Health information exchanges

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Health Information Exchanges Profiling four efforts Today’s HIEs are succeeding where previous ones failed. Here’s how four of them are getting doctors to share patient data to improve care and cut costs. By Marianne Kolbasuk McGee Strategy Session Analytics.InformationWeek.com November 2010 $199 Report ID: S2201110 Presented in conjunction with

Transcript of Health information exchanges

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Health Information ExchangesProf i l ing four ef for ts

Today’s HIEs are succeeding where previous ones failed.

Here’s how four of them are getting doctors to share

patient data to improve care and cut costs.

By Marianne Kolbasuk McGee

S t r a t e g y S e s s i o n

A n a l y t i c s . I n f o r m a t i o n We e k . c o m

N o v e m b e r 2 0 1 0$ 1 9 9

Report ID: S2201110

Presented in conjunction with

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3 Author’s Bio

4 Executive Summary

5 HIEs Get Doctors Sharing Data and Boost Efficiency

6 A Network for Everyone

7 Louisiana Rural Health Information Exchange

8 State Exchanges Under Way

10 HealthBridge

10 Where to Learn More

11 Michiana Health Information Network

12 Chesapeake Regional Information System for Our Patients

12 Five Key HIE Vendors

14 The Beacon Communities

15 More Like This

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CONT

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ABOUT US | InformationWeek Analytics’ experienced analysts arm business technology

decision-makers with real-world perspective based on a combination of qualitative and quantitative

research, business and technology assessment and planning tools, and technology adoption best

practices gleaned from experience.

If you’d like to contact us, write to managing director Art Wittmann at [email protected],

executive editor Lorna Garey at [email protected] and research managing editor Heather Vallis

at [email protected]. Find all of our reports at www.analytics.informationweek.com.

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Marianne Kolbasuk McGee has been reporting and writing

about IT for more than 20 years. She joined InformationWeek in

1992 and covers a variety of issues, including IT management,

careers, skill and salary trends, and H-1B visas. McGee also

closely follows healthcare IT issues, including the federal govern-

ment’s stimulus spending program for expanding the adoption of electronic

medical records systems. McGee holds a B.A. in communication arts from

Long Island University’s C.W. Post campus. She can be reached at

[email protected].

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Marianne Kolbasuk McGee

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There are about 200 health information exchanges in the UnitedStates today, and that number is growing fast, particularly now that thefederal government is expected to make the ability to exchange patientdata electronically part of the “meaningful use” criteria that physicians andhospitals have to meet to get funds to help them deploy electronic healthrecord systems.

HIEs feed data into patients’ EHRs from doctors and hospital visits, as wellas lab and other medical tests done at outside facilities. They alert doctorswhen information is available, helping speed decision-making by provid-ing faster access to data. They also cut down redundant testing and helpensure patient safety by letting all caregivers know what medications apatient is taking and other pertinent information. Most important, HIEsensure that all doctors providing care to a patient have the most up-to-date and comprehensive information.

While there’s a lot of enthusiasm for these networks, not everyone is com-fortable. There is a steep learning curve, and physicians are having to getbeyond petty concerns about how other doctors might use patient data tosteal patients and that patients could use easier access to their data tochange doctors more frequently.

HIEs aren’t new. Many were launched over the last decade without solidbusiness models and didn’t succeed. Now, with big money behind gettinghealthcare providers to install and use EHR systems, it’s possible that HIEswill have a better chance of surviving. This report looks at four thatappear to be off to a solid start.

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Exec

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HIEs Get Doctors Sharing Data and Boost EfficiencyThe push to get doctors using electronic health records is well underway. In tandem with thateffort is one that will ensure that healthcare providers are able to share patient records—notjust doctors in the same city or region, but ones across the country. To meet that need, healthinformation exchanges are quickly being developed.

These networks give doctors fast, easy access to information about tests and lab results, andother doctors’ diagnoses. They ensure that all doctors providing care to a patient have the mostup-to-date and comprehensive information on the patient’s condition. They also speed deci-sion-making by providing faster access to information; cut down redundant testing by provid-ing results of all tests a patient has had; and ensure patient safety by letting all caregivers knowmedications a patient is taking and allergies he or she has.

Many HIEs enable the sharing of electronic health information among providers in a localcommunity. Others connect providers across a region. And, more recently, HIEs are beingdeveloped across entire states and among neighboring states. The federal government is estab-lishing standards to link local and regional HIEs into a national network (see “A Network forEveryone,” page 6, for more on the national effort).

