In addition to gathering and reviewing information on systems capacity and infrastructure at consolidated health centers, site visit activities focused around understanding organizational decision making processes and tools used by consolidated health centers to guide their systems investment and maintenance activities. We found that consolidated health centers were aware of the need for better planning around systems at their health center, but had not yet adopted specific policies or tools. Most health centers indicated that their thinking in this area is evolving in tandem with increasing opportunities to collaborate with neighboring health centers on application acquisition and infrastructure through OCHIN. Specific findings with respect to budget and application selection issues are described below.
Budget decisions.Overall, our findings suggest that health centers spend less than five percent of their total annual expenditures on IS. This figure is lower than those seen in many comparable primary care health settings that serve the general population. We note, however, that some IPM partners indicated a dramatic (one year) increase in percent spending on systems in 2003 as they had to invest in hardware and connectivity upgrades necessary for the practice management implementation.
Notably, respondents suggested a link between their organizational affiliation and willingness to invest in systems resources. Consolidated health centers that are part of the county infrastructure may benefit because county governments often operate a single information system that works across all administrative and service agencies. Under this scenario, the cost of system maintenance and support is spread across a wider group of organizations is often funded out of central county budgets rather than out of individual agencies. While access to the county infrastructure may be more efficient, in some cases we found evidence that this connection to the county government IS may not be functionally useful, such as when there is insufficient county level investment in systems. Additionally, independent consolidated health centers face much greater incentive than county-based health centers to actively to monitor their bottom line and assure against write-offs at the end of a fiscal year. This often leads to a more frugal approach by these health centers to investments not directly related to revenue generation.
Applications decisions. While most health center Executive Directors we interviewed acknowledge the need for systematic, strategic thinking at their health center around systems issues, including decisions regarding applications investments, most reported no formal processes currently in place to facilitate this. IPM partners report learning a great deal about vendor procurement and evaluation practices following their experience with the practice management procurement and ongoing discussion regarding EMR. Health centers also report that regulatory (e.g., HIPAA) and reporting requirements (e.g., UDS) drive many application implementation activities.