Consortium of Safety Net Providers (CSNP)
The Consortium of Safety Net Providers (CSNP) was founded in 2002 to ensure that all residents of Glendale and Northeast Los Angeles have access to culturally competent, quality healthcare regardless of economic status. The CSNP has focused on strengthening the infrastructure of safety net providers with the goal of fully developing integrated and sustainable health systems that provide coordinated health care for the un- and under-insured. The CSNP membership consists of an array of public and private medical providers, including Los Angeles County Department of Health Services, and local community based organizations.
The CSNP initiated a strategic planning process to develop and strengthen integrated health systems that coordinate health services for the uninsured and underinsured. The overarching goal of the strategic planning process was to identify, coordinate and expand existing community resources to develop a comprehensive and integrated health services delivery system for the underserved. This intensive process occurred over a six-month period, throughout which, the CSNP created a comprehensive plan and procured federal Healthy Communities Access Program (HCAP) funding from the Health Resources and Services Administration (HRSA). This planning process produced specific and detailed plans for implementing the following safety-net improvements:
- Integrated technical infrastructure including software, hardware, installation, training, technical support, and maintenance/ operational support to improve communication safety-net providers
- Systems-wide improvements for creating referrals
- Provision of a coordinated system for expanding health education and health promotion
- Development of a coordinated system for case management of chronic diseases
- Development of a coordinated system for expanding enrollment in public health insurance programs and connecting individuals with a medical home
- Comprehensive operations plan, including budget, staffing, and timelines
- Evaluation plan for implementation of the project
For area safety-net providers, the ultimate goal of the strategic planning process was to design the infrastructure necessary to develop integrated health systems that will increase access and improve the quality of healthcare. This collaborative effort utilized a multi-faceted approach that combines collaboration among health care providers for coordinated referral services, improvements in chronic disease management, and expanded enrollment in public health insurance programs. This will be accomplished through use of coordinated and automated information systems technology that will result in improved referral services, medical management, standardized models for chronic disease care, increased enrollment in health care coverage, and expanded health promotion. The projected outcomes for implementation of this collaborative program include better health outcomes through 1) shared and coordinated health education and disease prevention, 2) early detection of disease, 3) improved communication between community providers, including referrals, 4) disease management services with a focus on best practices and 5) enrollment of individuals and families in healthcare plans. By achieving better health outcomes and reduced patient costs, the project will allow the CSNP members to increase the number of underserved individuals receiving health care and continue providing services that may not be as readily available after closures in the Los Angeles County Health Department.
Electronic Medical Records Project (EMR)
The installation of electronic medical records and Practice Management Systems in four Consortium of Safety Net Providers clinics improves chronic disease management for a highly mobile, underserved population by providing complete patient data from multiple providers into a consolidated format, alerting physicians about outstanding tests and procedures and providing protocols for best practices.
At a time of a collapsing county health system, safety net population demands far outpaced the level of technology supporting safety net clinics. Managing patients across the continuum of care is difficult, especially with the high mobility rate in Northeast Los Angeles and Glendale, where patients frequently change health plans or providers and may become uninsured. The electronic medical record (EMR) systems provide opportunity for medical management of patients with a chronic disease.
In 2004, GAMC initiated the implementation of EMR and Practice Management Systems in four Consortium of Safety Net Provider clinics, including the Family Medicine Center (Residency Program), Descanso Clinic, OB/GYN Center and All for Health, Health for All (an FQHC). Another clinic, Family Care Specialists (FCS), is funded and in the process of implementing EMR. These clinics are associated with GAMC, LA County USC Medical Center, and White Memorial Medical Center respectively. The logistics of physically moving patient medical records and test results between clinics and hospitals increases the risk of providing care without the benefit of complete information about the patient’s conditions, medical history, services provided in other settings, or medications prescribed by other clinicians. With electronic medical records, attending physicians can now access medical records in the hospital to ensure that patients are not allergic to medications or have other contraindications for procedures. Conversely, the clinic physicians can monitor patient progress in the hospital from clinic sites, aggregating all pertinent data under one unified medical record. Safety net providers are empowered with a better quality medical record with a more complete health history, resulting in improved patient care and reduced error rates.
Overall, carefully designed and evidence-based care processes, supported by automated clinical information and decision support systems, have contributed to improved outcomes from care for chronic conditions and improved safety related to pharmaceuticals. “About 75% of our patients are uninsured,” says Anna Nshanyan, FQHC clinic office manager. “We now can efficiently and effectively provide medical care because of the EMR. We also have more office space to provide services because we greatly reduced paper charts.”
Furthermore, efficiency and safety has greatly improved especially in the area of prescriptions. For example, when Vioxx was withdrawn from the market, the clinic would need to pull every chart to determine which patients were prescribed Vioxx; however, with EMR, reports of patients were generated instantly. These reports were then easily merged with notification letters.
Funding for this project includes $2.2 million (federal HRSA grant)