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


We conclude with some brief preliminary conclusions and areas for future inquiry that will inform overall conclusions for our final report.

Long-term staffing and sustainability. It is important to note that the initial development and ongoing management of the Alliance has involved a significant investment of time from a wide range of clinical, financial, administrative and IT staff at each of the core FQHCs. All of this time was invested in the Alliance, in addition to all of the time staff from these FQHCs spent performing their existing "day jobs." While the level of time invested in the Alliance has decreased since the EMR solution has gone live, the Alliance still depends on this external investment of "free" resources in order to perform its ongoing work.

Network focus. One interesting issue that surfaced in the interviews is the inherent tension between the Alliance serving as a consortium-type resource organization for the four core FQHCs and the Alliance serving as a hosted solution service provider for the additional SLA provider clinics. The additional clients provide funds to support the EMR implementation for Alliance members and expand the base of customers that support the entire Alliance staff.

On the other hand, by focusing on solutions that can be resold to other provider clinics, the Alliance and its owner FQHCs are not able to devote additional "mindshare" to the provision of other types of shared services that they could offer, such as other types of administrative software, human resource management, pooled purchasing and facility management. It remains to be seen to what extent the Alliance and its owners choose and are able to successfully expand the scope of the Alliance to include these and other types of services.

Research and innovation. One feature of this site visit that was not as evident in the site visits conducted three years ago is the interest of network leadership in capturing clinical data and using it to conduct research. Meeting participants were eager not only to use the clinical data warehouse to publish the impact of EHRs on the quality of care, but also to use these data to develop requirements and assess needs that could be addressed using different applications, such as different forms of personal health records (PHRs) and other technologies that could enable patients to take charge of their own health and health care.

Providing services remotely. While several health center networks have begun to provide extensive services to health centers that are geographically removed from their core sites, the process for broadening their reach beyond their core geographic area will also differ because each network employs different model. Alliance staff continuously made the point that their EHR implementation process was very "hands on" and focused on workflow assessment, improvement and development of a quality focus in each site rather than simply providing access to the EHR software.

They are cognizant that not all health centers are appropriate for joining the Alliance as their needs to be some agreement among the health center and network in the philosophy underlying their activities. They also noted that their approach requires extensive travel for network staff to remote locations. It will be instructive to note how this model evolves or is adapted as the network rapidly ramps up its membership as well as how the approach that is used by the Alliance differs from other networks that have expanded geographically.

[1] Taken from PowerPoint Presentation forwarded by Fred Rachman on 10/1/2008

[2] Taken from PowerPoint Presentation forwarded by Fred Rachman on 10/1/2008

[3] Taken from PowerPoint Presentation forwarded by Fred Rachman on 10/1/2008

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