In this section, we will detail a number of key themes emerging from our discussions with staff from CCHN and the health centers we visited as they relate to their interest and motivation to adopt health IT. Interestingly, unlike other health center network models we have observed, CCHN has not taken on the task of forging consensus among member health centers around pursuing a consistent approach to health IT adoption in the form of specific applications and adoption timeframes. Instead, CCHN has focused on understanding and addressing the needs and motivations of individual health centers and building a broad set of capabilities and flexible hosting options to addressing a range of needs.
Need to upgrade existing applications. One of the primary motivating factors for many health center members who are looking into adopting new health IT applications is dissatisfaction with their current practice management system. Centers noted ongoing dissatisfaction with their ability to use their practice management applications to efficiently address basic health center needs around grant reporting (e.g., UDS) and Medicaid billing. Some health centers had switched practice management applications somewhat quickly in response to Y2K system concerns and were later surprised to learn their practice management system could not fully meet HIPAA requirements could not facilitate quick, accurate reporting. Also, given that many Federally-Funded Health Centers in San Diego achieved status as Section 330 funded entities since 2002, many of these acquired their practice management system prior to being subject to the reporting requirements that come with federal funding.
EHRs seen as the wave of the future. Health centers we spoke with agreed that adoption of EHRs would be essentially a requirement in the near future. They noted their interest in pursuing new funding opportunities through the federal government and that many of those new funding opportunities focused on use of EHRs to improve quality and efficiency of care. They also noted an increasing preference among clinicians they are recruiting to work in a setting where they are using EHRs rather than relying on paper-based clinical record keeping and that regardless of whether they require EHR adoption, increasingly reporting requirements from federal grants required the aggregation of clinical data that could be facilitated by EHRs or other clinical applications. In particular, several health centers noted the requirement to report on clinical measures as part of UDS as being a motivator for EHR adoption.
Facilitating quality improvement. Both health center and network respondents discussed the potential for EHRs and other clinical applications to improve quality. Some of the health centers we spoke with were looking forward to implementing i2iTracks as an interim measure prior to EHRs and as an application that could ultimately compliment an EMR. Some noted the difficulties in keeping existing registries up to date and difficulties due to the lack of available customer support for the PECS software originally promoted for registry development and quality management. CHCN staff noted that most member centers were moving to implement i2iTracks and that once i2iTracks is fully implemented they would have greater capacity to do more quality of care review and benchmarking across the network in a more comprehensive, timelier and far less costly manner.
Motivation and interest in specific applications varied. We should note that although there was some enthusiasm around i2iTracks, there was also a diversity of opinion regarding whether i2iTracks as a stand-alone system was the best choice. One health center that had customized and implemented an open source integrated practice management and EHR solution, felt that it would be more effective to have disease registry functionality built into their EHR itself and is working towards that goal. Another health center noted that i2iTracks could help on quality, but believed that it alone would not address quality of care and improve reimbursement the more accurate coding in the manner that an EHR might.