Findings from our site visit demonstrate the potential of a centralized network to serve health center needs through substantial integration financial and information systems. The site visit shows, that when appropriately pursued, such integrations allow health centers to enjoy a much higher level of service than they could afford on their own. Key conclusions are highlighted in the paragraphs below.
Serving and leading. Respondents made it clear that HCN has worked hard to simultaneously serve and lead health centers. Kearns and other HCN staff take their role of systems administrators very seriously, asking health centers to comply with extensive guidelines related to systems use and maintenance making it very clear to health centers that compliance with these guidelines is necessary to achieve full benefits from their investment in HCN. In addition, HCN is firm on not allowing staff from individual health centers to have administrator rights over their applications, as they believe that centralized control is essential for maintaining a highly secure, highly reliable network.
At the same time, HCN has shown great flexibility in working to meet the specific service needs of a wide variety of health centers. Unlike in other networks, respondents from the smallest health centers did not notice any lack of responsiveness to their needs. Although all acknowledged resource limitations, there was consensus that HCN has done an effective job of maintaining a customer orientation with senior staff working creatively, often on a one to one level, to understand each health centers’ environment and to provide an appropriate level of service.
Incremental approach to meeting health center needs. HCN pursued an incremental approach, focusing first on “righting” the health centers’ administrative and financial position before moving on to EHR. All indications suggest that they met the first objective very well, providing a robust set of services delivering their members huge economies of scales and improvements in core functions such as billing, reporting and accounting. In doing so, HCN has built the trust among members necessary for encouraging health centers investments in EHR.
While other networks have successfully implemented EHR in the absence of networked practice management, it is clear that HCN’s EHR agenda would not be possible without their initial success in helping health centers address threats to their fiscal survival. Unlike other networks, HCN has been able to successfully roll-out EHR in health centers without a very large, one time private sector donation, relying instead on piece-meal funding from the ICT-grant, network revenues and the health centers themselves.
Slow, but steady goals for EHR. Consistent with the considered incremental, approach to overall systems design and implementation, HCN’s EHR roll-out is occurring deliberately with a focus on understanding and applying lessons learned at the early stages to subsequent stages of implementation. For example, early experience in the EHR pilot phase highlighted the downsides of beginning EHR using “out of the box” templates. As a result, HCN works very closely with clinician leaders, allowing them to drive customization and functionality for the EHR and to build buy-in and confidence in the usefulness of the system among their clinician colleagues. To some extent the slow, phased approach to implementation is a benefit of the funding model which requires health centers to find resources internally to incrementally fund a portion of necessary hardware and licensing costs to bring each provider live.
Effective vendor management strategies. HCN enjoys a much closer relationship with its major practice management and EHR vendor, Medical Manager/WebMD, than typically experienced by health centers. The network has worked very closely with the vendor over the years in setting up health center specific customizations and helping Medical Manager effectively market itself to other health centers. HCN has successfully leveraged their strategic position as a high volume purchaser and early adopter to obtain products highly tuned to the requirements of their health center members.
More importantly, HCN’s relationship with Medical Manager results in significantly enhanced responsiveness when issues arise. Kearns indicated that he can easily get a meeting with Medical Manager and WebMD executives around the need to address problems. This level of access was particularly instrumental following the addition of out of state health centers when HIPAA-compliance became an issue for the first time. Purchasing power aside, it is clear that the vendor management and negotiation skills of HCN leadership have served its health centers very well. As a result, users report far fewer problems and frustrations compared with other health centers.
Return on Investment for EHR. Health centers acknowledge that it is too early in the implementation to make many concrete statements about return on investment for EHR; however they state that early indications are positive. Providers who are fully integrated into the system have seen some increased productivity with easier access to prescriptions, laboratory results and patient charts. Interviewees agreed that results have been largely positive from an ROI standpoint with reduced errors, fewer lost files, and increased revenues due to more accurate billing. Health centers also anticipated increased cost savings as use of EHR broadens.
Because the vision is for a paperless system across health centers, there are some costs that can be eliminated all together including medical records staff and basic purchases such as prescription pads and paper charts. HCN staff emphasized the need to consider and track societal returns from investing in EHR as use of this system begins contributing to better management of chronic illness and enhances the effectiveness of public health programs targeting the population served by the health centers.