After each case study was complete, findings from preliminary phone calls, site visit discussions and follow-up activities were analyzed and written into draft case reports submitted to ASPE and HRSA. Once comments were received, NORC revised each document and submitted it in final form. Each report drew richly detailed findings and lessons learned from stakeholder discussions. These case study reports are included in this report as Appendix B.
Our findings should be interpreted in light of the fact that we focused, by design, on early adopters of IT and health IT among health centers. While some of the barriers encountered by sites visited for this study may be mitigated over time through standards development, increased access to publicly funded capital, a more stable vendor market and better incentives for adoption (e.g., pay for performance), the majority of the challenges described in this report will be encountered by any health center that attempts to enhance their use of IT and health IT. In addition, we note that these challenges may be greater for health centers not studied here because they likely lack the characteristics that made this group early adopters in the first place.
Following a discussion of background, we present findings both at the health center network level and the individual health center level and explore different, but viable models for the adoption of IT in health centers. We describe the health centers’ experiences with implementing and using IT systems, including the various barriers and incentives affecting the implementation of such systems. Our conclusions focus on benefits and challenges associated with health center network activity, critical success factors for health centers implementing IT, special lessons learned from early experience with EHR and issues for future study.