In this section we describe the information systems capacity at each of our interviews with consolidated health centers and other primary care safety net providers in Virginia, as well as their experience and perceptions from working with CCNV/ComCare and REACH on systems priorities.
Health Center Organization and Governance. As BPHC-funded consolidated health centers, the majority of ambulatory care providers we spoke with were governed by a Board of Directors who select and retain an Executive Director and other senior staff responsible for ongoing management of the health center. Stakeholders note that there has been considerable turnover in leadership at Virginia health centers over the last 2-4 years, leading to some important challenges for community and State collaboration. The majority of health centers interviewed are stand-alone organizations with a long history of serving low income residents in their communities. Unlike other States, there are no consolidated health centers in Virginia that are housed within county or local health departments. One of the health centers we interviewed is part of a larger academic health care system in the State and is currently in the process of applying for CHC status.
Systems Leadership and Vision. Some of the State’s larger health centers have made recent efforts to improve their level of expertise by bringing on experienced technical managers to serve as Chief Information Officers. These centers have typically been going through a re-assessment process and are making improvements to technical resources and information management processes. Other health centers report having no financial flexibility to invest in information technology expertise and infrastructure and rely heavily on CCNV. Still other health centers are part of larger provider systems, including inpatient providers, where technology decisions and resources are governed at a corporate level. In the paragraphs below we describe key features of the technical infrastructure at health centers we interviewed, summarizing the differences in key domains according to the health centers circumstances.
Staffing. Even the largest health centers we interviewed (some with more than 50,000 annual encounters) rarely had more than 2-3 dedicated information technology staff. For the most part, health centers in Virginia — including most of the CCNV shareholders — rely substantially on consultants or vendors to support their requirements around hardware acquisition, networking set up and support. In addition, several indicate relying extensively on CCNV and Companion for all access and functionality issues relating to the use of the MegaWest software. Health centers with the greatest access to systems expertise and support were those connected with larger health systems where these services are provided on a system-wide level.
Networking and Internet Connectivity. A few of the health centers interviewed maintained local or wide area networks (LAN/WAN) connecting different sites. In one case the WAN was supported not through the health center but by their parent health system. Health centers that were networked generally reported adequate access to network technology including high end servers, routers and platforms for managing use of applications across the network. Other health centers operating out of a small number of sites with limited access to resources report very little networking activity outside of Internet-based connectivity to the virtual private network used to access MegaWest. As described above, several health centers we interviewed indicated recently upgrading connectivity to the Internet in order to facilitate their use of the MegaWest software.
Software. With one exception, all the health centers we interviewed used the MegaWest product developed and maintained by Companion Technologies, Inc. for practice management. Furthermore, the majority of health centers accessed this software via Comcare. We found that health centers in the Richmond area have begun use of the REACH MORE Access software which is interfaced with MegaWest, providing a direct link between each health center’s practice management system and a community-wide client tracking and eligibility determination program. In addition, some health centers mentioned ongoing initiatives to integrate their practice management system with commercial laboratory information systems to allow automated tracking of clinical laboratory results. Commercial laboratories whose software is involved in these ventures include LabCorp and Quest Diagnostics.
A few respondent health centers also report participating in a pharmacy application coordinated by the Mountain Empire Older Citizens organization and the Virginia Healthcare Foundation. This program, Pharmacy Connect, provides health centers with a soon-to-be Web-based application for linking specific patients with free or reduced-price prescription drugs provided by pharmaceutical companies’ patient assistance foundations. The program also stores patient prescription information. Participating health centers praised the program, but noted that the software system did not interface with MegaWest. Finally, most CHCs interviewed reported using separate financial software and general productivity software such as the Microsoft Office Suite.