In addition to consulting with HFP staff, we conducted interviews with major consolidated health center respondents in Philadelphia. Each of these health centers were HFP members though they differed in their levels of participation and attitude toward the data warehouse project. Health centers interviewed also differed in terms of in-house investment in information systems expertise and their level of sophistication in their use of practice management applications.
Health center governance. Each of the BPHC funded consolidated health centers we interviewed relied on a community Board of Directors for overall governance. An Executive Director (ED) typically managed the center, assisted by senior staff including a chief medical officer and administrative or financial lead. We also interviewed one of the HSA’s, FQHC “look alike” clinics. These clinics are governed by the City of Philadelphia rather than a Board of Directors.
Information systems staffing. Most of the health centers we interviewed reported having some knowledgeable and dedicated information systems staff. For one of the largest center (three sites and more than 100,000 encounters), this staff consisted of about three full time equivalents (FTE), a manager or coordinator level lead supported by an applications development specialist with some programming expertise and a technical support specialist focused on responding to support requests from individual users.
Lead information systems staff at the larger health centers indicated having some experience, approximately 5-8 years, in information systems development and support roles in health care provider settings (e.g., hospitals) prior to working for the CHC, but none had the title of Chief Information Officer (CIO) or experience with directing large scale health information systems as would be typical of health systems leads in large private health care provider settings.
In smaller health center with fewer resources, information systems activities were handled either by a single, less experienced employee, often with some formal training in information systems, or by two or three employees with other administrative responsibilities. In one health center, the information systems lead doubled as the human resources coordinator. Importantly, most of health center respondents indicated that dedicated information systems staff reported to department heads responsible for finance or administration rather than directly reporting to the ED.
Information systems decision making. Smaller centers with fewer resources tended to make these decisions on an ad hoc level, relying substantially on guidance provided by Marc Wilcox a part-time CIO who provides services under contract with the HFP. Many of the larger health centers did have sufficient expertise in house to make strategic decisions regarding information systems and use standard operating procedures for day to day systems activities. Although, even these health centers report that needs assessment and planning activities occur on a relatively informal basis.
Hardware and connectivity. Health centers interviewed in Philadelphia generally reported operating in a networked computing environment. Smaller, individual site health centers use local area networks (LAN) to allow for shared use of network applications. Larger, multi-site health centers generally operated wide area networks (WAN), maintained T1 line connections across disparate sites and adequate server capacity to support administrative applications for billing and accounting as well as basic computing needs such as printing and email. One health center in an infrastructure-poor area of North Philadelphia has not yet purchased a T1 line and does not have access to broadband. As such this health center relies on a dial-up Internet Service Provider (ISP) for connectivity to the Internet. Health centers generally reported having adequate access to computing hardware.
Core applications. Health centers interviewed indicated using a wide array of software applications, including applications related to practice management, tracking of care for populations with specific chronic conditions, electronic billing, accounting and interfacing with laboratory providers. For practice management, health centers reported using products designed specifically for CHC use including those developed by HealthPro and Medical Manager. In addition, some health centers reported supporting programs that facilitated communication with clinical laboratory services vendors or specialized applications to support provision of mental health or dental services.
- Larger centers with in-house applications development expertise report having developed a number of data tracking tools using commercial database software such as MS Access to track care delivered and cost associated with treating specific populations. In many cases, these specialized databases draw a baseline level of data from the practice management system and then supplement these data with clinical data. Several centers we interviewed participate in the BPHC-sponsored Health Disparities Collaborative program, these centers report using the either CV-DEMS or PECS software developed as a part of this program to track care and outcomes for clients with ambulatory care sensitive conditions. Finally, all health centers reported using the standard MS Office Suite for general productivity software.
- Three of the health centers interviewed are actively taking part in the community-wide data warehouse initiative coordinated by HFP and have gone through the process of transferring data from their practice management system to the community wide data warehouse using the extracts described above. Health clinics governed by the City of Philadelphia Health Department, have the benefit of the City’s relationship with Siemens, Inc which handles issues related to their network and access to practice management data. These health centers use a practice management product called Signature developed by Shared Medical Systems a system typically used in private sector group practices.
Electronic Medical Records. While we did not speak with any providers in Philadelphia who are currently using electronic medical records, all health centers indicated a strong interest in pursuing EMR implementation in the coming years. Several health centers have said that it is an internal priority to investigate EMR options and come up with a development plan. The HFP is supporting a federally funded EMR pilot in one of the consolidated health centers. This health center is currently closely investigating a new product being marketed by WebMD. This product, called Intergy, is a combined EMR/practice management system with a menu-driven interface designed to streamline clinical evaluation and chart writing. The interface walks clinicians through a series of closed-ended questions regarding an individual patient evaluation and, based on answers, produces a standard preliminary write-up of the clinical evaluation.