Background
Washoe County Health District, located in Reno Nevada, needed an upgrade from their previous EHR system, which had an antiquated billing system and was no longer meeting their needs.
“We had fallen into a hate-hate relationship with our previous vendor and we were being forced to upgrade by January 2019,” stated Steve Kutz, RN, MPH, Division Director, Community and Clinical Health Services at Washoe County Health District. So the search began.
“I looked at pretty much everything out there and it seemed like they were all geared towards hospitals first... and Public Health has very different needs,” stated Brantley Hancock, Department Systems Specialist charged with finding a new solution.
Steve, Brantley and the EHR team met regularly and after reviewing many options of EHR systems on the market, they decided to partner with Patagonia Health. In October 2015, the District Board of Health approved the contract with Patagonia Health and “general excitement ensued.”
Developing an Immunization App
“While most of the staff was very excited and loved the demo provided by the Patagonia Health team, there was a strong hesitancy on the Immunization supervisor’s part as the system just did not meet their program and reporting needs. Despite not even being sure we would go with Patagonia Health, we started working with them to develop a new Immunization app.” - Steve Kutz
Since March of 2015 when Patagonia Health first visited Washoe County, and long before they became a customer, the staff at Washoe County Health District has been a huge help in the continuing evolution of Patagonia Health’s Immunization App. Patagonia Health regularly works with many customers, but WCHD has been exceptional in the amount of effort they have put into explaining their needs and validating new features during the development process.
WCHD provided detailed requirements and feedback on many of the immunization improvements including:
- User interface designs for adding patient immunization history
- User interface designs to allow easy entry of multiple vaccine administration records on a single page
- Bar code scanning of vaccine for vaccine administration and vaccine inventory
- Registration of families
- Official reporting for patient vaccinations and vaccine inventory
- Best practices when handling vaccines with diluents
- Processes supporting the barcode scanning of vials to pull from inventory lots and then send specific packaging NDCs to billing
Thanks to the involvement of the team at Washoe County Health District, the Immunization App is now a robust immunization platform available to all customers.
Health Department Q&A
Q. What organizational needs were not being met by your previous EHR system?
A. Steve: Reporting and ease of use, ease of posting, and billing. Cleaning up of financial records. We were trying to invest in new modules to make things better but because of the lack of support for training and implementation we had to stop throwing good money after bad. So we just pulled the plug; just take our money and go away! With the decision to move to a new EHR, general excitement ensued. I took the whole team out that night to celebrate because we were going to end our bad relationship and move onto a new healthy and productive relationship. And I will give a shout out to Patagonia Health as they have been impressive from the first web demo and on-site demos throughout the implementation and follow-up. They were helpful and really worked to get the appropriate information from us so that we could be as successful as possible with the implementation.
Q. Did the “script to PDF” process for data extraction completely fulfill the data record retention requirements or do you maintain a “read only” version of the previous EHR?
A. Brantley: I would say it met 80-90% of the data we needed. For the most part, my predecessor was a SQL expert. He had written a lot of EMR notes and EMR dashboards which already pull all these various data points into one coherent single PDF. So we finished all the SQL scripts of the dashboards and then converted them all into PDFs and migrated those over to the charts. We’re still currently using the previous EHR mostly for reviewing charts here or there, but there’s no new data being generated, it’s all being done predominately in Patagonia Health now.
Q. Who builds the tables behind the scenes?
A. Brantley: This is one of the biggest joys for me because I don’t have to anymore! Most of that is all done by Patagonia Health. It’s not like our old system where if you want to change a couple of things in a widget you have to modify 20 or 30 tables and write custom SQL code that we’d have to test and make sure it worked and was coded correctly - in the past, I manually had to get into the database and edit SQL code - I no longer have to do any of that. I just have the simple adding or removing users or changing users permission levels. Beyond that there are no cryptic table configurations at all.
Patagonia Health has a full development staff that manages all the enhancements as part of the subscription fees. They provide enhancements at no charge. The releases come out every six weeks.
Q. When updates or changes are provided, does it only effect the county that requested the change?
A. Brantley: It varies. When we approach them, we put in for what would work for everybody rather than just us. For example, the completely rebuilt Immunization widget, the automated applying charges for meds and immunizations on charts, the entire HIV widget, a one click report-out of all HIV data with 195 columns of data for CDC. So the stuff we’ve developed with Patagonia Health can be rolled out to everybody.
There is some customization, like individual encounter notes you would use for your charting that would be specific to your agency and wouldn’t impact everybody.
Outcome
With their previous EHR system, Washoe County Health District required an inordinate amount of IT staff time and resources. Their financial records were such a mess in the previous EHR that they made the decision not to migrate it into Patagonia Health.
“We posted fiscal year to date (9 months in) over $149,000 after implementing Patagonia Health. This is the best we have ever done - for all of fiscal year 2016 we only posted $9,300,” claimed Steve in regards to the increased revenue they have achieved since go-live.
Steve’s advice? “Start talking about potential change with your staff early on.” In regards to workflow efficiencies, finding an EHR that fits the needs of a health department was paramount to WCHD’s success. As Brantley put it, “Don’t try to fit a square peg into a round hole.”
About Washoe County Health District, NV
Washoe County's population is around 400,000 people, and while they don’t serve all of them, the public health department definitely does touch all of those folks.
They’re governed by a district board of health and have an appointed district health officer. The Community and Clinical Health Services Division comprises approximately 56 full-time equivalents, and a budget of approximately $8 million, which is a mix between grants and local funds.
