Most of the clinics we interviewed in the Southeastern Kentucky region did not have a robust technical infrastructure or support staff, although access to information technology resources and staff expertise varied significantly across the region. Some of the region’s larger health centers and primary care clinics have a more sophisticated level of information technology either due to personal motivation on the part of center leadership, greater access to financial resources such as a higher proportion of commercial clientele, or both. Key aspects of technological infrastructure are discussed below to provide a general sense of the capacity of health centers and clinics in the safety net varying by size and other circumstances.
Organization and Governance. Given the relative lack of consolidated health centers in rural Southeastern Kentucky, the clinics we spoke to tended to have a less consistent organization and governance model. Most of the clinics were led by an Executive Director who often doubled as the Medical Director and chief clinician. Instead of a Board of Directors made up largely of clients, many of the clinics we interviewed were governed by a parent provider or by a group of community leaders. Decision making, including technology decision making, is often left to the health center’s administrative and clinical leadership.
Systems Leadership and Vision. Two of the larger health centers and clinics seemed to have a well developed vision around the importance of information technology in their everyday management as well as a structure built around information technology decision-making. These centers reported having had a dedicated Chief Information Officer, network administrator or an individual with some technical knowledge acting in that role. Other health centers did not share such a vision around information technology, but rather made do with what resources they had since many of these clinics report having no funds to invest in information technology expertise and infrastructure, relying on SKYCAP or using a purely paper-based system.
Staffing. Most of the clinics we interviewed acquired technical support from their relationship with community resources such as the University of Kentucky or through the various vendors of the software they use. The larger clinics and University-affiliated clinics tended to have network administrators and other staff that could aid them in terms of answering basic technical questions. However, most of the centers did not have a dedicated Chief Information Officer.
Hardware and Applications. Most of the clinics had access to basic computer hardware and productivity software such as the Microsoft Office Suite. The use of other software varied based on the clinics’ client volume and access to resources. For example, two of the clinics we spoke to were using specialized practice management systems, Medical Manager and Megawest, that allowed for scheduling, reporting and eligibility tracking functionalities and one health center had successfully initiated an electronic medical record system. Other clinics and health centers depended entirely on SKYCAP for administrative data, meaning that they used no other practice management system. However, some of these clinics reported using software designated by various grants that required them to enter data similar to the data elements in SKYCAP. Notably, since SKYCAP services are provided through a terminal workstation distinct from the information technology infrastructure of individual providers, none of the clinics or health centers acquired new hardware or software or performed upgrades specifically to participate in the program.
Networking and Internet Connectivity. A few clinics and health centers managed a LAN or WAN networking multiple sites. Almost all of the clinics we spoke to were able to gain access to the Internet, although assumedly the smallest and more remote partners in SKYCAP would be less likely to have adequate infrastructure to access SKYCAP through the Web. These centers may or may not be able to upgrade their connectivity to the Internet to in order to achieve the high speed connection needed to facilitate their use of the SKYCAP database.