Two of the case study entities were actively involved in building and populating a data warehouse using practice management and EHR data. Respondents from both sites expressed enthusiasm about the potential of data warehouses for improving provision of diagnostic and preventative services to vulnerable populations, generating reports to inform management decision making, public health policy and research. Some respondents indicated that data warehouses are particularly useful given the lack of other sources on health care utilization and costs specific to the uninsured. However, building and maintaining an effective data warehouse presents difficulties for many health centers: applications across providers are usually not interoperable and developing interfaces between them is expensive and difficult, which poses problems for networks that look to build data warehouses that combine data from several different practice management applications. Other ongoing challenges include assuring data validation/integrity and non-duplication of patient records, as well as the need to program new extracts following practice management system turnover.
In addition to practice management, EHR and data warehouses, we found that health centers used other specialized computerized applications to track specific clients and services. Often, these systems were homegrown databases constructed using Microsoft Access or other common database tools and serving functions associated with specific funder requirements. Health centers involved in the BPHC State and National Health Disparities Collaboratives made use of Federal and state-developed disease registries, including the Patient Electronic Care System (PECS) and the Cardiovascular/Diabetes Electronic Management System (CVDEMS). Centers involved in the Disease Collaboratives are required to enter and submit data on a monthly basis, which they do through PECS, for their population of focus, such as diabetics.
Health centers involved in the Women, Infants and Children Program (WIC) also used specialized software called the Immunization Registry Information System (IRIS) to track immunizations provided and to contribute data to a community-wide registry. Of the health centers visited for this project, four reported using PECS, three used IRIS, and one used CVDEMS. Several health centers also built their own patient information databases using Microsoft Access, to track patients, conditions, and services rendered.