Since their inception in the 1960s, health centers in the United States have provided excellent care to patients in low income and medically underserved communities. Today they have an additional mission to treat patients who have not sought care to more proactively prevent health issues and manage chronic diseases. The challenge is that not all health centers are uniformly compensated for this new work. For example, a fee-for-service payment system only pays for the patient receiving services. Nonetheless, health centers have invested hundreds of thousands of dollars to purchase Electronic Health Record systems (EHRs) to help them to improve care and quality, and reduce cost. These efforts support the Triple Aim. When implemented and used fully, EHRs can help health centers to optimize their organizations and achieve the Triple/Quadruple Aim. 

Health centers can use EHR systems to support the Triple Aim but many health centers are under-resourced, which can make it difficult to staff Health Information Technology (HIT) and quality improvement roles. When health centers are able to fill these roles, staff retention remains an issue and staff turnover creates continuity challenges.  To meet these challenges, some health centers have had to ask staff to take on additional responsibilities. Staffing challenges can make it difficult for health centers to pursue the Triple Aim.  

EHRs help organizations to measure and analyze performance of key measures and continually adapt systems to improve quality. Staying current in a changing healthcare environment requires ongoing training and sometimes re-designing or reconfiguring an EHR. A health center needs qualified staff to do this and to train others in the health center.