The Massachusetts League of Community Health Centers Inc. (Mass League) HCCN will focus on providing training and technical assistance for our Massachusetts participating health centers (PHC) in various activities so that health centers can accurately collect electronic health record (EHR) data that can be used to support the evaluation of health equity, inform operations and strategy, improve coordination of care with the use of interoperable data in the EHR, participate in value based care, and use our data warehouse, Azara DRVS, for reducing health disparities and improving health outcomes. Using the objectives of patient engagement and digital health tools, the HCCN proposes to engage in activities that will increase patient access to data, assist with integration to their electronic health record, focus on strategies to close care gaps, and improve communication with their providers. The HCCN will also continue work to educate PHCs about data protection and security by supporting annual Security Risk Assessments and increasing the use of Health Information Exchange capabilities, striving for increased data integration across care settings to facilitate improved patient care coordination and population health management in a safe and secure manner. To improve health IT usability and adoption, the HCCN will use survey tools and training guidance on digital technology to aid in reducing provider and staff burnout, and improve care coordination and patient outcomes. The HCCN will continue work with PHCs to map social risk factor data into our data warehouse application to enhance their ability to use that data for population health, to advocate for necessary social services, and to close referral loops to maximize the clinical quality outcomes of their patients. In addition, the HCCN will assist PHC’s with their data utilization that will allow staff to easily identify and treat patients that require specific services, such as behavioral he
alth, and provide technical assistance on how to monitor both quality of care and outcomes. We will collaborate nationally with other health centers and HCCNs, which use our reporting tool, to maximize use of registries, dashboards, and care coordination tools. We will include a special area of focus on health equity and research and will facilitate the data collection and reporting necessary to highlight health inequities in pursuit of institutional research efforts that directly benefit our PHCs and their patients. Lastly, via our work with the Massachusetts FQHC Telehealth Consortium, we have learned what digital health tools are the most successful amongst our PHCs. We will provide technical assistance and establish a learning collaborative so that PHCs are using the best possible tools available for successful virtual care.