From the health center networks that achieved the implementation of an EHR we drew several lessons for future funders and implementers of technology.
- High level of clinician satisfaction and adoption observed in successful networks. Case studies demonstrated the importance of having not only buy-in, but significant involvement from clinicians at all phases of an EHR implementation. Because EHR implementation changes clinical work flow in profound ways and must be customized across a number of dimensions to support efficiency as well as improved quality of care and safety, clinical leadership must be involved in making core design decisions at the earliest phases. Once systems were implemented, clinicians tended to see clear benefit in using the systems and preferred electronic entry to paper records, citing that they “wouldn’t go back”.
- Three levels of substantial funds are required. Health centers implementing EHR reported three significant investments that accompanied the rollout of their systems: seed money for start-up, money to build infrastructure and transition workflow, and funds for the ongoing maintenance of technologies. Seed money is used to purchase software and licenses, hardware, implementation assistance and technical staffing that health centers reported was as critical as the software application itself. Ongoing funds are critical to help health centers implement and transition smoothly. For example, post-implementation health centers must continue to adjust tools to increase usability and allow centers to leverage the new functionality. None of the networks had achieved self-sustaining funds to pay for ongoing maintenance and future systems purchases, and will rely on outside funding until that is achieved.
- Impacts of technology use can be quickly demonstrated. Respondents suggested that fairly soon after implementation, EHR systems can lead to improvements in patient outcomes. While these benefits have a real impact on an individual health center level, achievement of broader public health benefits is still limited by the absence of robust data sharing with public health agencies, hospitals, Medicaid and other ambulatory care hubs.
- Opportunities and challenges for future initiatives. The health center networks studied here were early adopters of health IT, providing lessons for other networks that will follow suit in adopting technologies to improve operational efficiency and clinical effectiveness. However the challenges these initiatives faced as early adopters may decrease in the near to long term, especially given the recent emphasis of the President in leveraging health IT adoption for the improvement of health care quality.6 Practice management and EHR software will likely become more robust and the adoption of data standards may increase the level of “built-in” system interoperability, eliminating the need for costly customizations and extracts for data exchange. In addition, the success of the network model as a driving force for health IT adoption may spur more funding for new collaborations from Federal and private sources. Despite this ripe environment for adoption, future initiatives may still have to overcome organizational barriers to forging collaboration among health centers and vendors as well as reluctance to data sharing.