Some HIEs focus on sharing specific kinds of data that comes from patients’ EHRs, such astheir problem and allergy lists, drug histories, hospital discharge summaries, and radiology andlab reports. Others are more comprehensive, providing a platform to share many differentkinds of patient data.

The broader goal for these HIEs is to make it easier for health information to follow patientswherever they get care, letting healthcare providers securely access data in order to make moreinformed clinical decisions.

There are about 200 HIEs in the United States, according to the eHealth Initiative, a non-profit group that advocates using IT to drive quality, safety and efficiency in healthcare.That number is growing rapidly, particularly now that the federal government is expectedto make exchanging patient data electronically part of the “meaningful use” criteria thatphysicians and hospitals must comply with to get funds under the American Recovery andReinvestment Act. Besides incentive money to get healthcare providers using EHRs, the feds also are providing $564 million in ARRA funds to help states deploy HIEs and expand

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existing ones. Earlier this year, the Department of Health and Human Services awardedstates or an organization designated by states grants ranging from $4.6 million to $38.7million (see “State Exchanges Underway,” page 8).

While there’s great enthusiasm for these networks, everyone isn’t comfortable with them. Somedoctors don’t want to give up paper-based processes for digital ones, says Dr. Mark Sandock,who recently retired from a medical practice in South Bend, Ind. As with EHRs, there’s going tobe a steep learning curve, says Sandock, who now works as a consultant.

Physicians also worry that sharing data makes it easier for colleagues to steal patients and forpatients to easily switch doctors. But those fears are fading as doctors start using HIEs. “Peopleare recognizing that it’s not as much a competitive issue. It’s a convenience issue,” says TomLiddell, executive director of the Michiana Health Information Network. With the meaningful

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On top of all the regional and local health in-formation exchanges, the federal govern-ment has a national exchange in the works.The Nationwide Health Information Network

is a set of standards, services and polices to enable se-cure sharing of health data over the Internet.

NHIN, which is being developed by the Departmentof Health and Human Services with input from thehealthcare industry and others, aims to let health infor-mation follow patients as they move among caregiversand institutions locally and around the country. The abil-ity to electronically exchange data is expected to be oneof the requirements healthcare pro vid ers have to meetto demonstrate “meaningful use” of e-health records andqualify for federal incentive money.

NHIN, originally called the National Health Informa-tion Infrastructure project, was started in 2002 with thegoal of tying together regional health information or-ganizations. Today, it’s also bringing together state- andcommunity-based HIEs—which in some cases are re-placing failed or faltering regional groups— and evenindividual providers.

The original vision of NHIN as a network of regionalnetworks made it difficult for individual doctors withlimited IT resources to be a part of the national ex-change, says Bob Steffel, CEO of Health Bridge, a non-profit organization that runs an HIE of 28 hospitals, 17local health departments, and 700 physician offices andclinics around Cincinnati. The new approach providesmore flexibility, Steffel says. “When NHIN was originallyconceived, we scratched our heads and wondered howare they going to pay for this, and why would you dothis,” he says.

Smaller practices and individuals can download opensource software, called Connect, to access NHIN and evenset up their own HIEs. Connect was originally developedto let federal agencies share health data and includes acore ser vices gateway, enterprise ser vice componentsand a universal client framework that lets users developapplications using the enterprise service components.NHIN Direct is an offshoot of Connect that includes addi-tional standards and specifications to support point-to-point interactions between organizations, such as labsand physicians offices.

A Network for Everyone

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use criteria now expected to include HIE use, “it will be more difficult for a provider not toparticipate in a data exchange,” he says.

HIEs aren’t new. Over the last decade, regional health information organizations, known asRHIOs, were launched with data sharing as a core part of their mission. Public and privategrants funded many of these earlier efforts, and they looked quite promising initially, but fell apart when money ran out and healthcare providers didn’t want to fund these effortsthemselves.

One of the most notable ones that didn’t make it was the Santa Barbara County Health DataExchange. Launched in 1999, it aimed to get physicians in Santa Barbara County, Calif., usingEHRs and sharing data. That ambitious project shut down in late 2006 when the initial $10million grant money ran out, and healthcare providers in the region failed to see the value inpaying to keep it going.

