Assessment of Health IT and Data Exchange in Safety Net Providers: Final Report Appendix. Challenges in Health IT Adoption


While some key factors helped DCPCA and its members to effectively implement a new PMS/EHR system, other aspects presented challenges.

Staff expertise/learning curve. Staff presented a number of challenges for DCPCA members. Participants noted low levels of computer literacy among some staff as the primary personnel challenge. Some employees had trouble with basic tasks such as opening technical support tickets and using computers and the internet for work tasks (rather than entertainment).  Other staff members simply could not perform computer-related tasks in a timely manner.  Some providers had trouble adjusting to the constraints of an EHR, having been able to write “what they want” on the paper record.  Others relied on administrative staff to enter things from the paper chart into the EHR.  Some health center representatives at our meeting discussed the specific needs of their administrative support staff, indicating that requirements that staff reflect patients demographically and a predominance of Spanish-speaking staff at another center presented challenges in vendor selection, training and implementation.

Needs of non-medical staff and specialty providers. DCPCA member centers expressed some frustration with eCW’s inability to address the needs of non-medical staff and specialty providers. Not all members are FQHCs or lookalikes (e.g., some are free clinics) and some had no existing practice management system. Also, DCPCA member centers provide other services including determination of benefit eligibility, WIC, case management, social work and behavioral health.  Because eCW serves as the patient record for these centers, staff in non-medical divisions often find themselves accessing patient medical information unnecessarily, compromising patient privacy. One participant explained, saying, “Every time a case worker goes in, all of their history of medications is there. But that kind of extensive data is not necessary for securing bus tokens and other unrelated social services.”

Additionally, non-medical staff and specialty providers have expressed frustration with eCW’s inability to adapt to meet their own needs. For example, behavioral health providers at one center were unable to create a solution within eCW to track patients’ progress on 90-day treatment plans. These plans amount to a significant aspect of care for behavioral health patients, yet no clear functionality exists or has been created to incorporate plan progress data in eCW. Behavioral health providers have also had trouble scheduling individual providers for group treatment sessions.

Others indicated that eCW does not generally reflect the interconnectedness of medical and social service functions within centers. Staff working in other areas such as WIC and public benefits have had difficulty working with eCW, continuing to rely on standalone applications in some cases. One participant summarized saying, “Our staff are frustrated because eCW is really medical software.” While the medical focus of eCW has presented challenges for DCPCA members, panel participants suggested that staff in non-medical positions and specialty providers have not entirely rejected eCW. One participant noted, “Our case management and social work staff are living with it, but they are not entirely happy with it.”

Vendor support. Some participants noted difficulty in working with eCW throughout the implementation process. One health center representative indicated that the vendor had not been helpful in general, while others pointed specifically to the trainings conducted by eCW staff as problematic. Those who found eCW trainings lacking were glad to have the Cumberland Consulting available for additional trainings. One participant recognized deficiencies in working with eCW, but put them in a broader context, saying “In the whole scheme of EHRs, any vendor goes in there to make money, and they started out making these for hospitals. CHCs are unique because we provide free care. We have so many funding sources, each with their own requirements, and data fields are dependent on those requirements. There is no EHR out there that could meet all of our needs.”

Reporting functionality. Reporting was often raised by participants as a key difficulty in working with eCW. Participants noted difficulties in accessing reports on financial data, HIV positive patients and labs ordered. Generally, health center staff  have found the reporting functionalities within eCW to be lacking in terms of user friendliness. Some attributed difficulties to a lack of experience and expertise on the part of health center staff and leadership, pointing to additional training as a possible solution. Others felt that eCW simply, “wasn’t good at reporting.” These participants pointed to difficulties scrubbing data and problems encountered by auditors and reviewers in working with eCW reports. DCPCA has taken steps to address some of these issues, hiring an additional staff person to build customized reports for things like Title X family planning funding.

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