i-net - IPHCA's SIMIS Network

SIMIS from the Bureau of Primary Health Care’s Perspective

Reprinted with permission from various pages on the BPHC’s web site at http://bphc.hrsa.gov.

Every community health center knows that the demand for data in the healthcare marketplace is increasing. More stakeholders are requesting access to health information for healthcare delivery and quality assurance purposes such as strategic planning, accreditation, public health reporting, and research. Thus, health centers must be able to easily access, capture, aggregate and utilize quality data to compete and survive.

In 1997, the Bureau of Primary Health Care (BPHC) convened a panel of experts in clinical practice management systems, with the goal of developing recommendations for how the BPHC can best support CHCs in their effort to stay competitive in an unstable marketplace. This work group examined various strategies for health centers to move from being cost-based to cost-competitive. The group concluded that a major barrier to cost-competitiveness is the lack of information management.

Frequently, a health center’s information is found in different locations and formats, and the costs of software, equipment and staff necessary to bring it together are prohibitive. Thus, data aggregation and manipulation is a challenge. One strategy for meeting this challenge is for health centers to integrate their management information systems. Health centers can establish information linkages to capture and disseminate the data needed to support the delivery of healthcare, effectively manage their business operations, improve the quality of patient care, and provide the necessary data to requesting organizations.

As a result of their workgroup’s findings, the Bureau developed the Shared Integrated Management Information System (SIMIS) Initiative in an effort to significantly improve the health center’s ability to collect, manage and use information, in order to improve its ability to be more cost-competitive.

The focus of the SIMIS Initiative is to strategically align health center information systems with business objectives in an effort to meet demands driven by competition in the marketplace. Health centers that are funded through this program will achieve improved coordination, greater efficiency, enhanced quality, effective information analysis, increased access, greater economies of scale, and a larger market share.

The Bureau recognizes that the integration of information systems across health centers may provide many benefits to patients, providers, and payers, including:

Improving the sophistication level of technologies in health centers.
Making possible the sharing of patient demographic data and health plan eligibility and enrollment data within a network, among payers, and across managed care organizations, thereby increasing administrative efficiency and reducing duplicate demands for such information.
Laying the groundwork for increased or continued integration in the future.

Benefits for Patients

Improving the continuity of care by allowing providers and practitioners at various locations to access clinical information concerning a patient from all points of care within an integrated services network in a timely manner.
Providing coordinated registration and scheduling of patients to increase efficiency and reduce inconvenience to patients and their families.
Enhanced development of outcomes management programs and other quality of care measurement programs may occur.

Benefits for Providers

Enhancing medical decision making and promoting lifelong learning by healthcare professionals through access to knowledge-based resources (e.g., decision-support tools, research databases, government and educational bulletin boards, and the Internet).
Improving the ability to attract and retain qualified information systems staff by providing increased management information system (MIS) growth opportunities, pay, and MIS challenges.
Improving information analysis and reporting capability.
Improving the continuity of care by allowing providers and practitioners at various locations to access clinical information concerning a patient from all points of care in a timely manner.
Facilitating communication among primary care physicians, specialists, hospitals, and other providers within a network and with organizations outside the network (e.g., inter-agency) through the use of electronic mail.
Providing coordinated registration and scheduling of patients to increase efficiency and reduce inconvenience to patients and their families.
Providing comprehensive clinical, financial, and administrative data across the continuum of care to support the management of provider networks.
Providers may achieve improved market influence in negotiating with payers. A shared information system can enhance the administration of an effective utilization management program.

Benefits for Payers

Potentially reducing or eliminating duplicate testing, with its attendant expense by making test results available to all providers and practitioners within a network.
Enabling access to capital at a network level previously incapable at the health center level thereby minimizing information system development costs (shared equipment, group pricing, access to expertise).
Improving information analysis and reporting capability.
Automating and centralizing the billing, claims processing, and payment processes thereby increasing administrative efficiency, and reducing administrative costs and making expedited payments possible.

Therefore, the BPHC established a separate SIMIS grant which gives priority to Statewide networks that plan to integrate data using a common data structure, common business rules and practices, and a common information system (including a common vendor software) to facilitate centralized data integration. Awards made through the Initiative are intended to aid those networks that have displayed a firm commitment towards the goal of a shared, integrated management information system. All networks are expected to apply with cost-competitive business proposals, sound financial plans, and a signed Memorandum of Agreement from their members.

