Community Health Center Information Systems Assessment: Issues and Opportunities

Introduction

Contents

• Importance of the Current Study
• Overall Approach

NORC at the University of Chicago (NORC) is pleased to present this Final Report for Community Health Center Information Systems Assessment: Issues and Opportunities to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the United States Department of Health and Human Services (HHS).  The project applies qualitative methods to describe the use of information technology (IT) among ambulatory health care providers funded by the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) under Section 330 of the Public Health Service Act (hereinafter “health centers”) and health center networks around the nation. NORC conducted this project under contract with ASPE; HRSA and BPHC worked in conjunction with ASPE to guide activities under the project.  In this report, we refer both to health centers’ use of IT generally, and, as a subset of IT, to those applications which directly may improve the safety, quality, efficiency and effectiveness of health care delivery, known as health IT.

This report represents a synthesis of several prior deliverables, including an environmental scan and seven interim reports detailing findings from case studies. Overall, we report on findings from discussions with over 120 respondents from health centers (38 total, several with multiple sites), health center networks, public health agencies, associations, foundations and other relevant stakeholders, shedding light on the experiences of health centers and health center networks at various stages of implementing IT programs. We also describe important challenges to the development and long term sustainability of health center network arrangements as well as the obstacles health centers face when initiating IT projects alone or in collaboration with other providers.

Importance of the Current Study

Health centers represent a critical resource for individuals and families who face barriers to securing medical insurance or seeking care through private providers. In FY 2003, health centers provided medical care to approximately 12.5 million Americans, the majority of whom live below the poverty level. In addition to assuring this population access to primary care medicine and ancillary services (such as radiology, clinical laboratories and pharmacy), health centers often link these individuals to Federal, state and local social services programs such as Temporary Assistance for Needy Families (TANF), Medicaid, mental health and substance abuse treatment, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).¹

In the past decade many health centers have served the growing national uninsured population comprised increasingly of immigrants and selected minorities while working with reduced Medicaid reimbursement rates and managed care. During this period, health centers have also increased their emphasis on quality improvement for care delivered to patients with chronic illness as well as more effective use of diagnostic and preventive services through participation in a variety of initiatives sponsored by BPHC.

Seeking to achieve administrative efficiencies, optimized reimbursement from third party payers, improvements in clinical decision-making, and better management of chronic illness, many health centers rely on IT applications such as practice management, electronic health records (EHR), disease registries, community-wide client tracking programs and health data repositories.  Health centers seek to maximize gains from IT while navigating challenges related to selecting vendors, implementing and customizing the chosen systems, training providers in appropriate use of the systems, and complying with Federal health data standards and privacy rules. 

This project is unique in that it provides policy stakeholders with a detailed understanding of health centers’ use of IT — including the challenges related to obtaining systems, funding IT, managing vendor products and relationships, training clinical and administrative staff to use IT, providing user assistance and the technical infrastructure to support IT and using information systems for overall quality improvement.  This report comes at an opportune time as the nation’s leading policy makers have identified health IT as an important component to improving the quality and efficiency of care across the health care system. Health centers and health center networks described in this report represent an early laboratory for IT, and specifically health IT, implementation, use and impact among ambulatory health care providers. As such, we anticipate that findings from this study will not only inform efforts to improve health center use of health IT, but will provide guidance to providers, policy makers and other stakeholders interested in understanding the broad potential for IT to improve the way health care is delivered in the United States.

Overall Approach

Given that formal assessment of IT use among ambulatory health care providers is still at its early stages, ASPE specified a multi-tiered qualitative approach to data gathering and analysis for this study beginning with an environmental scan where existing literature was reviewed and thought leaders were consulted. We then conducted detailed case-based data collection among health centers and stakeholders in seven geographic locations and analyzed findings across the entire study.

Because this is a qualitative study of providers and networks at various stages of IT adoption, we emphasize similarities and differences across different models for IT adoption as well as the facilitators, barriers, challenges and opportunities specific to each model and to IT use in general. Findings are framed as potential lessons learned relevant to the desirability, sustainability and replicability of the various approaches encountered in our study. The remainder of this report is organized as follows:

• Study Methods.  We begin with a brief discussion of the overall approach and specific methods used to collect and analyze information gathered during the two main phases of the project: the environmental scan, which included in-depth discussions with sixteen thought leaders as well as a review of existing documentation, and seven case studies comprised of telephone and in-person meetings with 120 respondents across 38 health centers and seven health center networks.
• Background.  We follow the methods section with a brief overview of the health center landscape, including the health center program’s history, funding structure, special issues and challenges for health centers, and the rise in IT adoption by health centers.  We also present key themes and conclusions drawn from the environmental scan, which informed the design of and findings from the seven case studies.
• Health Center Network-Level Findings. We begin our discussion of findings from case studies by presenting findings at the level of the “leading edge” health center networks, including the impetus behind their development, key characteristics and trends, the benefits of network membership for health centers, and ongoing challenges for networks.
• Health Center-Level Findings.  Next, we review the IT status and experience of individual health centers, including their approach to IT infrastructure (staffing, resources), uses of IT, including health IT, and participation in health center networks.
• Conclusions.  We conclude the Final Report with a discussion of broad conclusions following from the environmental scan activities and the seven case studies.  These conclusions include lessons learned from the experience of health centers and health center networks implementing IT and implications of these findings for key stakeholders such as policymakers and other providers.

Footnotes

1.  Testimony by Elizabeth M. Duke, Health Resources and Services Administration on “A Review of Community Health Centers: Issues and Opportunities” before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, United States House of Representatives. May 25, 2005.  Available online from: <http://www.hhs.gov/asl/testify/t050525.html>

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