226072 Health IT Implementation in the Safety Net, Lessons Learned from Early Adopters

Monday, November 8, 2010

Adil Moiduddin, MPA , Health, NORC, Bethesda, MD
Daniel Gaylin, MPA , National Opinion Research Center, Bethesda, MD
Caroline Taplin , Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC
Mike Millman, PhD , Health Resources and Services Administration, Department of Health and Human Services, Rockville, MD
Prashila Dullabh, MD , Health, National Opinion Reserach Center, Bethesda, MD
Background: In 2002 and 2007, the Department of Health and Human Services, Assistant Secretary for Planning and Evaluation (ASPE) initiated projects to assess health IT use among federally qualified health centers and health center networks. These efforts recently culminated, producing findings on the challenges and opportunities providers looking towards adoption and meaningful use of EHRs.

Objectives: This presentation will inform decision making related to EHR adoption and use at the provider and program level. We will focus on providing practical guidance to providers seeking to implement EHRs and those charged with providing assistance to them.

Methods: With guidance from ASPE, NORC conducted site visits to over 60 health centers and 15 networks. These site visits included in-depth discussions with over 300 health center and network leaders including Medical Directors, IT Directors, Chief Information Officers, Executive Directors and Quality Improvement (QI) Directors.

Findings: Networks have played an important role in supporting health IT adoption by assisting with vendor selection, hosting, training, implementation and QI. However, providers face significant challenges at every stage of adoption. Even with active support of networks and use of “add on” applications such as data warehouses, using EHRs to promote QI required significant effort to counter problems with data integrity and alert fatigue.

Discussants identified a need for additional training and declines in productivity following implementation. The majority of implementation costs were associated with professional time rather than software and hardware. Benefits, at least at early stages, were difficult to quantify, and we found limited evidence of safety net participation in regional health information exchange.

Discussions/Conclusions: Our findings highlight the need for intensive, in-person assistance for safety net providers throughout the EHR adoption process and the potential need to “reset” expectations regarding the time and effort required to translate EHR adoption to improvements in quality and efficiency.

Learning Areas:
Administer health education strategies, interventions and programs
Administration, management, leadership
Chronic disease management and prevention
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Explain challenges encountered by safety net providers seeking to adopt electronic health records Articulate experience on costs and returns from EHR use by safety net providers Identify priorities for technical assistance providers charged with assisting safety net providers acheive meaningful use of EHRs

Keywords: Health Information Systems, Safety Net Providers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I contributed to this study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.