In this section we summarize the Philadelphia health centers’ experiences with their practice management systems, other features of their information systems, and the HFP consortium. In particular, we focus on the centers’ perspectives on the data warehouse project and their general organizational interactions with HFP.
Practice Management Functionalities and Satisfaction. As described above, there is no consistent practice management software system utilized across all Philadelphia health centers. When deciding to implement a data warehouse, the network made a conscious decision to forego standardizing the practice management systems and instead to develop extracts for each system that would then deposit each center’s data into the warehouse. Two of the centers use Medical Manager, two use HealthPro, and one uses GE’s Centricity system.
Access to data and reporting. As described above, HFP has sought to enhance health centers’ access to their own vital administrative and clinical data. Four of the nine health providers currently extract their data to the data warehouse, and a fifth (the local health department, which operates its own health centers) hopes to contribute its data in the coming few years. The HFP data warehouse is not completely functional at this stage. Due to the ongoing data validation and need to program new extracts following practice management system turnover. As such, participating health centers still predominantly rely on their respective practice management systems to gain access to their data, but at least five health centers reported looking forward to the enhanced access to data they feel will follow from the data warehouse initiative.
The two health centers we spoke with do not plan to involve themselves in the data warehouse — one of which uses Medical Manager; the other has the Centricity system. These health centers report relatively few problems accessing and manipulating their data. One respondent indicated that she had been successfully manipulating her practice management data for seventeen years and didn’t understand why a common data warehouse was necessary. Respondents at another center expressed similar views, indicating that they easily extracted the data they needed from Medical Manager. As would be expected, health centers that have not “bought in” to the usefulness of the data warehouse tend to be the larger health centers and those with the expertise necessary to support development of custom reports.
The centers we interviewed who participate in the data warehouse reported experiencing significant problems accessing and manipulating their data through their practice management systems. Center respondents indicated that their practice management system reports rarely produced reliable figures and that they were not user-friendly or flexible. For example, one health center executive using HealthPro reported that while she could access necessary encounter data for the center as a whole, she did not have access to this data not broken down by the health centers’ sites. In the bullets below we summarize health center comments on ease of reporting with specific practice management applications.
- HealthPro. Health centers described HealthPro’s reporting functionality as adequate, but indicated that center staff had spent considerable time and resources to validating data and revising reports. The two health centers interviewed that use HealthPro independently reported that they had done extensive manual comparison and “hand-counting” of reports to make sure that the data was correct One center indicated that half of the “canned” reports provided by HealthPro needed to be revised in order to be useful. Both centers look forward to full implementation of the HFP data warehouse.
- Medical Manager. The two centers using Medical Manager generated reports in different ways. The smaller of the centers could not afford to purchase the system’s report-generating module and paid the vendor to produce all of their reports. This center eagerly anticipates having new reporting functions through the HFP data warehouse. The larger center used the report module and indicated that it was relatively satisfactory, although the staff did not completely trust the report data and checked their accuracy before sending UDS reports to BPHC.
- GE Centricity. The health center using GE’s Centricity practice management system indicated that it worked adequately for their purposes and they had experienced few problems. This health center is not participating in the data warehouse project.
Billing. All of the centers reported that their respective billing and claims submission modules generally worked well. A few indicated that their billing systems were a significant improvement over those of their old practice management software products, and had increased accuracy of claims and reporting requirements fulfillment while reducing paperwork. Electronic claims submission is not ubiquitous; even the centers that submit some claims electronically noted that not all payors are set up to receive the claims and remit payments electronically.
Scheduling. Three out of the five health centers reported no problems with their systems’ scheduling modules. Of the other two centers, one center’s respondents indicated that staff had experienced considerable initial difficulties with the Medical Manager scheduling module, but that many of the problems were due to a lack of initial training on how to use the system. This center, which is quite large and had three dedicated IT staff, had also custom-built a second scheduling model to deal with walk-in appointments. The second health center, which is using an older, currently unsupported version of HealthPro, indicated that the system lacks desired functions such as being able to see appointments by specific provider and that appointments often got erased while staff manipulated data to produce desired information.
Organizational Experiences with the Health Federation. The participating health centers reported that the HFP’s IT staff was responsive and quick to resolve routine problems. There is also evidence that HFP works collaboratively with health centers with special needs. For example the HFP has agreed to assist the Philadelphia’s AHS clinics set up an interface between their practice management system managed by Siemens and the warehouse. Connectivity between the centers and the data warehouse has not been an issue for the network. The health centers dial directly in to the system via high-speed T-1 lines, or in one case a 56K dial-up, and reported no problems with downtime.
Challenges associated with data warehouse implementation. Although participating health centers reported a generally favorable view of services received through the HFP, it is clear from our interviews that the network encountered various problems during the first phase of the warehouse development. First it took two years before agreements were worked out for producing data extracts and the various vendors had completed programming. After the programs were written, important differences in key data definitions were identified, creating some concern regarding data quality and significantly complicating the task of correcting and validating data.
For example, depending on their internal policy, some sites recorded a client visit as a single encounter, whereas other centers defined encounters in terms of billable procedures that were provided during the visit. Some respondents said that, at the onset, they were not aware of the level of health center staff time that would be dedicated to running extracts and validating warehouse data. One larger participating health center had enough IT staff to dedicate to the program, but other centers employed staff who had no background in data validation and were then required to spend many hours doing hands-on tasks that they thought, at the outset of the project, would be automated.
Finally, while the prospect of sharing proprietary data did not discourage the four providers we spoke with from participating in the warehouse; it has proved a barrier to two of the network’s other centers, which so far have refused to contribute their information. These centers indicated that they were reluctant to allow others to view their data in a safety net provider environment which both described as competitive. Respondents from one of these centers noted that they already shared their data at the Federal level and saw no need to do so at the regional level. These respondents felt that the HFP should be focusing its IT efforts in other areas, such as developing an Internet site allowing the health centers to view announcements, share documents, and post to electronic message boards. They also felt that grant money related to IT infrastructure was better allocated on the health center, rather than consortium, level.