Similar to previous studies that have examined the impact of health information technologies and functionalities (i.e., electronic health records, decision-support) on quality of health care,
[11, 12, 14, 29–31] we showed that HIT capacity at FQHCs is associated with improved quality of care. Our results showed that high HIT Capacity was significantly associated with increased use of reminders to patients to facilitate follow-up care for preventive services and promote continuous care, receipt of discharge summaries, and timely appointment for specialty care. However, after adjusting for the other control variables, the association between high HIT capacity and the outcome measures dissipated for receipt of discharge summaries and patient reminders. On the other hand, the association was strengthened for timely appointment for specialty care. These findings are promising and suggest that greater adoption and increased capacity of health information technology at FQHCs could help increase the likelihood that patients will realize improved quality of care. This is particularly important because patients who receive reminders from health service providers, including vulnerable patients, have higher rates of cholesterol, breast, and prostate cancer screening, as well as adherence to treatment
. In the context of this paper, our results suggest that achieving greater capacity for health information technology is likely to improve quality of services provided by health centers. Additionally, the utilization of HIT and associated computerized processes could increase patient engagement in the care delivery process and continuity of care.
While our findings suggest that HIT has potential benefits for improving quality of care, it also indicates that FQHCs may not be maximizing the potential benefits of health information technology. For example, higher HIT capacity was significantly associated with patient reminders and timely appointments with specialists who operate outside of the health center. However, the magnitude of the association with receipt of discharge summaries was lower. This may be due to lack of collaborations that take full advantage of HIT functionalities, absence of HIT at hospitals where patients are admitted, or HIT systems that cannot be integrated. Addressign each of these possibilities would provide a pathway to increasing meaningful use of HIT and quality of care. We also found significant disparities in FQHCs that serve a larger proportion of minority clients. The relationship between having 50% or more minority clients and declines in quality was observed for receipt of discharge summaries and timely appointment for specialty care. This finding may suggest that participation in the HRSA disparities coordination program improves some indicators of quality of care but not equally for all population subgroups and may not necessarily reduce racial/ethnic disparities. Effective strategies are thus required to ensure that the needs of minority patients are integrated into initiatives to improve quality of care, including the adoption and meaningful use of HIT
Lastly, organizational factors in general have varying influence on different measures of quality. Having all hospital affiliations was significantly associated with improvements in receipt of discharge summaries as well as ease of getting timely appointments for specialty care. However, nurse vacancies, greater proportion of minority clients, and geographic location outside the Northeast U.S. was associated with declines in receipts of discharge summaries
. Similarly, physician vacancies, an increasing percent of Medicaid patients, and greater proportion of minority clients was associated with declines in timely appointment for specialty care.
Based on our findings, there are several implications for planning and policy. Firstly, to ensure equity in the benefits of HIT, it is important to assess the capacity of health facilities to provide a series of technology-driven services. It is also important to assess the association of these services to the overall quality of care and care processes within health care organizations. Secondly, HIT should generate information for service providers and patients to improve the care delivery process and quality of care. But, these system should ultimately lead to improvements in patient health outcomes
. Thirdly, organizational resources are critical to the effective use of HIT and the effectiveness of coordination programs such as the HRSA disparities initiative on quality of care, especially for the underserved. Establishing hospital affiliations, addressing staff vacancies, and the underserved, i.e., Medicaid and minority patients, appear to be the most important strategy health centers can implement to improve quality of care.
Additionally, the role of organizational characteristics in increasing the benefits of HIT and quality of care has been noted
[16, 31]. A focus on cultivating relationships with local hospitals, and improving care delivery to all clients may lead to even greater improvements in quality of care. HIT capabilities should be effectively extended to foster collaborations and coordination of care, as well as inform approaches to improving organizational functioning (i.e., tracking and meeting the unique needs of disadvantaged groups). Moreover, understanding and averting the unintended consequences of HIT is essential to realizing the benefits and improving quality of care delivery and patient outcomes
[34, 35]. Developing strategies and platforms informed by HIT could help facilitate improvements in access to care (i.e., specialty care services) and quality of care
. Specifically, Directors of health centers might consider developing more formal arrangements for collaboration and strategies for technical support
Lastly, most of the previously published research reveals a positive effect of HIT on care and focused on specific functionalities
. As such, there is a need for studies that focus on a broad range of functionalities and provide comprehensive measures of adoption and use of HIT. This will inform requirements for optimal functionalities and use of HIT to improve quality of care, especially for underserved populations. There is also a need for further examination of factors that may facilitate the progressive effect of HIT. As reported by recent studies,
 a further understanding of how physicians engage with information technology systems, as well as the efficient and effective use of information generated from electronic systems at the point of care and beyond, is essential to optimizing the benefits of HIT.
The study has several limitations. First, because we did not have access to dates of HIT implementation, we could not determine the number of years that HIT had been in place or the phase of implementation. Previous research shows that phase of HIT, particularly earlier phases of implementation are associated with declines in quality of care,
 and that the benefits of new technology may take up to fifteen years to be realized
[8, 11]. Although we could not determine the length of time for which HIT had been in place, the phase of implementation, or establish temporal sequence, the HIT revolution is still in its early stages, thus, the full benefit of HIT is likely to be observed in the future
. Additionally, previous studies have suggested that functionalities of HIT and the extent to which HIT is implemented, specifically the capacity of HIT, may be more relevant than the length of time that the HIT system has been in place
[42, 43]. It may be that FQHCs, with better quality of care, had more favorable operating environments, whether financial or otherwise, and were better positioned to adopt HIT and implement advanced functionalities.
Because our study used a facility survey, we were unable to control for possibly relevant variables such as patient age, socioeconomic status or clinical indicators. Although we used the best available measures and accounted for proportion of minority and Medicaid patients served by the health facilities, these measures may not have been adequate. Additionally, the absence of case mix and other factors by level of HIT capacity could also have resulted in missed small differences between lower and higher capacity adopters of HIT. Given the promise of HIT as a mechanism for improving quality of care and health outcomes, especially for vulnerable populations, the information presented in this study is an important step to identifying areas for further empirical examination and improvement.