Santa Barbara and some other disappointing HIE efforts were launched years prior to the feder-al government current effort. Now, with big money being used to encourage healthcareproviders to install and use EHR systems, e-prescribing, computerized physician order entry,and other health IT systems, it’s possible health information exchanges will have a much betterchance of surviving. What follows is a look at four HIEs in different parts of the country, eachwith different goals but all of them very promising efforts.

Louisiana Rural Health Information ExchangeThe Louisiana Rural Health Information Exchange, or LaRHIX, was launched three years ago toserve 1.3 million patients in north central Louisiana, a poor rural area underserved by primarycare doctors. It was formed by the Rural Hospital Coalition, a statewide non-profit organizationthat gets funding from the state to work with Louisiana’s rural hospitals.

Because of the shortage of doctors in rural Louisiana, patients often must wait three months ormore for appointments with specialists like cardiologists and pulmonologists. They frequentlymust travel great distances to get to those specialists, a significant hardship for low-incomepatients who don’t always have cars and can’t afford other means of transportation to get to themedical center for in-person visits, says Jamie Welch, LaRHIX CIO. Many patients end up notseeing specialists, and that often results in “a domino effect” of serious—sometimes deadly—medical complications, Welsh says.

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California Health and Human Services Agency Received $38.8 million to create a statewide HIE as part of more than $101 million in American Recov-ery and Reinvestment Act funding awarded to California for health IT efforts and healthcare job cre-ation programs. The ARRA funding also included more than $31 million for two Regional ExtensionCenters in California.

Texas Health and Human Services CommissionReceived $28.8 million, part of which will go to support the development of a Medicaid-based HIE system.

New York eHealth CollaborativeReceived $22.4 million. NYeC is a public-private partnership that serves to build consensus on statehealth IT policy priorities, and to collaborate on state and regional health IT implementation efforts.

Florida Health Information NetworkReceived $21 million to provide health data exchange services to healthcare providers. It aims to pro-vide timely information at the point of care and improve the coordination of patient care amonghealthcare providers.

Illinois Department of Health Care and Family ServicesReceived $18.8 million to fund the creation of the Illinois Office of Health Information Technology,which will develop and implement the state’s health information technology initiatives, including astatewide HIE.

Pennsylvania Health Information ExchangeReceived $17.1 million to create a secure statewide network for sharing e-health information amonghealthcare providers and patients.

Michigan Health Information NetworkReceived $15 million to improve healthcare quality, cost, efficiency and patient safety through elec-tronic exchange of health information.

Ohio Health Information Partnership Received $14.8 million to develop an HIE as part of $43 million Ohio was awarded in ARRA funding todevelop healthcare IT, including job training and two Regional Extension Centers.

Missouri Office of Health Information TechnologyReceived $13.8 million to support the development of a secure, statewide HIE. MO-HITECH is part ofthe state’s department of social services.

Georgia Department of Community HealthReceived $13 million to develop and implement a statewide HIE to facilitate access and use of clinicaldata to provide safe, timely, efficient and effective patient-centered care.

State Exchanges Under WayThe federal government recently awarded grants to states to develop health information exchanges.Here are the 10 largest awards:

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IBM’s Websphere and Carefx’s Fusion provide the infrastructure for LaRHIX’s Web portal,which gives healthcare professionals real-time access to medical records from any providerdatabase connected to the network. Doctors associated with the 24 participating hospitalsare able to share patient information with each other and with the Louisiana State Univer-sity Medical Center in Shreveport. The exchange allows specialists at the medical center to review patients records and tests without requiring patients to make the long trip to the city.

Authentication and single sign-on capabilities, policy-based authorization, identity federationand auditing access are being provided by CA’s Identity and Access Management products.Telemedicine technology, including Webcams, let specialists examine patient remotely. The ulti-mate goal is for LaRHIX to serve the entire state, although a specific timeline hasn’t been estab-lished for that, Welch says.

Hospitals participating in the exchange can use the EHR system they want, so they aren’tforced into adopting a system that doesn’t work for their needs, Welch says. A federated datamodel stores patient information at the source, but doctors have secure access to patient’s datafrom any participating hospital.

Another service of the exchange is mobile digital mammography, where radiology equipmentand technicians are sent to the rural hospitals to conduct exams. Images can be sent to spe-cialists at the Shreveport medical center for analysis. Before leaving the screening, a remoteradiologist reads a patient’s images, and informs the patient if any suspicious lesions werespotted that need to be further examined or tested. “If you let a woman leave the screeningwithout a diagnosis, you may never see her again for treatment,” says Welch. LaRHIX recent-ly received a $250,000 federal grant to expand to its mobile mammography to seven addi-tional hospitals.