BPHC’s Lessons Learned

Community Health Centers (CHCs) have been working together for many years, but only recently has this collaboration become essential for CHC survival. While it is difficult to recreate the cohesion that results from shared history, it is possible to learn from these successful organizations. Following are lessons learned from health centers that have successfully formed a network.

A network requires strong commitment and involvement from senior leadership (CEOs, CIOs & CFOs).

Executive commitment to information systems initiatives is critical to initiative success.
Commitment to the network needs to flow downward from senior management.
Commitment should cut across multiple dimensions of the organization - not just information systems. Human resources, billing, clinical processes and decisions may also be integrated and/or centralized.
Commitment also manifests itself in the degree of empowerment invested in key staff. It is critical that the CIO and the Information Systems (IS) staff be empowered to move forward quickly and efficiently.

A network requires center financial investment and legal commitment of its members.

Financial commitment is often just as important as a senior leadership commitment. Without this “stake” in the enterprise, it is too easy to walk away from network initiatives. By having made an investment in the future of the network, health centers are more willing to support the network in tough times and to work toward a solution rather than taking their money and going elsewhere.
A Memorandum of Agreement (MOA) detailing each member’s responsibilities and signed by each member of the network formalizes the financial and legal commitment and is required for a complete grant application.

A network may not save money in the short run.

Benefits of integration may not be quantifiable.
Potential intangible benefits include improved information, improved healthcare, ability to access capital, and improved management reporting.
Return on investment (ROI) may not be the appropriate measure for information systems success (at least in the short run). The information system must deliver on promises of functionality, schedule, and budget.

Communication is a key to success.

Meeting regularly to keep all informed and to gain consensus is critical.

Ensure that network and vendor staff have community health center experience.

Network staff must understand how CHCs operate. They will be making decisions affecting business operations and outcomes at the CHC level. Thus, they must understand this business.
It is also helpful if vendor staff have CHC experience. This will make vendors more effective in developing systems and providing training and ongoing user support. Vendor staff must understand health programs, Uniform Data System requirements, and challenges that CHCs face (competitive environment, outdated infrastructures, etc.).

Use challenges as a learning experience (don’t give up).

Failures are inevitable; however, they are an essential part of the learning experience.
Shared failures can provide cohesion to a group that was previously disjointed.

Look for small, incremental successes.

Incremental successes can come in several forms. They can be an important part of a large information systems project or they may be scheduling a specialist to provide services across the network. Seeing early success is especially important when the network is newly formed.
Publicize these successes so that staff can learn that positive results are coming from the network collaboration.
Start with small, incremental successes. These can be obvious, easy-to-make changes. Again, early accomplishments are important for newly-formed networks.

Ongoing training is important to ensure that there are similar skill levels across the network.

Training is an important component of the network, especially when a new information system is being introduced. Some centers will naturally implement IS effectively and others will not reap the potential IS-related efficiencies. Training can help remove this disparity.
It is important that trainers continue to be available for questions once training is completed.

Ensure staff buy-in to reduce the “us versus them” mentality.

Communication and public relations can help center staff recognize the long term value of the network concept.
Participation in decision making in areas of collaboration by health center staff can also give them a voice in the process.

Set and maintain realistic expectations and goals.

Forming a network is not a silver bullet. Everyone will have to compromise in order for the network to be successful.
It may take time for economies of scale to be realized. There may be some significant up-front investments that will bring benefits over extended periods of time.

Maintain centralized control over the IS architecture.

When implementing a new network-wide information system, it is important to maintain centralized control over standards and infrastructure components.
Without centralized control, when centers make IS purchases, there is a risk that they will not integrate effectively with network components.

Case Studies

The transition of moving multiple health centers into a successful network often includes the challenges of dealing with differing business methods, overcoming distance between sites, and melding together leaders who are used to functioning autonomously. Critical to your survival in a competitive marketplace, this transition requires time and patience from all members of a network. The BPHC hopes that future networks can gain insight into their own project planning by learning from these two successful models of network integration.
In the case of Health Choice Network in South Florida, it has taken over twenty years of collaboration between health centers and at least one failed information system to get where they are today. In contrast, health centers with the INConcert Care network in Iowa and Nebraska have been working together for a shorter time. They have overcome their challenge of distance to become one of the largest area-based networks in the nation. Finally, the Community Health Access Network in New Hampshire, in response to automate its clinical support function, successfully implemented an Electronic Medical Record System in all of its health centers.