As described above, provider use of SKYCAP varies substantially. Interviews with various providers highlighted specific issues and concerns with respect to tracking clients under SKYCAP, relating both to the general user-friendliness of the system and to specific functionalities of the database and tracking application. In this section we describe provider reports regarding their use of the SKYCAP client tracking system.
Ease of Use. Most users felt that the system was easy to use once they were trained and that data entry did not require a high level of technological sophistication. Generally, SKYCAP reported that participant complaints related to loose cables or incorrect system hook-ups rather than issues with the software itself. However, participants did note the inconvenience of using a system that did not communicate with other software they used. Physicians and nurses, as well as FHNs in the field, were also inconvenienced by having to enter data from a separate SKYCAP terminal in a designated office rather than from desktop computers or laptops that they used for regular work activities. Most participants cited these two items as the greatest barriers to their full participation in the program.
Most of the clinics believed that system utilization would increase if the system could be accessed through the internet using a standard browser versus using a dedicated application on a stand-alone terminal. This change was proposed to be implemented in March of 2004 so it is too early to gauge its success. Since clinics had such varied technological capacity, it was often hard for the limited SKYCAP staff to be able to accommodate the clinics’ various needs or desires in terms of service provision. Different computer versions created a difficulty for SKYCAP staff to easily bring all clinics up to full participation in a timely manner.
Reporting. Stakeholders felt that SKYCAP’s reporting capacity was still in early development and did not yet met their needs. Often, clinics complained that it was labor intensive to pull data adequate for a comprehensive report. In particular, the HCH reported that they could not rely solely on the SKYCAP database to provide all the information they needed to complete a UDS report given the data’s inconsistency and the effort required to pull useful data. Users observed that baseline information entered by FHNs was usually complete across all clients but health information was less complete, forcing clinics to draw from various sources to get a complete set of information needed for a comprehensive report. SKYCAP is still working on improving this function as the vendor completed the front end and left the back end for SKYCAP to develop internally.
Duplication of Services. Several clinics were already using practice management software or internal electronic medical records systems that tracked some of the same elements as SKYCAP. These clinics found that it was less optimal for them to double-enter data into both programs as they would get the same benefit if they entered client information into their internal system only. At least one health center reported that they were unlikely to continue their use of the SKYCAP system since it duplicates services they already gain through an existing software program. They believed that the software could be much more effective if it was interfaced with other existing software in the community or if its use was more standardized across all parties.
Case Management/Disease Education. Many clinics indicated that case management and disease self-care education was the core service that SKYCAP provided. While clinics did not directly speak to their experience with this portion of the tracking system, certain stakeholders felt that this element had benefited the community by providing information which allowed FHNs to efficiently distribute care for low-income clients across the community so as not to overburden a single provider. Others praised the system for providing clear benefits in terms of lower unnecessary emergency room utilization.
Perspectives on the Future of the System. Many of the stakeholders we spoke with were optimistic about the sustainability of the navigation portion of SKYCAP. However, stakeholders expressed concern over the future of the patient tracking system portion, describing it as the part of SKYCAP that is most in jeopardy of disappearing. It has been a problem to secure funding the information systems portion through community resources. For example, area hospitals are willing to fund an FHN to be staffed at each hospital unit but not the community-wide tracking effort. Although the hospitals recognize that they are saving funds in uncompensated care due to their participation in SKYCAP, they claim that the savings do not amount to a large enough incentive for substantial investment in the MIS system given that the hospital does not generate much revenue.
A group of respondents indicated that the elimination of the electronic patient tracking system would severely impede data sharing and access to care for SKYCAP clients would suffer. Providers would lack real time data, services would be duplicated, and FHNs would not be able to evaluate and coordinate clients’ care and services as effectively as they could using the electronic tracking system. Future potential endeavors described by SKYCAP leadership include a “next generation” SKYCAP which will expand on the current model and will extend to additional counties. While this is not yet fully developed or funded, it is clear that SKYCAP continues to seek greater participation among providers as well as a wider client base. Also, while broader dissemination of SKYCAP data and use for research or policy purposes has been contemplated there is currently no funding available for furthering these ideas.