Currently, Access relies on the Meditech practice management system hosted by the Sinai Health System (the network first implemented Meditech in 1987). In addition to serving the usual practice management functions such as scheduling and billing, this system houses and maintains patients’ basic clinical data and is able to share data between individual Access clinics and specialty and emergency providers at Sinai. Meditech also has a communication module that is used by Access providers as an alternative to email (administrative staff rely on MS Outlook). Notably, Meditech does not allow appointment scheduling across Access sites.
As part of developing an IT strategic plan, Access concluded that Meditech should be replaced both because it had limited functionality and because it was inefficient for a network of Access’s size. In the last several years, network leaders have acquainted themselves with the EMR market, various vendors and the experiences of other health center networks with them. The Access senior management team narrowed the initial field of EMR vendors to five. Criteria for making the selection included the desirability of a single application for practice management and EMR, robust clinical decision support capabilities and the ability to track specific quality measures.
In 2008, network leaders asked regional managers and regional medical directors to assist in selecting a vendor for both a new EMR and PM system from among the five finalists. Those involved formed committees based on specific needs and concerns and attended demonstrations of the five finalists. The final determination to move forward with a contract with Epic was made in mid-year 2008. Since the vendor selection process concluded, regional leaders have reached out to their staff to help build buy-in.
At the time of the site visit, network leaders had begun discussing developing an arrangement with the Oregon Community Health Information Network (OCHIN) to provide FQHC-specific training and data management services. In addition to the OCHIN arrangement, Access negotiated contracts to migrate data from legacy systems and paper systems to the new Epic system. These negotiations have stalled and created delays for the OCHIN-led training and implementation effort. Training of super users was set to begin in August, with practice management implementation beginning in select centers weeks after. EMR implementation would begin in January 2009 with a goal of full implementation in 10 centers by the end of the fiscal year and an overall goal to complete implementation over a 24-month period. While the network remained hopeful that this timeline would remain intact, they acknowledged that contracting issues could create delays that would prevent them from adhering to the original timeline above.