While case studies demonstrated that there is more than one model for successful implementation, we did find several factors closely associated with successful adoption of IT among health centers.
- Understanding the relationship between clinical and administrative applications. Depending on the immediate need articulated by health centers, networks took different approaches towards prioritizing between practice management and EHR. Overall, we found that having a robust practice management application was a necessary first component to implementing an EHR, as the full benefit from both applications comes with the ability to seamlessly exchange information between the two. Even in networks where EHRs were pursued in the absence of networked practice management system, each participating health center did have a successful practice management implementation that they were able to then interface with the EHR.
- Structure of the network impacts function and success. Across the seven sites, we observed a link between the operational model of the network and their success in implementing clinical technologies. We found that more integrated networks where there was strong buy-in for shared systems generally managed a smoother implementation of the technology. Health centers in less integrated networks sometimes could not agree on shared systems, focusing resources instead on systems such as data warehouses and external client tracking systems which have proven very difficult to implement. We illustrate the relationship between network and function and relative success in Exhibit 5 below.
Exhibit 5: Level of Integration and Function
- Building trust through strong leadership. We found that strong, skillful leadership played an indispensable role in building trust and successfully implementing IT on the network level. For example, highly skilled and charismatic network leadership in Boston, New Hampshire and Florida were able to garner trust and buy-in not only for membership into the network but to pool resources for the purchase of common, centrally-housed practice management and EHR systems through which data could be exchanged. These leaders demonstrated not only a strong skill for fostering collaboration but also expertise in key areas such as selecting vendors and building sustainable business models for health center IT investments. Strong leadership was also the keystone to building a vision for systems adoption that facilitated the evolution towards a unified goal of quality improvement for the safety net population both at the network and health center level. In addition to strong leadership, consortia also benefited from a high level of collaboration among consortia partners and public health stakeholders. CHAN, for example, credited a large part of its success to the health centers’ consistent desire to exchange data, overcoming challenges other networks faced in building members’ buy-in and trust.