When I first arrived at White House Clinics (WHC) it was really overwhelming. I was intrigued by clinical administration, but had never worked in a clinic or hospital setting before. I was immediately immersed in many different aspects of primary clinical care—from diagnosing and treating patients to the business processes related to clinic administration. It was like learning many different languages all at once, from the language of medical professionals to the language of billing and coding transactions. My project was development of a department-level scorecard based on data from their new electronic health record (EHR).
The new CEO felt passionately that the WHC strategic plan needed to incorporate quality improvement and lean healthcare. The scorecard was to connect measures of quality, access, and financial performance not just to the overarching goals of the clinics, but to the mandated Federally Qualified Health Center (FQHC) goals and the Patient Centered Medical Home certification. The scorecard would need to help everyone align their jobs with these goals; plus it needed to be sustainable. Now that the process is in place, an employee can confidently generate biweekly departmental scorecards with an hour or two of work.
This reporting mechanism and these measures have large implications for the organization. By example, in the clinic arena, we can monitor the percentage of charts for patients over 2 years old that have BMI documented. This is important not just for the clinics, but for other overarching programs—particularly in demonstrating meaningful use of the EHR system for Medicare/Medicaid payment incentives. BMI is a particularly useful measure to inform clinical decisions and what providers discuss with patients, such as diet and exercise. The scorecard could be useful not just for monitoring outcomes of the clinical process, but ultimately outcomes for their population and trying to move the needle. That would be my vision of where they could continue to take this down the road.
Implementing a system like the EHR is painful in the best of circumstances. Developing a performance management tool that service line managers can use to not just identify issues, but drill-down into the causes of these issues gives WHC a capability that few other FQHCs possess. Other organizations that don't have the resources to create a scorecard can look to this work as a model.