Although the ASP model reduces requirements for the procurement, management, and maintenance of technology at each health center site, it does require health centers to purchase and maintain (with the help of OCHIN) some key internal technical components. In addition, most IPM partner health centers also maintain a systems infrastructure independent of their use of the Epic Systems practice management application supplied through OCHIN. Systems infrastructure characteristics at IPM partner health centers are described below.
Infrastructure related to the ASP connection to OCHIN: Wide Area Networks (WANs).The ASP model arrangement requires some level of technical capacity on the part of each health center. For example, site workstations have to be configured with the Citrix clients, secure connectivity has to be procured and maintained, and the site must be able to maintain a good working relationship with their Internet service provider (ISP). In many cases, OCHIN has been able to provide technical support to health centers that needed assistance with initial startup desktop and connectivity configurations.
All of the IPM partner health centers maintain a high-speed, secure connection to OCHIN which includes necessary security technology in addition to the high-speed T1 connection lines. In addition to being on the OCHIN WAN, most of the IPM partner consolidated health centers have multiple sites which are networked together using the building blocks of network connectivity: high-speed lines, routers, firewalls, virtual private network (VPN) technology (for secure networking using the public Internet), and some form of remote access. A subset of the sites belong to a collaborative named Community Health Network of Oregon (CHNO), which is also funded via an HHS grant and provides network application services such as Internet connectivity, email services and clinical indicator tracking to its safety net clinic collaborators.
Infrastructure related to internal connectivity: Local Area Networks (LANs) and basic communication services.Within the four walls of a site, the IPM partner health centers typically operate LANs which connect file servers, email servers, and other networked applications detailed in the following section. In order to manage basic center communication and file sharing, each IPM partner operates these LANs along with certain communication systems such as telephone services. If the health center is part of a county health department, such as the Multnomah County consolidated health center, the health center can sometimes “piggyback” on the county infrastructure for these services, thus reducing the center’s responsibility for their construction and maintenance. Although, some health centers report that the requirement to use a county network infrastructure can present a burden. Other health center respondents that were not affiliated with a health department demonstrated a high level of sophistication in this area. For example, the Klamath Open Door Clinic operates its own WAN to connect two sites, participates in the OCHIN WAN, and maintains a LAN and several servers as well as networked applications. We note that prior to practice management implementation, OCHIN did assist some IPM partner health centers with their internal network setup this service was particularly valuable for rural health centers.