With almost no exceptions, health centers we spoke with were working with usable hardware and adequate access to basic software and connectivity. However, reflecting the diversity of health centers’ size, access to funding, and investment priorities, we found that the overall computing environment varied considerably from center to center.
Hardware and Connectivity. In addition to reporting adequate access to hardware, including computers, monitors, hard drives and printers, most health centers we spoke with (75 percent) reported operating in a networked computing environment. Smaller, individual site health centers tended to use basic local area networks (LANs) to allow for networked applications and file sharing with limited file storage and server capacity. In some cases, these health centers were not able to provide many applications over the network and relied instead on installing some types of software locally on user computers (e.g., accounting staff had accounting software installed on their computer). These centers also had basic Internet connectivity and could access applications housed at servers outside their walls through use of virtual private networks (VPNs).
Most centers connected to the Internet or point-to-point shared servers either through a dial-up, cable or broadband connection. Many of the health centers we spoke with upgraded their infrastructure in order to access networked software. In Virginia, for example, several health centers indicated recently upgrading connectivity to the Internet in order to facilitate their use of the practice management software provided through a VPN by their network. Centers that lacked high-speed connectivity tended to be rural or smaller health centers. These centers also tended to experience a higher level of disruption in service compared to others.
Health centers with greater access to resources often used wide area networks (WANs) to create a seamless computing environment across geographically separate sites. With a WAN, health center sites could also access shared applications through their regional health center network. These networks connected to their WAN using dedicated T1 line connections and had adequate server capacity to support administrative applications as well as basic computing needs such as printing and email.
Data Management Capabilities. Several of the health centers we spoke with are maintaining or contributing to master patient indexes (MPIs). Some larger centers with in-house applications expertise were able to build and maintain their own MPI, drawing data from their practice management systems and, in the most sophisticated centers, supplementing administrative data with clinical data from EHRs. Health centers used these sources for querying for UDS reporting and to produce reports used for making management decisions.
Most of the health centers we spoke to were contributing to data warehouses external to their center, housed either in their health center network or a public health stakeholder such as a County Public Health Department. In Philadelphia, for example, the network has developed a community-wide data warehouse which extracts data from the practice management systems of participating health centers. In Boston, members of Boston HealthNet contribute administrative and clinical data to the network through extracts built from their practice management and EHR systems. These warehouses then allow network staff to produce community-level and center-specific reports on cost, utilization or, in some cases, quality of care measures.
As summarized above, we found that health centers we spoke with had a usable IT infrastructure and used a variety of applications. In the remainder of this section, we describe the uses, functionalities, vendors, and health center experiences associated with selected health center computer applications including practice management, EHR and data warehouses.