The state of Louisiana has provided LaRHIX’s $40 million in funding so far. It wasn’t difficultto convince state legislators that there was a need for this type of service, Welch says. “Thehard sell was the money,” she says.

Many of the rural hospitals participating in LaRHIX have been able to deploy EHR systems withLaRHIX funds and are already HIMSS stage 6 or 7, the highest stages of EHR adoption, Welchsays. Now with the federal government’s $20 billion-plus EHR incentive program underway,

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more Louisiana hospitals will likely begin rolling outthese systems, and that will make it easier to expandthe network statewide in the future, she says.

LaRHIX “has done so much with so little money, inonly a couple of years,” says Jennifer CovichBordenick, chair of eHealth Initiative. There’s evi-dence that it’s already helping lower the incidents ofbreast cancer among underinsured patients, she says.

HealthBridge There are two models for health data exchanges.Regional ones like LaRHIX provide a broad healthinformation exchange that often involves state and localgovernments, while smaller exchanges often serve a more defined community.

The large efforts typically rely on government funding to keep going and that money, like theARRA funds, is often in the form of grants. Once the money is spent, the question is whetherlocal and state governments have the money to keep the exchanges going. If they don’t continueto fund these efforts, who will?

HealthBridge, a non-profit organization covering a 50-mile area near Cincinnati, is one of thosesmaller efforts. The 13-year-old HIE is one of the oldest in the country, and it’s profitable. Itwasn’t created with a one-time grant and, until recently, hasn’t relied on government money.Instead, HealthBridge took out loans that it’s still repaying. “It’s run like a business,” says CEOBob Steffel, and that’s the secret to its success.

HealthBridge is leading the Greater Cincinnati Beacon Collaborative, which has received a$13.8 million federal Beacon Community grant that will fund its initiative to improve care forasthmatic children and diabetic adults.

HealthBridge uses Axolotl’s HIE technology to connect more than 28 hospitals, 17 local healthdepartments, 700 physician offices and clinics, as well as nursing homes, independent labs, radiol-ogy centers and others healthcare providers in the region, Steffel says. Although it covers a smallgeographic area, the exchange operates one largest community-based secure clinical messaging sys-

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Where to Learn More

> Interactive online map of state HIEsacross the countryinformationweek.com/hc/02/map

> National Information Health Network(NHIN) specification, forums, and otherresources informationweek.com/hc/02/nhin

> Community Portal for Connect, theopen source software to develop an HIEor link to one that supports NHIN informationweek.com/hc/02/connect

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tems in the country, delivering about three million clinical messages to more than 5,500 physiciansa month, Steffel says. Doctors get free subscription to the service that provides them with lab andradiology reports, as well as hospital admission and transfer records, and electronic notificationswhen patients visit emergency rooms and are admitted or discharged from hospitals. They can signup for other services, such as e-prescription services for less than $100 a month.

HealthBridge works with 30 EHR vendors, and patient information is sent directly to whichev-er EHR system that a participating doctor uses. Physicians who don’t use EHRs, can receive thepatient information via fax, e-mail and even snail mail. HealthBridge delivers information toevery doctor in its region, and 96% of what it delivers is done electronically, Steffel says.

Hospitals, labs and other large data providers pay for the services because the exchange savesthem time and money. “If you faxed 20,000 reports per month, the question is whether thedoctor got it. With our services, you can answer that question,” Steffel says. HealthBridge rein-vests the money it makes in expanding its services, including upgrading its infrastructure andhelping other communities launch HIEs.

The idea behind HealthBridge is that “healthcare is local,” Steffel says. While patients move,travel and sometimes seek specialty care outside the HealthBridge region, “the bulk of health-care is within a small radius,” he says.

Michiana Health Information NetworkThe Michiana Health Information Network, or MHIN, covers parts of Michigan and neighbor-ing South Bend, Ind. Like many of the HIEs that so far appear to be most successful, 10-year-old MHIN doesn’t use public money and is run like a business, says executive director TomLiddell. Labs, healthcare organizations and doctors that participate in MHIN pay fees for theservice, he says.

Data is stored and distributed from a central repository. Doctors pay $49 to $59 a month tohave their EHR systems automatically populated. It’s important for data users, like doctors, topay even a small fee, Liddell says. Otherwise, they can easily fall into the mindset that since it’sfree, “its worth is somehow devalued,” he says.

