We conclude with some brief preliminary conclusions and areas for future inquiry that will inform overall conclusions for our final report.
The technical service organization model. CCHN is an interesting network model in that it is relatively distributed with no centralized approach to practice management, administration and billing, yet still manages to be very engaged with working with and across health centers on IT and quality improvement priorities. The network thinks of itself as a technical services organization ( TSO) with a small fee for entry into the network and then a highly modularized approach to purchasing additional services. While this is a relatively new model for health centers, there are several networks that seem to be moving in this direction especially within California.
Pros and cons of a distributed model. Network discussants articulated a coherent rationale for making sure that they stay flexible to meet the needs of their member health centers. Ultimately, there is a realization that unless grants require them to explicitly, health centers will tend to arrive at different conclusions regarding the suite of clinical and billing applications that best suits their purpose. This is consistent with the reality that while similar in many respects each health center has its unique organizational history, administrative practices, clinician staffing, populations served and services provided beyond primary medical care.
Adjusting to ARRA. Finally, throughout this report we note that this site visit was conducted prior to the American Recovery and Reinvestment Act of 2009. As a result, several of the factors creating motivation or lack of motivation for EHR adoption cited here have become overwhelmed by the financial incentives that will be available through Medicare and, in particular, Medicaid for providers engaging in meaningful use of EHRs. We will explore implications of ARRA for the findings from this site visit and others as part of our final report for the project which will integrate findings across all of the site visits.