In this section we describe the IS capacity across the BHN health centers interviewed highlighting both shared, network resources and areas where health centers use dedicated in-house resources. Although they are convened together through affiliation with BMC and BHN, each of the 15 BHN primary and secondary partner health centers retain a distinct IS infrastructure reflecting their individual needs and the development of their internal IS operations over time. While eight health centers are using the Logician EMR system implemented as part of the CHART project, two others are using EMRs by a different vendor. Similarly, all 15 health centers maintain their own practice management systems, with the majority using either HealthPro or Medical Systems Incorporated (MSI) products.
Vision and decision-making. Interviews conducted with health center leadership demonstrated large variation in the extent to which health centers developed and refined a specific vision and strategy for IS decision making. One larger health center that had implemented an Epic Care EMR system independent of the CHART project, indicated that they developed and worked from a five year strategic plan to guide their decision making including the extent to which they leveraged BHN resources for their systems needs. Other health centers indicated that they lacked resources and expertise for this type of planning and instead relied heavily on BHN initiatives to identify and pursue new IS programs.
Although all health centers interviewed indicated that they participate actively in IS discussions on the BHN level, most reported that final decision making on IS issues was handled by their own Board of Directors and Executive Director in consultation with committees and IS staff internal to their health center. Health centers that implemented EMR reported that they based this decision on several factors including the potential for improving patient safety, efficiency of care, and compliance.
In the network context, decisions that affect all of the health centers using the Logician application are brought up through BHN in working groups and discussions. Proposed enhancements and new functionality are assessed based on their cost, available resources and the breadth of benefit. For example, the CHART project will prioritize the development of specific Logician reports if there is a critical mass of health centers requesting that particular report. However, if one center needs an interface from Logician to a specific application, not used by other health centers, this request will be given relatively lower priority.
Staffing and technical expertise. Health centers we spoke also varied greatly in the extent of their internal IS staff resources. One center had an IS staff of five including a network manager, PC and phone support staff, and data managers all reporting to a CIO. Another had a staff of three relatively junior IS support staff. For health centers using Logician, the network provides “Logician Analysts” for two years after implementation. These staff provide technical support and training for the EMR as well as infrastructure support. The BHN also maintains a CIO responsible for managing the Logician analysts assigned to each health center and a CHART help desk. In addition, the HCAP project works with health center medical directors and IT staff to identify and support specific data and reporting needs. For example, they will pull data on specific diseases and utilization patterns from the data warehouse for center specific analysis. HCAP staff also worked extensively with health center IS leads to design and implement data extracts for the data warehouse.
Infrastructure and connectivity. While most CHCs fund hardware, connectivity and basic systems
applications from their internal operating budgets, there are targeted areas where BHN provides
infrastructure support. For example, through a $50,000 grant in 2001 from the National Institutes of Health National Library of Medicine, BHN secured a shared Internet service provider for all 15 health centers. In addition, the private donation of Logician software included funds for some hardware purchases and upgrades. Logician health centers also benefit from use of dedicated EMR servers that are all located and maintained centrally by BHN and connected to health centers via T1 lines. Finally, health centers also have a Citrix-based connection to BMC’s inpatient medical record data. By clicking on a Logician desktop icon and entering an individual password, appropriate users can gain access to BMC clinical systems such as laboratory and radiology to access test results anytime, from any location within the BHN network. By being able to quickly “cut and paste” hospital test results directly into the CHC database, one physician reported that he has become less dependent on his colleagues for important patient information. In addition, the physician’s ability to access the full patient record at all hours has allowed him to avoid unnecessary hospital admissions that previously used to occur due to a lack of information. Specialists do not currently share such a link with the Logician system but BHN is working on achieving that capability.