" Full Circle not only helped us to develop a strategic technology plan that was truly tailored to our organization, but they provided tools and guidance to leverage our own skills and capabilities. They lived up to their name."

Debra A. Farmer

Westside Family Health Center

Case study 1:
Design and implementation of grant-making programs
The Colorado Health Foundation has deep roots in
health care and wellness. They wanted to add a grant-
making program to help safety-net clinics plan and implement electronic health records (EHRs) and Health Information Exchange (HIE).
The Challenge:
•  Design a program flexible
enough to support large, high-
performing clinics, as well as small clinics with few resources.

•  Consult with individual clinics about the most strategic way to plan and implement health information technology (HIT).
•  Help clinics implement HIT and use it to build capacity, improve clinical measures and move
towards evidence-based medicine.
Our Approach:
In Phase I of this multi-year
Healthy Connections HIT
Initiative we:

•  Designed a program able to
meet each clinic where they
were and to provide the appro-
priate support.

•  Advised individual clinics on implementing HIT without
making an investment that
might put the organization
at risk.

•  Selected, trained and man-
aged local technical assistance providers to support the grant-
ees in their assessment process.

•  Assessed the ongoing work of
the clinics and used information from their experiences to fine-
tune the grant-making program.
The Results:
The program is ongoing and has
led to the creation of clinic
cohorts that are well-prepared
for further innovative work.

•  Steered over 40 clinics
through several steps towards advancing their use of HIT. Over 70% of the clinics have been
through a structured assessment
of their HIT needs, and over
70% have adopted EHRs.

•  Expanded the Foundation’s
ability to achieve its mission to “increase access to quality
health care” for the people of Colorado.

•  Laid the groundwork for
further assistance for safety-net clinics not supported by the
American Recovery and Rein-vestment Act (ARRA).
Case study 2:
Procurement and implementation of health information technology (HIT)
While safety-net clinics have some common needs and constraints, each clinic presents its own challenges.
The Challenge:
•  Steer the clinic through an assessment that finds the gaps in readiness for HIT implementation.
•  Help the clinic staff understand their internal strengths and chal-lenges and define their require-ments for an IT system going forward.
•  Work with clinic leadership to define the steps and the tactical structure that will increase the likelihood of successful implemen-tation and ongoing operations.
Our Approach:
Our rich experience with HIT readiness and deployment
allows us to perceive each
clinic's stage of readiness for

•  Prioritized organizational
issues such as how different
staff will use the system, the allocation of scarce resources,
what pre-implementation plan-
ning is required and how the
system will operate over the
long haul.

•  Provided a structure for
thinking about the multiple uses
to which HIT will be put:
improving clinical outcomes as
well as practice management (finances and operations).

•  Helped clinic leaders target measurable outcomes for each
part: the communications plan,
the provider training, and other critical success factors.
The Results:
Clinics built capacity and put in place a robust plan for continu-
ing to move forward.

•  Provided a roadmap for nego-tiating implementation issues
such as: workflow analysis,
planning for capturing data for clinical documentation, chart abstraction and training.

•  Built organizational capacity
for expanding the use of HIT into other clinic functions and using
HIT to measure clinical out-
comes and provide integrated

•  Used our extensive knowledge
of best practices to design a solution appropriate to the
specific organization and the resources available.
Case study 3:
Program evaluation
The goal of the California Networks for EHR Adoption (CNEA) initiative
is to speed the adoption and lower the costs of EHRs in California
community clinics and health centers. Full Circle Projects worked with
CNEA funders and grantees on a comprehensive evaluation of the program.
The Challenge:
•  Evaluate a program that sup-ported four different models of
EHR deployment: national net-works, clinic consortia, multi-site expansions and hospital-based extensions.

•  Assess process and outcomes
to identify the trade-offs between standardization and flexibility at three levels: network, clinic, and individual (provider and staff).

•  Address the non-technical
barriers to a collaborative technol-ogy project: issues of governance, leadership, collaboration and business planning.
Our Approach:
Because EHR implementation affects nearly every staff
member in a clinic or network,
Full Circle Projects developed an evaluation process that elicited feedback from everyone
involved in the program, from funders to providers to clinic
front-office staff.

•  Conducted extensive inter-
views and site visits and posted monthly topics of focus on the
CNEA grantees’ participatory

•  Brought together information from in-depth interviews with all eight grantees, industry
research, and our extensive
field experience.

•  Gathered a wealth of tactical information about EHR readi-
ness and implementation into a series of issue briefs published
by the California HealthCare Foundation.
The Results:
We found that issues of trust, governance, leadership, and provider buy-in are critical suc-
cess factors regardless of the
EHR deployment model

•  Advised several grantees
about how best to position their organizations to take advantage
of regional extension funding.

•  Identified for the funders additional ways to support the grantees through expert
assistance, conferences and advocacy.

•  Developed tactical issue
briefs that highlighted best and promising practices in HIT imple-
mentation, maintenance and optimization.
The Results:
Case study 4:
Building a service model and planning for sustainability
California Health Information Partnership and Services Organization (CalHIPSO) is one of the largest of the federally-designated Regional Extension Centers supported by ARRA and HITECH stimulus funds.
Full Circle Projects was selected by the founding partners to assist the Executive Director in achieving a rapid start up to meet federal goals.
The Challenge:
•  Support the Executive Director
in all aspects of start up, including the development of an operational plan with risks and risk mitigation strategies for year one.

•  Contribute to the grant applica-tion by which CalHIPSO was

•  Define a service delivery model for the Regional Extension Center, including a model for providing
core services.
Our Approach:
Advised CalHIPSO on how best
to help clinical providers achieve meaningful use of electronic
health records.

•  Determined the qualifications
and standards for organizations wishing to become Local Exten-
sion Centers (LECs).

•  Defined the application/ap-
proval process and structured
the LEC business model.

•  Used our expertise with HIT implementation at all levels to
help define the scope of services that CalHIPSO and its LECs
should provide.
The Results:
Helped the largest REC in the
nation (in terms of providers served, budget and geography) establish a sustainable business model.

•  Built into the LEC structure a balance between using federal subsidies and preparing to be
self-sustaining when the federal subsidies are gone.

•  Developed curriculum and
content for the CalHIPSO educa-
tion and training center.

•  Coordinated a team of experts charged with developing a
longer-term sustainability plan
for CalHIPSO.

"Full Circle Projects helped
our members to see the value of collaboration on technology projects and built the structures to sustain that collaboration for many years."

Brian Nolan, MPH

Vice President: Member Community Clinic Association Los Angeles County