Kalkaska Medical Associates, a service of Kalkaska Memorial Health Center, operates two Certified Rural Health Clinics serving Kalkaska and Antrim Counties. Through their work with the Michigan Center for Rural Health and the National Kidney Foundation of Michigan in the Chronic Kidney Disease (CKD) Learning Collaborative, Kalkaska Medical Associates implemented an Electronic Medical Record (EMR) workflow change that expands urine albumin-to-creatinine ratio (UACR) screening following a hypertension diagnosis—an update now reaching patients across Munson Healthcare’s network!
Over the past four months, these clinics have participated in the CKD Learning Collaborative. As part of the Diabetes HIPE (Healing Inequities. Through Partner Excellence) grant, funded by the Centers for Disease Control and Prevention (CDC), the Michigan Center for Rural Health and the National Kidney Foundation of Michigan lead this collaborative by providing technical assistance, peer learning opportunities, and quality improvement support to help rural health clinics strengthen CKD screening, management, and patient education for priority populations. Through monthly learning sessions, peer sharing, and tailored technical assistance, participating clinics build practical skills and confidence to improve early detection, care delivery, and long-term outcomes for patients at risk for CKD. Through this work, Kalkaska Medical Associates identified an opportunity to expand UACR screening following a hypertension diagnosis and developed an EMR workflow update to support earlier detection of chronic kidney disease.
This new EMR workflow change supports earlier identification of CKD in patients who might otherwise go undiagnosed until later stages of disease and aligns with existing professional guidelines to test people with diabetes and/or hypertension – the two leading causes of kidney disease.1,2 The addition of a screening prompt for persons with hypertension is critical because a recent study found that the prevalence of CKD has decreased in US adults with diabetes from 1999-2018 but has not declined among persons with hypertension despite the fact that the prevalence of diabetes and hypertension has increased over the time period.3 Following a February 2 meeting of the Cerner Ambulatory Workflow Committee, the updated workflow was approved. Kalkaska Medical Associates operates under Kalkaska Memorial Health Center (KMHC), an independent Critical Access Hospital in Kalkaska County with close ties to Munson Healthcare, including shared use of Munson’s Cerner EMR system. As a result, this workflow update extends beyond Kalkaska Medical Associates, impacting primary care screening workflows across Munson Healthcare’s network and reaching more than 500,000 residents across 30 counties.
MCRH is proud to partner with rural clinics like Kalkaska Medical Associates to support quality improvement efforts that strengthen care for rural patients across Michigan. We thank Jeremy Cannon VP, Chief Nursing Officer, Dr. Doug Gentry, Katie Daman, and the entire Kalkaska Medical Associates team for their hard work. This project would not be possible without the National Kidney Foundation of Michigan and their expert team.
If you are interested in quality improvement projects for your rural health clinic, please reach out to Jill Oesterle, Director of Provider Solutions.
References:
1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. doi: 10.1016/j.kint.2023.10.018. PMID: 38490803.
2. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025 Aug 14. doi: 10.1161/HYP.0000000000000249. Epub ahead of print. PMID: 40811516.
3. Bragg-Gresham, J., Li, Y., Nunes, J. W., Herman, W. H., Powe, N., Banerjee, T., ... & Saran, R. (2025). Decreasing Prevalence of Chronic Kidney Disease among US Adults with Diabetes, 1999-2018. AJPM Focus, 100453.