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

01/01/2010

As usual, we end this report with conclusions from this site visit that may relate to broader themes to be explored in this project.

Chronic disease management system v. EHRs. SFCCC members have generally not implemented EHRs and many of them have looked to other applications to perform the functions typically done by an EHR. i2i Tracks specifically has filled in gaps for SFCCC members, with its progress note functionality, population health management tools and patient printouts.  Still, some providers have had their  appetites whetted for health IT with their initial use of i2i Tracks, the LCR and practice management systems.  Some providers are looking for an application to use at the point of care to tell them about the patient in front of them.  Still, i2i Tracks may be a cost effective solution, especially for small centers like Lyon-Martin that cater to a very specific population.

Multiple sources of funding create opportunities and challenges. Respondents in San Francisco were quick to cite the many generous funding opportunities that are available to them through corporations, charitable foundations and local government.  We did notice less of a reliance on federal funding in California relative to other site visits.  However, we also noted that multiple sources of funding are sometimes in competition with each other to fund similar interventions and that there is potential for systems based initiatives to get established in parallel rather than in conjunction with other similar efforts.

For example, the i2i Tracks implementation being sponsored by the Community Clinics Initiative in Alameda County and elsewhere in the state, would have allowed SFCCC sites the ability to implement i2i at the health center-level, however they were not eligible for that program because they already had access to i2i (albeit not at a health center level) through a Kaiser Permanente grant to SFCCC.  Also, even government sponsored efforts such as LCR and One-e-App are not usually integrated or interfaced effectively.

A single network’s reach is limited in some cities. Although SFCCC has an impressive reach in San Francisco, it is clear that its members make up one pocket of a very complex safety net with a range of institutional relationships. The site visit to San Francisco illustrates the complexity of the safety net in some cities and the inability of a single consortium or network to serve as an umbrella for all safety net IT efforts.  SFCCC’s approach has been to work collaboratively with any provider that requires assistance and look for ways to leverage advances made by others such as the DPH in furthering their mission. This does result in some confusing relationships and overlapping responsibilities, but is ultimately seen as a reality of supporting safety net initiatives in this setting.

Very difficult to understand costs and benefits.  Perhaps because of the multiple sources of charitable funding and perhaps because many of them are not accustomed to reporting on operations as FQHCs, the clinics that we visited in San Francisco were not able to give us a solid understanding of their total spending on health IT initiatives or the returns they were expecting.  In terms of QI returns from IT, most providers we spoke with were focused on process outcomes such as increasing the number of individuals tracked as part of their disease specific registries and establishing baseline data on process measures relevant to key populations such as diabetics.  Providers were able to comment on the improvements afforded by access to the LCR, eReferral and One-e-App systems, but these benefits focused on improved efficiency and convenience in accessing necessary information rather than clinical improvements. 


[1] Diagram provided by SFCCC in Spring of 2009.

[2] Diagram provided by SFCCC in Spring of 2009.

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