Table 3.

Clinic resource factors.

Clinic resource factors		Examples	Result (barrier/facilitator)
Financial	Lack of funds	1. Lack of funds for purchase of appropriate equipment	Barrier: Clinics make do with inferior HIT systems
		2. Lack of funds prevents hiring of additional staff needed to run sophisticated HIT systems	Barrier: inefficient usage of new system adopted
	Fundraising and donations	1. Clinic CEOs seek out donations of funds	Facilitator: allows clinics to offset some costs
		2. Clinic IT directors seek out donations of technology
Human resources	Lack of time for HIT training	1. Time taken from clinic activities when setting up and training staff on new HIT systems	Barrier: disruption to patient care when staff in training
		2. Slower processing of billing when establishing new HIT system	Barrier: disruption to clinic revenue with new HIT
	Timely access to HIT	1. Lack of funds for public sector clinics	Barrier: bureaucratic impediments to the adoption of new technology
		2. Time required to obtain approval for acquisition of new technology
	Billing complexity	1. Numerous and changing social programs and eligibility criteria confusing for clinic staff	Barrier: Inaccurate billing reduces cash flow and suggests fraud
		2. Development of HIT to increase billing accuracy and cash flow	Facilitator: More resources available to clinic and successful HIT facilitates staff buy-in
	Collaborations within and across clinics	1. Group negotiation of vendor contracts	Facilitators: clinics negotiate reduced rates
		2. Clinic user groups for sharing of best practices and staff training	Facilitator: clinics share resources and troubleshoot common problems
		3. Development of a website describing billing guidelines for social programs funding safety-net health-care services
	Consultants	Use of consultants to target appropriate HIT systems	Facilitator: intelligent adoption of HIT system for clinic that can afford consultants

IT: information technology; HIT: health information technology; CEO: Chief Executive Officer.