Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. Network Governance, Operations and Infrastructure


The network operates under a flexible but relatively formal model. Permanent governance derives from a Board of Directors, whose makeup is described below.  A standing Integrated Delivery System (IDS) committee oversees issues specific to the nine health centers that have fully devolved their fiscal and IS functions to the network and are therefore considered IDS members. An additional set of topic-specific committees allow member health centers to make collaborative decisions and recommendations, which are reported either to the IDS standing committee or the Board of Directors.

Board of Directors and IDS Committee. The HCN Board of Directors is comprised of representatives from member health centers and health center networks. Founding members, including Family Health Centers of Southwest Florida (who were grandfathered in as a Founding member in 1996) have two representatives on the Board, while all other Florida health centers have one representative. Health centers contracting with HCN from Utah and New Mexico are represented on the board through their respective local networks. The HCN Board also includes a clinical representative and consumer Board members of its health centers.

The IDS standing committee governs business relationships between the network and 9 member health centers that have entered into agreement to share access to centralized core business functions through the network. This standing committee closely oversees these integrated functions and makes recommendations to the full Board of Directors.

Decision Making and HealthCenter Relations.  A critical aspect of the network’s organization is its committee structure.  Committees that report either to the full Board of Directors or the IDS standing committee are responsible for recommending policies specific to a wide range of network activities. In addition to making policy recommendations, the committees serve as an important forum for health centers’ staff to provide feedback directly to the network, discuss common problems and share lessons learned. Current committees include Finance, IS, Human Resources, Grants, Clinical and Dental.

Importantly, these committees cover topics of ongoing interest to health centers, regardless of the level of formal network involvement. For example, the committee on clinical issues had been in existence prior to the start of the EHR initiative and became a natural forum for introducing the EHR concept and customizing the EHR application once it was introduced. The committee system was widely praised by both network and health center staff regardless of the size of their health center.

Membership tiers and fee structure.   Site visit respondents noted that HCN dues are relatively high.  Network  members pay annual fees of $15,000 for founding centers and $20,000 for new ones.  There are also cost-based usage fees for using Medical Manager, frame relay lines, Platinum Support, and maintenance fees. These additional fees are loosely based on the size of a health center and average 1.5% of the overall health center budgets.. Finally, health centers obtaining other services through the network (including centralized billing or membership in risk contracting with Medicaid managed care organizations) pay an additional fee.

Network and health center staff indicated that this fee structure is considered very fair, as the services that come with IDS membership would cost centers between $600,000 and $700,000 per year to procure independently.  Health centers disinclined to become full members of the Affiliated IDS have the option of joining as Network level member only, which have access to selected services based on payment of fees for those services.  The health centers in Utah and New Mexico with contractual relationships with HCN mediated through their local networks form a third membership tier.

HCN Staffing. HCN currently has 85 network staff including approximately twelve on Florida’s West coast.  IT staffing includes several executives and managers as well as a large cadre of billing specialists, programmers, technical support staff and trainers. The executive team includes a President and CEO, Senior Vice President for Development, a Medical Director, a Senior Vice President for managed care operations, and Kevin Kearns, the joint CIO/CFO for the network.  Kearns supervises two Vice Presidents, one for finance and one for IT, as well as a Director of Reimbursement and Director of Implementations.

Infrastructure, Connectivity and Security. HCN operates a highly consolidated systems infrastructure.  All systems including production servers are housed at HCN headquarters, and networked computers at individual centers can act simply as terminals, running all their applications over the network. HCN has partnerships with two major telecommunications providers, with whom they have negotiated pricing and service contracts: BellSouth in Florida and QWEST in New Mexico and Utah.  In Florida, the network uses BellSouth T-1 lines with ADSL backup connections in all large facilities on a secure, high-speed wide area network (WAN).  BellSouth provides both routers and WAN lines, all of which terminate at HCN headquarters in Miami.

For enhanced security, all connections are point-to-point, with no connection to the public internet.  The connections are additionally secured by IP-level access control — only users at a given center can see that center’s data.  All practice management and accounting data as well as some EHR data is downloaded nightly into a SQL server database and backed up.  In case of disasters, HCN maintains capability to completely restore data and services within 24 hours for all centers. This system is tested twice annually.  HCN maintains a 50KW generator at their headquarters that can keep systems running for 7 days independently. In addition, the network has contracted with a mobile backup unit which can provide change-over generator coverage in case the generator at HCN headquarters is compromised.

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