MHIN uses a Web-based real-time messaging product from Axoloti to send information topractices that don’t have EHRs. Currently, the exchange has about 100 data sources, including

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hospital admission and discharge data, and radiology and lab results. MHIN plans to add out-patient surgical and endoscopy centers.

The system is used by approximately 3,500 providers, including 1,000 physicians. About 140of those doctors already use EHRs and are able to contribute patient data to the exchange. Thegoal for the next two years is to have 300 to 400 doctors contributing to the exchange.

When South Bend, Ind., physician Sandock’s practice signed up for MHIN’s services several yearsago, five doctors in the internal medicine part of the group saved a $1 million in transcriptioncosts in the first year alone. They no longer had to dictate reports on lab and other medical test forthe hundreds of patients who were tested at outside facilities each week and whose test resultswere previously sent back on paper. Instead, the MHIN network sends the doctor an e-mail alertwhen a patient’s lab results are available, and it automatically feeds the results into the patient’sEHR. “Quality of care is improved, and you’re saving money at the same time,” Sandock says.

Chesapeake Regional Information System for Our Patients Maryland’s Chesapeake Regional Information System for our Patients, or CRISP was started in 2006.

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There are dozens of vendors offering health infor-mation exchange products, but only five are con-sidered in more than 10% of buying decisions,according research firm KLAS. Those five are:

1) Medicity. This company was considered in 23% ofHIE buying decisions. Its products include NovoGrid, adeployable, intelligent network with vendor-neutraltechnology connecting hospital systems to any EHR, hos-pital or ancillary system. Medicity also offers iNexx, anopen, modular platform for plug-and-play healthcare ITapp design and delivery.2) Axolotl. It’s considered in 22% of buying decisions.

The company’s products are based on open standards,with cloud-based infrastructure and software-as-a-ser viceapplications. Axolotl’s Elysium Express products providehospital-to-physician and physician-to-physician connec-tivity. Lab results, transcribed reports, referrals and other

clinical information are sent to physician in real-time. 3) RelayHealth. McKesson’s connectivity business is

considered in 16% of HIE buying decisions. Its SaaS prod-ucts interoperate with more than 20 EMR and practicemanagement systems.4) Informatics Corporation of America. ICA, is con-

sidered in 11% of HIE buying decisions. Its CareAlignproducts provide standards-based interoperability andinclude clinical portal, secure messaging, order and re-sult automation, population management and report-ing, and patient matching capabilities.5) Epic. This vendor is evaluated in 11% of HIE buying

decisions, but its data exchange products are consideredmainly for Epic-to-Epic links. However, its HIE offerings inter-face with non-Epic systems. Epic’s products include CareEverywhere, an interoperability framework that allows thedata exchange between Epic and non-Epic EMR systems.

Five Key HIE Vendors

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Its first phase will launch this month, letting healthcare practitioners and other providers inMontgomery County, Md., exchange patient data, including demographic information, lab and radi-ology results, hospital discharge summaries, and other reports.

Using a $10 million state grant and a $9.3 million federal grant, CRISP is expanding statewide, brin-ing in hospitals and other community healthcare providers that have already set up their own HIEs.It also will set up direct links to its exchange for healthcare providers that haven’t already joined anHIE. In the meantime, CRISP has been chosen as Maryland’s Regional Extension Center to help areahealthcare providers deploy EHR systems.

The nonprofit is using Axolotl’s HIE technology to create the infrastructure for the secureexchange of data under a model where content from hospitals, such as discharge reports, is storedin edge devices either hosted by the hospitals or third parties, says Scott Afzal, CRISP’s programdirector. This content will be automatically pushed to a patient’s primary care doctor. Otherauthorized clinicians, like emergency room doctors, would be able to query the exchange as towhether any data is available about a patient arriving in the ER.

Hospitals and doctors won’t be charged to use the data initially. Once there’s enough data in theHIE for the value to be clear, they’ll have to pay a still-undetermined subscription fee that won’t bebased on transaction volume so as not to provide a disincentive to using the exchange, Afzal says.

Coming up with a sustainable model is a significant challenge, Afzal says. “We want to be surethere’s enough data available to make it valuable to participants” before phasing in subscriptionfees, he says.

CRISP will work with EHR vendors and service providers, such as eClinicalWorks andAthenaHealth, to ensure that continuity-of-care data can be exchanged on the Maryland HIE,Afzal says. Such documents contain a patient’s clinical, demographic and administrative data.

