This section will detail key factors that have both helped and hindered DCPCA in its PM/EHR implementation process.
DCPCA leadership. While DCPCA’s approach differs somewhat from more unified health center controlled networks and individual FQHCs, the organization’s leadership amounts to a significant enabler for its members. DCPCA made efforts to standardize the approach to health IT adoption among its members, although some variation was permitted. Members saw the importance of a shared approach for data elements such as appointment types. In cases such as this one, member centers agreed on the type of appointment to build into eCW and the way to store appointment data. At the same time, differences in the intervals between appointments were permitted.
Even when differences persisted, having DCPCA as a forum to discuss differences across health centers and their needs proved useful in developing a shared system. For example, one health center does not bill for homeless patients, but others might. Being able to discuss the implications of differences like this was an important enabler to adoption for DCPCA members. Additionally, health centers noted that they had neither the time nor the staff to pursue and implement an EHR on their own. Members looked to DCPCA for expertise and strategic thinking. Health center staff felt pressed to find the time needed for things like vendor selection, planning, training and implementation. Having to handle grant applications, software installation and data management would have completely overwhelmed member centers’ staffs.
Grant support. While some participants decided to pursue an EHR after being presented with a grant opportunity, the DC government’s support also served as a general enabler for success for DCPCA members. Participants noted on numerous occasions that they would not have been able to implement an EHR without the District’s grant money. DCPCA staff supported this characterization, indicating that health centers did not need to provide significant support for the initial costs associated with eCW. The grant covered hardware costs such as PCs, tablet PCs, scanners and printers. The only start-up costs not covered by the grant were things like improving internet access for member centers (i.e. going from a DSL connection to T1). While the DC government grant covered nearly all initial costs, member centers now pay all of the ongoing costs through fees to DCPCA (eCW invoices DCPCA).
Consultant support. Consultants also provided valuable support for DCPCA and its members. They assisted in vendor selection, adapting eCW to members’ needs, data collection and overall strategy. Participants expressed appreciation for this support, while also noting some minor difficulties. One participant indicated that Cumberland’s schedule for adoption prevented them from asking questions at some stages. Others simply wished that representatives from Cumberland Consulting had been available for longer periods of time or had transitioned away from their support role in a more seamless way. Despite these issues, members seemed to view Cumberland Consulting in the same way they discussed DCPCA’s support: not perfect but still essential.