As part of this site visit we attempted to establish findings related to the experience of health centers’ with EMR adoption and specifically look at the motivation and experiences of health centers that work with a network that is headquartered in a different part of the country. Overall, we found that health centers in Utah and New Mexico did experience the benefits that had motivated their decisions to join HCN.
Discussants appreciated a variety of features of their EMR and PM systems, including remote access to medical records, the ability to send and receive records electronically, increasingly efficiently production of reports and interfaces with labs and e prescribing. We also found that some health centers faced challenges using HCN services due to inadequate connectivity and difficulty in getting the customizations necessary for rural providers. Finally, in conversations with HCN's national leaders, we learned of new direction for the overall organization as they look to re-organize and achieve sustainability in the near future. We highlight several key conclusions below.
Challenges Facing QI Activities. Overall we found that HCN was able to adequately support health centers’ needs relating to implementation and support for practice management. Although health centers reported varying levels of satisfaction, most health centers in Utah and New Mexico believed that they had received the level of service and value from its practice management application that they had signed up for when they joined HCN. However, for QI support, we found that health centers in New Mexico and Utah felt removed from HCN’s clinical committee and improvement efforts underway in Florida.
Health centers in New Mexico and Utah were also compromised in their ability to re-create the Florida environment which encouraged collaboration on QI issues in states where there were greater distances between health centers and greater variation in patient population and focus. In some cases, these health centers did not have a high level of expectation for collaborative QI support. Also, it was difficult to use the EMR tool for active QI if they had to work with HCN’s clinical committee in Florida to make changes to EMR templates.
While in South Florida, one medical director at a health center was able to coordinate medical director colleagues at other health centers and develop a detailed set of requirements and forms for the EMR, even very motivated medical directors in New Mexico and Utah were not able to achieve a similar level of enthusiasm and willingness to collaborate within their own State.
More integration, more benefit. Our findings generally support the idea that health centers that health centers that are most integrated within the HCN system report deriving the most benefit. Being fully integrated means adopting HCN-hosted PM and EMR software and allowing HCN to serve in the CIO role for the health center. Full integration also means a health center taking an active role in the management of HCN through its board, and in the ongoing development of HCN’s products and services through its various working committees.
While several of the health centers in New Mexico and Utah are considered “fully integrated” from an application and service uptake perspective, we found some distance-related limitations in their ability to participate actively in some committees. In addition, we found that HCN national’s ability to maintain a tight level of integration and coordination is increasingly compromised as they grow larger.
Scalability and continuity are issues. While health centers working with HCN from Utah and New Mexico were positive overall on their involvement with the HCN network, they did express some concerns regarding the HCN’s ability to provide a consistent level of service over time. They have noted that applications are not always configured to meet the requirements of non-Florida sites that the committees may not adequately prioritize their needs and that sometimes essential fixes, such as mandatory changes to billing screens, take longer than is ideal.
Impetus to be self-sustaining may result in organizational changes. If HCN is successful in achieving outside funding through foundation partnerships or other sources, their orientation may change over time. Up until now, HCN has been focused on delivering on the goals of their federal grant sponsors as well as the needs of their health center customers. There has been a relatively close alignment between these two objectives given that both the health centers and HCN are funded through HRSA. Their primary strategy for achieving self-sufficiency has been through expansion to other health centers. If HCN or other networks move to a privately funded model, there may be less alignment between network funders and network customers over time.