This month the Health Resources and Services Administration (HRSA) highlights the William F. Ryan Community Health Network for their use of health information technology (IT) for integrated HIV testing. In 2006, the Centers for Disease Control (CDC) issued new guidelines for all healthcare providers on integrated HIV/AIDS testing. The Ryan Network used workflow analysis to streamline and evaluate how the new guidelines could be incorporated into the services provided by both the clinical and non-clinical staff. In addition, The Ryan Network’s workflow analysis allowed them to create a HIV Lab Template for electronically entering information into the patient’s electronic health record, which provides the staff a multitude of clinical and administrative benefits.
In 2006, the Centers for Disease Control (CDC), as part of the National HIV/AIDS Strategy, issued new guidelines for all healthcare providers on integrated HIV/AIDS testing. Under the new guidelines, health facilities, such as federally qualified health centers (FQHCs), and Ryan White clinics, offer HIV screenings as part of their appointments. One significant reason for the new guidelines is that people infected with HIV take years to develop symptoms, and to receive a diagnosis that they are HIV positive.
While patients can opt-out of testing, integrating HIV screening into a patient’s appointment helps diagnosis HIV patients earlier. An early HIV diagnosis facilitates patients in receiving appropriate care and services in a timely manner, as well as helping reduce the spread of HIV to other people. FQHCs and Ryan White clinics, such as the Ryan Network, serve on the frontlines of treating and providing primary care to HIV vulnerable populations. Because of these factors, it was important that the CDC’s new integrated testing guidelines successfully become part of the Ryan Network’s culture.
The William F. Ryan Community Network
Since 1967, the William F. Ryan Community Health Center, Inc., a Federally Qualified Health Center (FQHC) accredited by the Joint Commission, has provided high quality, affordable, culturally and linguistically competent, primary and preventive health care, dental, mental health, and support services to minority, medically underserved residents in Manhattan. Ryan’s main site is located in northern Manhattan and serves the Upper West Side, Central Harlem/ Morningside Heights, and Washington Heights/Inwood; a satellite center, Ryan/Thelma C. Davidson Adair serves Central and West Harlem; another satellite center, Ryan-NENA serves the Lower East Side (LES); and, an affiliate center, Ryan/Chelsea-Clinton serves the midtown neighborhoods of Chelsea and Clinton. The four main Centers comprise the William F. Ryan Community Health Network (Ryan Network), and share a common mission supported by the founding principle that health care is a right, not a privilege. The Network’s service sites also include clinics at three family living transitional shelters and one mental health rehabilitation agency; five School-Based Health Centers (SBHC); and, a new Women and Children’s Center.
The Ryan Network offers a comprehensive set of preventive and primary care services that are delivered through an integrated system by bilingual and multicultural practitioners through all levels of the Network’s points of care. It also attracts the highest number of HIV positive clients of all the freestanding clinics in the New York City area. The Network currently receives Ryan White Part A, B and C funding, Health Center Cluster funding, Patient Navigator Outreach and Chronic Disease Prevention Program funding, and a Hepatitis C Special Projects of National Significance Expansion grant.
In order to help clinical and non-clinical staff acclimate to how integrated HIV testing would impact patient care and their job responsibilities, the Ryan Network’s management and staff developed a workflow analysis plan. Workflow analysis refers to observing how a change or operational process takes place. This analysis involves evaluating and measuring the process and improving it for efficiency and effectiveness, in order to successfully implement change or a new system.
The workflow analysis plan allowed the Ryan Network to analyze and evaluate the best way to integrate the CDC’s new HIV testing guidelines and realign staff responsibilities. In addition, The Ryan Network took advantage of their health IT system to evaluate, measure the effectiveness, and conduct clinical quality improvement the integrated implementation of integrated HIV testing. Ms. Ana Taras, Chief Planning and Development Officer states, “these new guidelines represented a big shift in how health centers think about HIV testing. The new guidelines meant that health centers, such as the Ryan Network, would move from separate stand-alone testing to an integrated testing format that would impact a patient’s clinical experience and how staff provides care.”
Before the CDC’s new HIV Testing guidelines, HIV testing and treatments was conducted in health centers by separate care teams compromising care coordination and continuity for Ryan White patients. Because HIV/AIDS patients are now living longer due to the advancement of pharmaceutical interventions, the integration of HIV testing and provision of health services is especially important.
The workflow analysis plan shown above, also allowed Ryan Network staff the ability to develop a lab-testing template for their electronic health record (EHR) system. In creating the HIV Integrated Testing EHR Lab Template, the Ryan Network used the template as a tool for assimilating HIV test requests and results with overall patient’s care to enhance workflow. Some examples include documenting when staff scans patient consent and registration documents into the template and EHR system, verifying when patient lab results are received and analyzed, and documenting the notes to capture next steps recommended for a patient if the lab indicates a HIV positive test. The workflow analysis plan helped the Ryan Network rethink their approach to patient care and improve care coordination among their patients who opt for the integrated HIV testing.
Please see the Ryan Network’s Lab Results template below for an example for how staff enter and receive a patient’s HIV test information.
The Ryan Network’s use of health IT as a tool for implementing and evaluating workflow analysis allowed them to change their culture of patient care with respect to HIV testing. It also allowed the Ryan Network to measure and evaluate their successful adherence to the CDC’s new HIV testing guidelines and ensure that patients receive appropriate, high quality care. The lab template allows Ryan Network staff to receive data in real time which supports quality improvement, early intervention in a patient’s HIV care, and streamlining the ability to report data to public health agencies.
For more information on workflow analysis, please email the Ryan Network at Ana.Taras@ryancenter.org.
Additional HRSA technical resources on health IT, quality improvement and work flow analysis can be found at HRSA Health IT Toolboxes and Webinar portal and HIV/AIDS Bureau’s Target Center. In addition, please see the CDC’s HIV section for additional tools and updated information on this subject, as well as a report on HIV Integrated Testing and its affect on healthcenters.