Open Door’s mission and guiding philosophy is to provide quality health care and human services at affordable prices to the community, particularly the economically disadvantaged.
All of Open Doors doctors, dentists and nurses are licensed professionals who are salaried employees of Open Door. Since 1972, Open Door has cared for Westchester’s most vulnerable residents. What workers and volunteers of Open Door have known since its founding might come as a surprise to those who aren’t local; Westchester is home to staggering poverty. Ninety percent of Open Door patients live below 200% of the federal poverty line in an area where the cost of living is notoriously high. What began as a free clinic in a church basement, with the goal of addressing the needs of this poorer population, has evolved into a federally qualified, non-profit community health center with six sites in Ossining, Port Chester, Sleepy Hollow, Mount Kisco, Brewster, and Mamaroneck, as well as six school-based health centers. One of the largest community health centers in the region, Open Door serves as the medical home to over 50,000 individuals.
Open Door emphasizes access by means of a sliding scale fee discount, convenient hours and locations, and by maintaining a bilingual, multicultural, and culturally competent staff. Services include primary and preventive medical and dental care; acute and chronic care services; optometry, dermatology, podiatry, laboratory services, mental health, and case management. Open Door is a Joint Commission (JACHCO) accredited, Federally Qualified Health Center where no one in need of health care is turned away, regardless of their insurance status or ability to pay. With a patient base consisting primarily of Westchester’s working poor: low-income families and vulnerable populations, Open Door serves as a critical safety net to the communities it serves. A full 40% of the center's patients have no health insurance of any kind.
With this poverty comes a myriad of health problems and care barriers, but perhaps because Westchester is incorrectly assumed to be a uniformly affluent suburb, resources tend to locate in New York City instead. Dr. Janet Bozzone, Director of Dentistry at Open Door, previously worked in the city and her experience is that the need in the Bronx pales to that of Westchester, where serious health problems show up early and often. Open Door continues to do its part to bring vastly needed attention and health resources to the working-poor of Westchester through its numerous health programs and dedicated staff.
Three hundred and twenty employees including a panel of 30 highly qualified board certified or eligible physicians and 35 certified mid-level providers ensure that the health care needs of the community are met. All of Open Doors doctors, dentists and nurses are licensed professionals who are salaried employees of Open Door. Physicians have admitting privileges at Phelps Memorial Hospital, White Plains Hospital Center and Northern Westchester Hospital, as well as faculty appointments at New York Medical College.
Even as Open Door has grown, its roots as a volunteer driven organization can still be seen today with over 100 community volunteers lending their support through board participation, fundraising and advocacy activities and serving a key role in building community awareness.
Health Information Technology:
Open Door's health information technology platform was significantly enhanced in 2007 with the implementation of eClinicalworks and Dentrix electronic health records systems in medicine and dentistry, respectively. The sophisticated use of cutting edge health information systems to support physicians at the point of care has provided tremendous efficiencies and clinical reporting advantages. In addition to the electronic medical record system, Open Door’s practice management and billing functions are also performed by eClinicalworks.
A critical aspect underpinning the medical home model is a robust electronic medical record system that allows for the easy exchange of vital health information between all of a patient’s health care providers across the community; one that supports and informs clinical decision making on the part of those providers. On this count Open Door has positioned itself ahead of the curve. With sister health center Hudson River Health Care based north of Open Door in Peekskill, New York as the lead applicant, Open Door collaborated and applied successfully for HEAL V funding from the New York State Department of Health to establish a health information superhighway in the Hudson Valley. These applications funded consortia of community based providers who are aligned with Regional Health Information Organizations (RHIOs).
The sophisticated use of cutting edge health information systems to support physicians at the point of care has provided tremendous efficiencies and clinical reporting advantages. Open Door and Hudson River are the community health center members of the pioneering Taconic Health Information Network and Community (THINC) RHIO in Fishkill, New York. THINC is one of over 150 RHIOs nationwide where “clinical, insurance, administrative, and demographic information for more than 600,000 patients is available on a secured Internet infrastructure incorporating standards (HL-7, LOINC, ICD-9/10) for data exchange” constituting a “multi-stakeholder, community-wide data exchange among community physicians, hospitals, reference laboratories, pharmacies, payers, employers, and consumers.” Such secure access of data promotes a smooth continuity of care, less errors, and is a critical piece of the medical home model.
Chronic Disease Management:
Open Door has a robust chronic disease management program. This program was developed as a result of five years of participation in a Bureau of National Primary Health Care diabetes collaborative. Open Door’s chronic disease management program provides comprehensive case management for patients with chronic diseases. Eight patient advocates (one for each medical unit) provide patient education, reminders, self-management support for patients with diabetes, hypertension, asthma and cancer. Care coordination and management is accomplished through the use of the electronic medical record. In addition, Patient Advocates coordinate cancer screening services for the uninsured.
Quality Improvement Implementations:AHRQ and CDSS
Perhaps the most noteworthy of Open Door’s new quality improvement measures is the nexus of the patient centered medical home model supported by the robust utilization of the electronic medical record. This nexus is seen most clearly in a project that focuses on care of our patients with hypertension. Open Door has partnered with Columbia and New York Universities and the Primary Care Development Corporation (PCDC) and received funds from the Agency for Healthcare Research and Quality (AHRQ) for “risk-informed intervention development and implementation of safe practices in ambulatory care” project specifically focused on our providers’ use of clinical decision support when caring for patients with hypertension. The aim of the research is to “identify, develop, test, and implement safe practice interventions” and to then widely share the findings. The most exciting aspect of the project involves our clinical decision support system (CDSS) built into our electronic medical record; a system that was agreed upon and developed by Open Door’s own clinical team. The CDSS piece is a dynamic, interactive feature blended into the EMR that gives real-time information in the form of alerts and treatment algorithms to providers. For example, a physician seeing a patient with elevated blood pressure will receive prompts of best practices, reminders of standards and required tests, and alerts for irregular results or contraindication of drugs. In the big picture it means that the electronic medical record isn’t just an ever amassing electronic storehouse of clinical information, but a tool to make that information work for the betterment of the health of our patients. In this way, the health information system allows Open Door to respond effectively and proactively to both emerging clinical and business needs. Although the hypertension project is still underway, we have already begun to see improvements in the population of focus.