The convergence of the national conversation about Health Information Technology, Electronic Health Records, and the need to improve our health care system has resulted in a level of energy around the questions about what it means to implement Electronic Health Records and how it should be done. The national conversation has taken place largely in the headlines and as sound bites in Presidential press conferences. What we know through research conducted by CHCF and through the experience of CCI's grantmaking to community clinics, is that this conversation is complex and challenging. The reality of making EHR a tool that works for CHCs and advances their mission is a long way off.

The CHCF-CCI EHR project grew out of a belief that the needs of CHCs must be taken into account in the development, deployment, and policy debate around the use of technology tools to improve health care. As we observe these national discussions, and work with grantees that are trying to implement EHRs, we have seen little evidence of an organized understanding and response to CHCs from the vendor market place. Also, CHCs have not been able to collectively articulate their unique needs in a way that vendors can respond to. Along the way, we have learned about the unique needs of community health centers, the promise and the limitations of EHRs, and the intense need to reflect on and refine an organization?s systems and processes. This will prepare them to use technology tools to improve clinic operations, improve health outcomes, and to ultimately improve community health.

It is this critical issue of Readiness that brought us to the guide that follows this introduction. As you may recall in 2003, CCI released a report to the field entitled Technology Management to Build Capacity and Create Sustainability, written by Tom Dawson and SA Kushinka of Full Circle Projects. This report and the model call for clinics to implement a continuous cycle of technology improvements. Instead of applying resources to technology in short intense bursts, or on a project-by-project basis, the model calls for clinics to build and maintain significant technology management capacity. Clinics can use that capacity in a continuous sustained effort to keep technology systems moving forward, aligned with clinic business planning and processes. Because of the success of this model, we have asked the authors at Full Circle Projects to revisit the model with an eye on the pathways to successful EHR readiness and eventual adoption.

Full Circle Projects has worked with domain experts to develop a guide containing tools, case studies, techniques and methods for successful procurement, implementation and integration of information systems into clinic operations. This outline is just the beginning of what we hope will be a growing body of knowledge compiled as a practical resource guide, with contributions from the field as you find tools and resources along the pathway to healthier communities.