When Tina Buop transitioned from her role as the CIO of a very successful multispecialty medical group in the East Bay region in the San Francisco Bay area to becoming the deputy CIO and CTO of a community health center/federally qualified health center, she knew that she was making a huge leap professionally and personally. Fundamentally, though, she felt she had accomplished everything she could in her previous job, and that her prior organization was extremely well set, IT-wise. In short, she was looking for a challenge.

So in May 2012, Buop joined La Clinica de la Raza in Oakland, Calif., which cares for a very broad population of the underserved across three East Bay counties—Solano, Alameda, and Contra Costa—through 30 sites and 1,200 employees. The organization counts 20 full-time and 150 part-time licensed clinicians, as well as a large group of what are referred to as consultant care providers, including healthcare educators, dieticians, dental associates, and outreach educators. La Clinica cares for about 74,000 managed care lives, plus a very large number of self-pay patients; and a large population of dental care patients. In addition to medical and dental care, La Clinica also offers integrated mental health and behavioral care, HIV, and a range of other services.

Tina Buop spoke recently with HCI Editor-in-Chief Mark Hagland about her experiences over the past several months, and her learnings. Below are excerpts from that interview.

What have been the biggest challenges you’ve been facing in your job at La Clinica? Is the biggest one overall a general lack of resources?

I look at all the reports that are required of us by the federal, state, and county governments. I look at those required reports, and pay for performance, and what we need for meaningful use, across all these lines of great services. And I used to call healthcare informatics a Rubik’s cube, but it really is actually even more complex than that.

It’s so mind-boggling, yet also so fun to figure out. We had a request from a local pharmacy that we give them information on all our local patients with a particular demographic in a particular area, because that store acts as a PBM [pharmacy benefit manager]. And we have to do this how often? Once a month? With what tools? Can I least have SQL Enterprise, and can I get Crystal Reports?

Tina Buop

How big an IT staff do you have, to accomplish all this?

I have 22, including myself and all management-level people; the number is 22 and growing.

So obviously, everybody’s stretched?

Yes, and that includes the technicians who are out at sites laying cable and doing other things. And it requires a willingness never to give up: si, se puede. For example, we recently came up with an issue in one of our counties that that particular county didn’t want to pay for the care of undocumented patients anymore. And some of those patients are immigrants, but others aren’t, they just haven’t gotten their documentation together.

What have you found thus far are the keys to success in a resource-constrained environment?

Leadership. We have fantastic senior management and a board of directors, and the board members are very involved. The board members and the executive leadership team are very invested in La Clinica. And Jane Garcia, the CEO, has been leading the team for some time.

What is on your plate, and on your horizon, over the next year?

A quick story: we’re not only implementing our EHR [electronic health record] for medical care, but also are implementing an electronic record for our dental centers, bringing our dental care into a good platform at the same time. The thing at a CHC [community health center] is that we need a good interface engine; we literally have 28 interface touch points. And you absolutely need an interface engine. So in rolling out the EHR, and the dental platform, and the imaging, the challenge in a CHC is that you need to find the funding first; it’s not like in the private world. Can you imagine if you had to go out and get funding every month to publish your magazine? It’s quite a challenge. And because we manage medical, dental, and optical, there’s a huge complexity around eligibility.

So automating that is really important?

Yes. And then automating eligibility for people who move around a lot, is tough. And birthdays aren’t always accurate. They have to become a patient to be seen by us, so we have to do a very thorough job with upfront registration.

And meaningful use is big, don’t get me wrong. But for us, with all these different service lines, and with our constant need to find funding for particular IT innovations, we face constant challenges. So, it comes down to, how can I get the report-writing capability for this element of our medical care? It’s a constant struggle. But the unique thing about CHCs is that you have people who have worked here for a very long time, and that’s helpful.