Overall, health centers and network discussants provided similar responses on topics related to their motivation for pursuing health IT and, in particular, pursuing health IT in the context of a network. We highlight these responses below.
Opportunity, resources. Most discussants highlighted the high cost of establishing and maintaining their IT infrastructure and the computer applications necessary for successfully fulfilling their mission as health centers on a day to day basis. The need for additional resources beyond those that could be reasonably dedicated by the health centers themselves became increasingly evident as the health centers looked to tackle complex issues such as Y2K preparation, HIPAA compliance and evaluation and contracting with vendors.
Documenting and standardizing clinical practice. Health centers also noted that they were looking forward to use of EMRs as a means for better clinical documentation and standardization of clinical practices, particularly those related to caring for high priority populations such as individuals with chronic illnesses. One medical director in particular noted being very impressed by an original demonstration of Cliniflow conducted for CPH in 2002. He instantly became convinced that use of the application would dramatically improve documentation and the ability for each health center to develop templates and reminders that would create a consistent level of clinical quality within each center.
Billing and revenue. While most health center respondents did not believe that use of EMRs was increasing their revenue and in some cases, health centers noted substantial dips in revenue particularly in early stages of adoption, some did note that they believed at the start that better documentation of clinical practice could lead to more accurate documentation and billing to Medicare and private payers. While most health centers predominantly treat the uninsured and Medicaid populations, we found that some more rural sites within North Carolina treated a larger number of Medicare and privately insured patients than health centers in urban areas, largely because the limited options for receiving primary care in their region. The health centers we visited in North Carolina indicated that between 10 and 30 percent of their patients has some form of outpatient Medicare (Part B or Medicare Advantage). Health centers in relatively rural areas typically had a higher Medicare payer share than those closer to population centers.
Better reporting and quality improvement. Finally, health centers indicated that one of the most important reasons for adopting health IT including EMRs was the ability to effectively track care, report on care delivery processes and outcomes and use information from these activities to create new incentives to improve care.