CRISP’s overall mission is to make it so healthcare providers don’t compete based on the avail-ability of information, Afzal says, but instead on the effective use of health IT to improve careand make practitioners more efficient. Reducing readmissions to hospitals and promoting fol-low-up care are among the goals, and doctors should expect that reimbursement models willshift to encourage these sorts of improvements, he says. When that happens, health informa-tion exchanges, like EHRs, will take off because everyone will benefit.

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In addition to providing funds for the deployment ofe-health record systems, the American Recovery andReinvestment Act includes $235 million awarded to17 organizations that are serving as Beacon Communi-

ties. These are programs and projects that serve as rolemodels and pilot programs in their use of health IT and dataexchange for improving quality of care for chronically ill pa-tients. Many Beacon Community efforts rely on the estab-lishment of a solid health information exchange to work.

The Beacon Community grants—averaging about $15million each—were awarded by the U.S. Department ofHealth and Human Services to 15 communities in May, andtwo more in September. The funding is to help these ef-forts build out their health IT infrastructure and data ex-change capabilities.

Among the two latest Beacon Communities selectedby HHS is Greater Cincinnati HealthBridge, an HIE pro-filed in the main section of this report. HealthBridge wasawarded $13.8 million to advance its health informationexchange program by developing new quality improve-ment and care coordination initiatives focusing on pedi-atric asthma patients, adult diabetics and smokers.

The other Beacon Community recently named wasSouth-Eastern Michigan Health Association, which wasawarded $16.2 million. SEMHA and its partners in thegreater Detroit area will use health IT tools and strate-gies to prevent and better manage diabetes.

Here’s the list of 15 Beacon Communities chosen byHHS in May:

� Community Services Council of Tulsa, Okla., receiveda $12 million grant for a community-wide health infor-mation system for doctors to monitor and improve careof diabetic and obese patients. Tulsa has one of the high-est rates of cardiovascular disease deaths in the nation.

� Delta Health Alliance of Stoneville, Miss., wasawarded a $14.6 million grant for diabetes management.

� Eastern Maine Healthcare System in Brewer, Me., got$12.7 million for telemedicine projects to help elderlypatients in long-term care facilities and at home.

� Geisinger Clinic in Danville, Pa., was awarded $16

million to enhance care of pulmonary and congestiveheart patients.

� HealthInsight in Salt Lake City, Utah, received $15.7million for diabetes management projects.

� Indiana Health Information Exchange was awarded$16 million to expand into additional communities.

� Inland Northwest Health Services in Spokane, Wash.,got $15.7 million for diabetes preventative services.

� Louisiana Public Health Institute in New Orleans,was awarded $13.5 million to improve diabetes controland smoking cessation rates.

� Mayo Clinic in Rochester, Minn., received $12.3 mil-lion grant for projects aimed at reducing hospitalizationcosts and emergency room visits by diabetics and asth-matics, and improving health disparities in rural and un-derserved communities.

� Rhode Island Quality Institute in Providence, R.I., wasawarded a $15.9 million grant for improving manage-ment of diabetic patients and immunizations rates.

� Rocky Mountain Health Maintenance Organizationin Grand Junction, Colo., got $18.9 million for projectsthat include improving blood pressure control in dia-betic and hypertension patients and reducing unneces-sary emergency room visits.

� Southern Piedmont Community Care Plan in Con-cord, N.C., was granted $15.9 million for coordination ofcare projects for chronically ill patients.

� The Regents University of California in San Diego,was awarded $15.3 million for projects including ex-panding pre-hospital emergency field care using elec-tronic data transmission and improving continuity ofcare for military personnel and veterans.

� University of Hawaii at Hilo received $16 million toimplement a regional health information exchange to im-prove care of patients with chronic diseases and in areaswhere there are shortages of healthcare professionals.

� Western New York Clinical Information Exchange inBuffalo, N.Y., was awarded $16 million for project involv-ing clinical decision support tools and telemedicine fordiabetic and heart patients.

The Beacon Communities

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Strategy: Electronic Health Records—Time to Get Onboard Four healthcare organiza-tions are taking different approaches to implementing EHR systems, but their goals arethe same: to help the practices they work with make the transition.

Strategy: EMR-Ready Servers In this report, we advise midsize practices on how to getup and running with a fully EMR-capable infrastructure, from scoping hardware andselecting software to deciding the in-house vs. outsourced question.

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