Project activities were conducted using a tiered-qualitative approach divided into two separate but interrelated phases: 1) an environmental scan, and 2) a series of seven case studies focusing on a set of geographically dispersed health centers and health center consortia with ongoing IT implementation projects. The environmental scan phase involved discussions with 16 thought leaders and key informants knowledgeable about IT and the health care safety net, and a review of published and unpublished documentation. Findings from the environmental scan supplied the basis for setting up the subsequent project activities, including the selection of case study candidates.
The second major phase of the study involved in-depth case studies of seven sites around the U.S. These case studies entailed a series of meetings with stakeholders at health centers and health center networks identified as “leading edge” — those that offered the greatest opportunity for providing policy-relevant lessons learned and informing sustainability and spread of gains from IT implementation. Candidate sites targeted for case study selection were communities maintaining several Section 330 health centers, including IT-savvy health centers and networks. The final sites selected were in the states of Oregon, Virginia, New Hampshire, Florida, and Kentucky, and in the cities of Boston, MA, and Philadelphia, PA. Overall methods included meetings with 120 respondents across 38 health centers and seven health center networks. Meetings covered a range of topics, including health centers’ approaches to and uses of IT, perceived barriers and enablers to technology adoption, participation in networks, and network governance and organization. Detailed case study reports were prepared for each site describing findings and lessons learned from each site visit.
Final analysis activities, which culminated in the current report, drew from findings and themes across all project activities. Findings are discussed at two levels — the health center network level and the individual health center level. We explore health centers’ and networks’ experiences with implementing IT, and describe the different models for IT adoption along with issues relevant to sustainability, replicability and public policy in this area.