We end with a series of conclusions regarding the relationship of findings from this site visit to broader project objectives.
Dynamics and savings from a consolidated approach (i.e. Access vs. a health center controlled network). Access offers a distinct organizational and management model, characterized by a centralized leadership team and regional managers to address both the administrative and clinical concerns of daily operation across the network’s 51 sites. While regions within Access’ organization maintain some autonomy and contribute to decision making through formalized channels (i.e. topical working committees), significant authority in areas such as health information technology and strategy are left to the network’s central leadership team. This structure differs markedly from the health center controlled network (HCCN) model that brings together independent health centers (often with multiple sites) for a handful of enumerated functions and services. HCCNs may have a board of directors and centralized staff, but they do not perform similarly comprehensive function for their members.
Challenges with buy-in. While decision making regarding technology has been rolled up to the network in Access’s model, buy-in among center leaders and staff cannot be assumed. Some staff were apprehensive about the financial investment being made by the network for technology, indicating a not entirely successful buy-in campaign. In this way, delegating decision making to network leaders represents a clear economy of scale, yet other considerations like buy-in become more difficult to achieve.
EMR as a tool. Both network leaders and regional leaders emphasized that moving toward a new PM system and EMR would not change the care they provide in a fundamental way. Access has experience with a limited EMR (Meditech) and some providers have already adjusted to consulting a computer application in providing care. More importantly, the EMR was framed as a tool for providers not as a revolutionary quality improvement initiative. While quality improvement may prove to be a beneficial side effect of moving toward an EMR, the stated reason for moving toward an EMR was to empower providers to more efficiently do the work they are currently doing. Access leaders also noted that the network has an entrenched culture and structure devoted to quality improvement (e.g. variable provider compensation based on quality metrics). The EMR is just one element of that value structure, not the linchpin or starting point. Additionally, staff see the EMR as a tool for finding information quicker. This will allow them to comply with various reporting requirements in a more efficient manner.
Influence of external partners in vendor selection. Access had a number of considerations in their vendor selection process. Interestingly, the attitudes and EMR adoption of neighboring academic medical centers played an important role in the selection process. Access has a historic relationship with Sinai Health System, a local community hospital. While the network’s movement away from Sinai’s Meditech system will limit its ability to exchange data with the hospital, Access sees Epic as a way of creating new partnerships and exchange agreements in the future. In their view, most hospitals in the area have chosen either Epic, Cerner or McKesson. Making lab exchanges more efficient and exchanging data with other local hospitals such as academic medical centers makes Epic an appealing choice for Access.