As typical in other networks visited, the in-house administrative and IS infrastructure at HCN health centers varies considerably. Some HCN health centers employ dozens of providers across up to 15 sites and manage between 40,000 and 50,000 patient encounters each year. Others are much smaller health centers, with one site that sees barely 5,000 encounters per year. HCN’s approach accommodates these differences very well; respondents from centers of all sizes said they felt more than adequately supported.
Hardware and connectivity. Access to hardware differs considerably across the network. While some centers are able to regularly upgrade their computers and purchase hand-held devices or Lifebooks as necessary to support EHR roll-out, other health centers work with relatively outdated computers and have begun implementing EHR using stationary terminals. Because all HCN-supported software is run over the WAN, centers can use older computers, which would otherwise be obsolete and need replacement, as ‘dummy terminals,’ saving precious capital funds. Smaller centers visited remarked that this flexibility was a major benefit for them.
Staffing and user support. With one exception, all health centers visited had personnel resources dedicated to supporting computing. At the larger health centers, the in-house computing personnel typically total three staff: an administrative manager, an operations hardware expert and a programmer or applications expert. These staff worked closely with staff from HCN to review infrastructure and hardware specifications needed to support HCN applications and maintain compliance with HCN’s guidance (e.g., regarding access to back-up hardware). In addition, health center IS staff work closely with HCN technical service personnel to respond to service requests from clinicians and other users.
Typically, staff at the health center will handle relatively minor requests for assistance, including any request involving faulty hardware or connectivity setup. Simple guidance regarding how to use HCN applications may also be provided by the health center IS staff, although the HCN help desk is required to deal with any request that requires changes to settings or permissions as in-house staff have no administrator rights for HCN applications. A key benefit of HCN membership, according to health centers, is the ability to maintain a relatively limited group of in-house systems staff even as the center continues to upgrade software and roll-out new functionality.
Software applications. HCN’s IDS member health centers typically restrict themselves to use of HCN supported applications available through the HCN network including Microsoft Office (including email), Medical Manager, the various EHR applications and Platinum. In addition, HCN provides health centers access to their practice management or EHR data for the purpose of producing custom reports using Info point or Crystal Reports.
In some cases, we found that health centers were using additional, non-HCN applications “off line,” including database software customized to tracking specific procedures or conditions linked to maintaining non-BPHC funding. Respondents indicated that HCN staff tries to help as much as possible with these applications, though their use is not officially supported or condoned by the network. Health center staff reports that they strive to use HCN supported software whenever possible.