In addition to talking with CHAN staff, we interviewed the directors and lead IT staff from three of the five CHAN network health centers. Network participation and collaboration over the last eight years have succeeded in substantially improving the technical infrastructure and capacity at each of the five health centers. All centers have both the Logician EMR and Millbrook practice management systems up and running (except for one site that will implement Millbrook over the next few months), provide a similar set of services to their patients, and participate in network directives like electronic linkages with local hospitals and the BPHC-sponsored Health Disparities Disease Collaboratives.
Health center governance. Each of the BPHC funded consolidated health centers we interviewed relies on a community Board of Directors for overall governance. An Executive Director (ED) typically manages the center and is assisted by senior staff including a chief medical officer and senior administrative or financial officers. The CHAN member health centers have experienced low rates of staff turnover; most of the EDs have held their positions for many years and buy in to the potential offered by CHAN. In addition, all site visit respondents indicated that the level of cooperation between New Hampshire safety net providers in general, and CHAN members in particular, is exceptionally high.
Health center information system staffing. Although each health center does employ some dedicated IS staff, CHAN and member health centers significantly share staff resources. CHAN itself employs 8 FTEs (including both IS and non-IS staff), spread out over fifteen people. Six of these fifteen work exclusively for the network, totaling 4.5 FTE; the remainder are “shared staff” based at one or more of the member health centers whose responsibilities include IS duties for both CHAN and the staff person’s base health center. For example, the CFO/CIO of the CHAN network is also the IT Director for Lamprey Health Care. These shared staff operate the network’s help desk, which is available five and a half days a week and is based at the CHAN central offices. The health centers’ dedicated IS staff is primarily responsible for general office support, such as assisting end users with hardware, database, and minor connectivity issues. They have formal training in information systems but are typically not qualified to do end user support for the Logician EMR system. Specific support related to Logician is provided through the CHAN Logician specialists and from Logician directly.
Information system decisionmaking. CHAN health center IS decisions are worked out through a highly collaborative process. Most of the member health centers have informal internal IS committees made up primarily of their IS staff. These committees assess needs and make suggestions to the wider CHAN IS committee, which is composed of network and health center IS staff, led by the CHAN CIO. This committee receives significant input from the centers’ clinical and administrative leadership. Once a consensus has been reached within committee that an initiative should be pursued following a specific implementation strategy, the proposal is presented to the CHAN Board of Directors (made up of the health center Executive Directors) which then decides whether to go ahead. CHAN’s CIO/CFO noted that since nearly everyone involved in the process wears two hats — health center and network — decisions are made with both responsibilities in mind. CHAN is the source of all IS components of the network, so any changes affect all five centers. The CHAN CIO could not recall a major systems decision being made that was not universally agreed upon by the committee members.
Health center IS infrastructure. Even prior to the development of CHAN, member health centers maintained relatively robust hardware and software to support a range of administrative applications including practice management and in some cases EMR. Under the current model where practice management and EMR applications are housed on a central CHAN-administered server and provided to health centers via a VPN/WAN connection, member health centers still maintain their own servers and support general productivity software such as the Microsoft Office Suite. Each health center connects to the CHAN server and Internet via T1 lines purchased, installed and supported in collaboration with CHAN.