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Small Practice eDesign

Small medical practices often lack the resources to implement electronic practice management systems. A pilot project in Tulare County helped integrate EHRs.

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Small medical practices, the cornerstone of effective health care across much of California, are under tremendous pressure as they struggle to maintain financial stability while improving patient care.

CHCF funded a two-year, $1.5-million initiative, called Small Practice eDesign (SPeD), to develop a prototype infrastructure and tools that support the adoption, integration, and meaningful use of electronic health records (EHRs) for small practices. The project developed, tested, and refined a model to support EHR implementation in 14 primary care practices in Tulare County. (One of the poorest counties in the nation, Tulare County is a federally designated primary care shortage area and has the highest prevalence of diabetes in California.)

The effort combined web-hosted software, centralized implementation, and technical support — with the medical practices working through a local trusted intermediary, the Foundation for Medical Care of Tulare and Kings Counties. The Massachusetts eHealth Collaborative provided much of the health IT implementation support. In addition, replicable tools were developed to support standardized data flows, redesigned office workflow, and other functions.

Small practices that participated in the initial pilot received subsidies from CHCF to purchase selected software and test the curriculum. The software combined practice billing and revenue management with an electronic health record and a patient portal.

In addition to demonstrating successful adoption of EHRs by small practices in Tulare County, the initiative worked with other communities to replicate these approaches and develop sustainable delivery network and business models.

Independent Project Evaluation

An independent evaluation of the project was conducted by Susan Eliot, MSPH, of Eliot & Associates, and Paul N. Gorman, MD, and Robert A. Lowe, MD, MPH, of Oregon Health & Science University. The evaluation process included interviews with participating physicians. An evaluation summary, case studies, and the full report are available as Document Downloads.

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