The Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS) has contracted with NORC at the University of Chicago, a non-profit social science and policy research organization to assess the status of health information systems at the nation’s HHS-funded community health centers (CHCs). The assessment will identify information management issues and opportunities facing CHCs and inform federal initiatives aimed at supporting CHCs in their efforts to more effectively utilize information systems (IS) on a center, community and regional level. A major motivator for the project is the National Health Information Infrastructure (NHII) vision articulated by HHS to maximize availability of health data for improvements in public health, health care financing policies and quality of care. The main purpose of this project is to gather and analyze information from CHCs on the relevant characteristics of their current systems applications, technical infrastructure, data management and transfer practices, processes for systems selection and implementation and the prioritization of information systems related issues within the larger organization. In summary the projects seeks to:
- Assess ongoing information systems related programs and practices employed by CHCs;
- Identify and describe models for successful systems implementation on a CHC and community level;
- Articulate major information systems challenges facing CHCs;
- Describe important barriers to realization of systems-related goals such seamless electronic data transmission to government and health care system partners; and
- Assess findings in relation to ongoing and potential policy initiatives at ASPE and HRSA and across HHS
This report presents results from the initial stage of this study, an environmental scan of the CHC and IS landscape. This environmental scan is based on review and synthesis of existing published and unpublished literature and a small set of discussions with thought leaders in the area of health information technology. The scan is designed to supply general context and background for the project and provide initial results and areas to be further explored during subsequent planned project activities. These activities will include detailed telephone discussions with 25 CHCs, and in-depth site visits with seven of these CHCs. The remainder of this document is organized as follows:
Environmental scan methods. We begin with a brief discussion of the overall approach and specific methods used to collect and analyze the information presented in the environmental scan.
Community health center landscape. We provide a description of CHC characteristics and goals as they relate to health information management activities. In addition to describing basic features of CHC financing and operations, we describe CHC activities that drive health center information system needs and requirements as they relate to administrative, financial and clinical practices.
Health center information systems and vendors. We next describe current resources systems used by health centers for the electronic management and exchange of clinical and administrative information. This discussion provides a description of “state of the art” systems used in larger public and private health centers as well as findings on use of technology such as practice management software and electronic medical records (EMR) more broadly among primary health care providers. The section also includes an overview of major software vendors who typically work with outpatient primary care health centers.
CHC information systems. Following the discussion of the basic CHC environment and the state of current information system technology relating to health centers, we describe the specific experiences of CHCs with information systems. Because this topic represents the main focus of key stakeholder interviews and site visits, this section will provide a very preliminary discussion based on our review of published and unpublished materials and conversations with thought leaders. In particular, we will identify models of innovative management of information systems at CHCs and raise questions for further elaboration with the planned qualitative data collection with CHCs.
Themes for additional study. We conclude the environmental scan report with a summary of key findings and conclusions for the larger study.
Appendices. Appendices 1 and 2 contain supplementary materials on project methods, including a list of printed materials identified for review and the main discussion guide used in conducting thought leader discussions. Next steps, in the form of possible CHCs to include in the next phases of the project and a CHC interview protocol are provided as Appendix 3. Appendix 4 contains a more detailed summary of the health information technology vendor marketplace to supplement the information presented in the main text and Appendix 5 includes an overview of our first planned set of stakeholders and case study involving community health care providers in Indianapolis, IN.