Community Health Partners (CHP) operates three clinics serving underserved populations in rural communities. Their integrated care model brings together primary care providers, behavioral health specialists, and community health workers—but their documentation systems weren't integrated at all.

The Challenge

Integrated care requires integrated information. CHP struggled with:

• Siloed systems: Medical records, behavioral health notes, and social determinants data lived in separate platforms
• Care team coordination: Warm handoffs between providers were difficult without shared visibility
• Community health worker support: CHWs in the field had limited access to patient context
• Outcome tracking: Demonstrating the impact of integrated care to funders was nearly impossible

The Solution

CHP implemented Notehouse as their care coordination layer, complementing their existing EHR. The platform bridges the gaps between clinical and social care documentation.

Strategic Integration

• EHR complement: Notehouse handles the "soft" documentation that doesn't fit in structured medical records
• Social determinants tracking: Community health workers document housing, food security, and transportation needs
• Care plan collaboration: All team members contribute to and view unified care plans
• HIPAA compliance: Secure sharing meets healthcare privacy requirements

The Results

After implementing Notehouse, CHP saw improvements across multiple dimensions:

• 35% increase in successful care plan completion rates
• 45% reduction in duplicate assessments across providers
• Improved patient satisfaction scores, particularly around feeling "heard"
• Grant success: Won two new grants specifically citing their integrated documentation approach

"Our community health workers are the eyes and ears of our organization. With Notehouse, they can share what they're seeing in real-time, and our clinical team can respond appropriately." — Dr. Patricia Williams, Medical Director

Scaling the Model

Based on their success, CHP is now training other FQHCs in their state on their integrated documentation model, with Notehouse at the center. They've become a regional leader in demonstrating how technology can support truly patient-centered care.