Evaluation Findings: Interim Report

Last month Full Circle Projects completed an interim evaluation report based on the extensive interviews and site visits that were conducted from February through May of this year. We’re sure that you may be wondering about our findings, so I would like to share some of what we observed, some preliminary conclusions to be drawn, and some of the issues we’d like to explore in the remaining 6 months of the evaluation process.

Strategic vs. Tactical
First of all, there was a lot to learn! While the primary focus of the evaluation was to examine the effect of collaborative or network EHR adoption across a number of domains (such as cost of deployment, speed of deployment, improved reporting, etc.), there were a multitude of implementation details we absorbed that had little to do with network versus direct to vendor models. We eventually came to sort the information we collected into two categories: strategic, i.e., dealing with the model of deployment (direct to vendor, regional extension, consortia based, national network), and tactical, i.e., dealing with specific techniques for accomplishing all the activities of implementation (chart abstraction and data conversion, for example). While the distinction between strategic and tactical is never as neat and precise as an evaluator would like, it did help us to organize the information and decide on various ways to disseminate the lessons we learned to the field. One very effective method was having many of you participate in the Pathways to Successful EHR Adoption conferences in July; feedback from that event has been overwhelmingly positive. Another communication device underway is an Issue Brief dealing with chart abstraction approaches and tactics, and how they impact providers’ productivity and acceptance of the system. Our findings suggest this tactic is singular in its importance and profound in its impact.

EHR: A vehicle to get from here to there and back again
Another useful framework that helped us analyze the strategic, or deployment model, issue was to use a transportation analogy. We suggest that health centers consider evaluating a network option versus a direct vendor relationship in the same way they might think about driving your own car versus taking public transportation. Buying a car and “going it alone” has a definite appeal: you can choose the make, model and color of the car, as well as the destination and the pace of travel. It can be the more expensive choice, however, fraught with hidden costs. It could mean having a mechanic on staff 24/7. There is parking and traffic to consider, as well as the price of gas, insurance and driver’s licenses. Public transportation comes in many forms and is less expensive but may take longer to get where you’re going. It’s possible to read a newspaper or multi-task in other ways while leaving the driving maintenance to someone else. However, not all forms of public transportation (bus, high speed rail, train, airplanes) are accessible in all areas. And perhaps just a car pooling arrangement would suit your needs. This analogy was useful to the evaluators in framing the tradeoffs in the network versus “go it alone” strategic discussion. In our report to the funders, we identified four major service categories – Implementation Services, IT and Hosting Services, System Procurement and Support Services, and Data Quality/QI Services – and listed the benefits and tradeoffs of networks in these areas. We hope to release this paper as an Issue Brief later this fall.

Moving Forward: Economies of Scale and Optimization
As we visited you earlier this year, most (but not all) organizations were preparing to implement or had just completed a pilot. For this reason, mst of the anticipated benefits of scale and experience had not had sufficient time to manifest due to the maturity level of the network. In the second phase of data collection, we would like to focus on issues of scale and sustainability. The data collection may be more quantitative than last round, and we are also interested in exploring your staffing and support requirements as you move forward, yet continue to support those clinics that are in various stages post go-live. The September evaluation question will deal with this topic and will be posted after Labor Day. Enjoy the last remaining days of summer and thank you all for your openness and time spent with us so far. We welcome your comments and input on our interim findings.
- The Full Circle Projects Evaluation Team