond the $1.5 billion provided by the ACA for National Health Service Corps recruiting.
  • Reconsider the 2015 expiration date of the $11 billion Health Center Trust Fund that has helped FQHCs serve an additional 4 million patients and provided support to 500 new clinic sites.
  • Expand the use of telehealth and telemonitoring services.
  • Extend enhanced support for health centers that provid¬e integrated behavioral health; that support is now set to expire after two years.

"In helping to meet the complex needs of poor and minority patients, federally qualified health centers are a core component of the health care safety net, and they will continue to serve as providers for new Medicaid patients as well as the remaining uninsured," wrote the authors.

"Our survey highlights areas where additional support is likely needed to enable these providers to continue fulfilling their important mission," they concluded.