Collaboration. Overall health centers were very pleased at opportunities for collaboration afforded through OCHIN. Many stated that prior to OCHIN there was little exchange related to IS between health centers in different counties. OCHIN provides ample opportunities to network with other health centers and share best practices. For example, OCHIN organizes specialty workgroups where representatives from different health centers and technology experts participate in regular conference calls. These forums allow health centers to joint troubleshoot over specific functionalities and regularly share new knowledge on a range of technical issues. The OCHIN Board of Directors, where health center executives can discuss current issues as well as the future path of OCHIN, provides another opportunity for collaboration.
Not all centers were entirely satisfied with the collaboration process. One of the smaller IPM partners remarked that they were not as influential in the Board’s decision-making process as were the larger consolidated health centers. Another IPM partner located far away from Portland noted the difficulty of collaborating on the Board through phone conferencing.
Training and support. The quality of training and support provided by OCHIN was reportedly mixed. During Epic’s implementation stage, many of the stakeholders appreciated having OCHIN/Epic technical support included in the package, and felt confident that this support would be responsive to their needs. Several health centers noted that OCHIN was doing as much as it could in terms of providing adequate support to its existing IPM partners and that its “track-it” system and helpdesk were effective and very responsive. Others believed that they were being left behind due to OCHIN focus on expanding to other centers.
In the months following the implementation of the Epic suite, more issues with the quality and availability of support and training surfaced. IPM partners that do not staff a systems expert and rely exclusively on OCHIN for support can face substantial delays in service. As a result, smaller size clinics such report relying on temporary staff to fix problems that they had anticipated OCHIN support staff would handle. Even larger centers often complained that the support process was not always as accelerated as they had hoped. Also, certain respondents noted that the differences between centers, such as those that are stand-alone versus affiliated with a local health department, were not always taken into account in the training modules. While several centers were dissatisfied with the delays in the OCHIN support process and the necessity for continuous training, the centers did appreciate their ability to support each other though networking and workgroups involving IPM partner consolidated health centers.
Customizations. As with similar ASP models, OCHIN requires payment from individual health centers for specific customizations they request. Once the customization is paid for by one health center all IPM partners can access its benefits. Under this scenario, smaller health centers have a strong disincentive to request customizations they believe will be requested by larger health centers down the road. Respondents from some health centers reported that they sometimes did without necessary customizations, waiting until Multnomah County decided that it needed the customization and was willing to pay for it. Several respondents agreed that it has been important for the success of OCHIN to have an IPM partner consolidated health center as large as the Multnomah County Health Department, which is able to invest significant resources towards customizing Epic’s software towards the needs of the participating consolidated health centers. Problems arise where customizations for the smaller health centers do not mirror those for Multnomah County. For example, the mix of managed care and private payers at smaller, rural health centers in the Eastern portion of the State is very different from Multnomah County’s leading to different billing format or reporting requirements.
Connectivity. Some respondents raised concerns related to connectivity. Rural health centers occasionally experience minor disruptions in their T1 connection to OCHIN. While many of these problems are now being addressed, it is important to note that connectivity was a barrier to satisfaction for certain health centers during the beginning of the implementation process.
Cost. In the start-up phases of OCHIN, most of the IPM partner respondents realized that the costs of using Epic would be significant but chose to invest the money anyway, and now believe they receive good value for their investment. There were some concerns reported with unexpected fees, such as the software licensing fees that OCHIN required its IPM partners to pay during the implementation process. Others expressed concern about the rise in per-encounter costs for existing IPM partners, which have been implemented in order to bring other centers into the collaborative. For most of the IPM partners, however, fluctuating costs did not seem to lower the health centers’ satisfaction with their participation in OCHIN in the long run. Other centers noted that the per encounter cost of Epic for smaller or rural health centers may become prohibitive over time as these centers expand their encounters. We also note that cost was an important reason for non-participation in OCHIN cited by those health centers that are not part of OCHIN.