A network requires strong commitment and involvement from senior leadership: Chief Executive Officers (CEOs), Chief Information Officers (CIOs), and Chief Financial Officers (CFOs).

• Executive commitment to information systems initiatives is critical to initiative success.
• Commitment to the network needs to flow downward from senior management.
• CEOs need to agree in principle on how the business will function before cooperation around the Management Information Systems (MIS) function will have an impact.
• Commitment should cut across multiple dimensions of the organization, not just information systems. As shown in the Collaboration/Integration Matrix, 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.
• CIOs must participate in network strategic planning.

Financial commitment is as important as 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.

• Legal commitment by each network member is also important.
• The existence of legal implications for leaving the network or otherwise breaching the network agreement may act as a motivator for working through difficult times.
• A Memorandum of Agreement detailing each member's responsibilities and signed by each member of the network formalizes the financial and legal commitment.

Legal counsel can be of invaluable assistance in:

• MOA drafting
• Software/hardware licensing contracts
• Formation of joint ventures and fully integrated delivery systems
• Advice on tax-related issues and other healthcare regulations
• Forming entities such as limited liability corporations to align with business objectives

• 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.
• There may be many hidden costs in forming a network and implementing a shared information systems project. One center paid $12,000 in data conversion costs alone.
• Ensure that staff are fully educated on network and information system requirements and that they explore all potential costs thoroughly.

• Regular meetings are critical, both to keep all participants informed and to gain consensus.
• This includes CEOs, the Information Systems Steering Committee (ISSC) (Word/PDF/Wordperfect), and committees to support integration in other areas.
• Between meetings, have a quick, easy way to communicate. Explore alternatives to face-to-face communication such as: email, video teleconferencing, extranets, etc.

• Network staff must understand how health centers operate. They will be making decisions affecting business operations and outcomes at the health center level. Thus, they must understand this business.
• It is also helpful if vendor staff have health center 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 health centers face (competitive environment, outdated infrastructures, etc.)

• Failures are inevitable.
• Shared failures can provide cohesion to a group that was previously disjointed.
• Look for small, incremental successes.
• Don't give up!

Incremental successes come in many forms – from a milestone reached in a major project to scheduling a specialist to provide services across the network.

• Early success is especially important for newly-formed networks. Publicize these successes so that staff can learn that positive results are coming from the network collaboration.
• Recognize opportunities to achieve small, incremental successes, such as obvious, easy-to-make changes that will get the network off to a good start.

Training is an important component of the network, especially when a new information system is being introduced. Some centers will naturally implement information systems effectively and others will not reap the potential information systems-related efficiencies. Training can help remove this disparity.

• Peer-to-peer training can be cost effective and is available free through HRSA.
• Professionally developed and delivered training is worth the investment.
• Additionally, it is important that trainers continue to be available for questions once training is completed.

• 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.
• Understand that 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 some significant up-front investments that will bring benefits over extended periods of time.

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 information system purchases, there is a risk that they will not integrate effectively with network components.

CHCs with limited technical or management knowledge are blaming implementation problems on vendors. Issues that should be solved locally are being pushed to the vendor to solve.

• Ensure that network staff and vendors clarify who will provide which type of support.