Improving access to care and clinical efficiency

Angela Barker, PA-C, is the chief medical officer of New River Health Association, a Community Health Center in West Virginia. We talked with her about how her organization is expanding access in a rural community, using athenahealth to engage patients and improve clinical efficiency, and thoughtfully exploring AI to reduce documentation burden.

Q: What makes New River Health Association and the community you serve unique?

A: New River Health Association is a federally qualified health center in south central West Virginia. We serve three counties — Nicholas, Fayette, and Raleigh. We have four main sites, six soon. We serve the West Virginia coal miners and Southern Appalachia. We see pediatrics through geriatrics. We have women’s health, school-based health, and pharmacy — we have a lot of services, and we have a very broad area that we serve. We serve about 110,000 visits a year with about 20,000 unique patients.

The coal miners end up with black lung because of the dust underground that they’re exposed to. So, we have a black lung clinic and a pulmonary rehab facility where they can try to gain some of their lung function back. We can test their lung function with pulmonary function tests and then try to get them back to breathing a little better. So that’s been a very great service for the area.

Our geography is very rough. It’s very rural, very mountainous. A lot of country roads. People live way out in the woods, and there is no public transportation system whatsoever. The elderly people rely on younger people to bring them, which is very difficult and definitely causes a barrier to care.

Q: How has your organization expanded care to meet those community needs?

A: About three years ago, we had a really exciting breakthrough. We purchased an abandoned K-Mart building. It had been abandoned for about 15 years. It’s 96,000 square feet. We remodeled 50,000 square feet into a clinic where we have our main hub.

It has primary care, urgent care, pediatrics, geriatrics, Ob-Gyn, vision, dental, behavioral health, pharmacy, pulmonary rehab, chiropractic, and dental.

We’ve also added the urgent care, which has been really important in the area, with the travelers coming through and the accidents with rafting and mountain climbing, mountain biking, and all the outdoor activities that the area offers. So that’s been a great help. We added vision recently, and we expanded dental because of the space. We now have nine dental operators and two dentists at that site, which is a big need in West Virginia.

Q: What has data sharing and care coordination looked like for your team?

A: Our nearest trauma center is in Charleston. It’s about an hour away. We get the records from them very quickly. The data sharing has been really good. A lot of times, we will have the hospital records before the patient can get back home. It’s so much faster that way.

Q: How are you using athenahealth to engage patients in a region where internet access can be limited?

A: We use athenahealth's Patient Portal as much as we can. We use a lot of email, text, and calling blasts because the internet is not the best in West Virginia, and our elderly population doesn’t utilize the internet very often. So they still need to be called or texted. So we do a lot of campaigns the old-fashioned way.

We use a lot of automated outreach to our patients because texting, email, and calling have been helpful. Our internet connectivity in West Virginia is spotty at best. We don’t have a lot of broadband coverage yet. So the texting and the calling have worked out well to get patients engaged in their care and remind them of the care they need and the preventative screening they need.

We send a lot of automated texts for quality incentives or quality programs that we’re doing — like free mammograms in October, colonoscopies, just any initiative that we’ve determined there’s something we need to address. We will send all of our patients a message through athenaOne®, and that’s worked out well for us.

One thing we’ve used with Patient Portals is to have the elderly population get their kids involved. That way, their kids can watch their labs and watch their appointments and make sure they’re going and make sure they’re taking their medicines. So that’s been helpful because a lot of their children are taking care of them anyway; that’s been a great asset.

Q: What strategies have helped your clinicians improve documentation efficiency?

A: Part of their incentive is tied to the same-day encounter close rate. And that’s been instrumental in keeping that number down because it just makes them value it more, because it’s tied to an incentive. So it shows they can do it. They just need to be reminded.

We’re geared to clinical efficiency because you always have those providers who will let things stack up, and they can’t get them done. But if they’re constantly encouraged to stay on top of them, then it’s just easier for all the departments — from front desk to billing to provider satisfaction. They just need to be reminded to stay focused.

The ease of operability with athenaOne has been so instrumental in provider satisfaction that it’s pretty simple. Now I have new providers straight out of med school that are teaching themselves to use athenaOne without even the orientation process.

Q: How are you approaching artificial intelligence for documentation, and what benefits do you see?

A: We are going to start a pilot project after I get back from Thrive (athenahealth's annual community summit) with Ambient Notes. I have three very enthusiastic providers who are signed up to start using AI to do their notes, so I think it will go well.

Some don’t like to change and are afraid that if they go to AI, they may have to change their workflow. And they’re set in their ways, and it’s just easier to stay the way they are. But I think once they see the benefits and someone who actually used it in practice, that will pay dividends in their decision to change.

I think this will be instrumental in making us move faster and hopefully see more patients — especially with the urgent care at the new facility.

Q: What will it take to build broader clinician and patient trust in AI?

A: I think just hearing it from their peers. They don’t want to hear it from sales. They don’t want to hear it from the corporate level. They want to hear it from their peers — someone who’s been in the exam room, someone who’s walked up and down the hall with them.

We have one provider that came from another facility, who’s used AI. So she has a little bit of a jump. I think that will help drive the rest of the group. And then they’ll slowly start to come on. But West Virginians are hesitant in nature. So it’ll take some convincing.

I think if you tell the patients that it helps you with your job to get it done and get the note completed, they’ll be OK with it. If you explain to them that it’s helping your doctor get their work done and go home and see their kids in the evening, then they’ll be OK with it.