The ONC's Beacon Community Cooperative Agreement Program has provided $250 million in grant funding to 17 communities across the country to develop focused projects that demonstrate the value of health IT in improving health and patient care while reducing costs.
The Greater Cincinnati Beacon Community received a grant of $13.7 million to fund programs designed to improve the health and care of pediatric asthma and adult diabetes patients, help members of the population stop smoking and provide high-quality decision support tools to healthcare providers in the area.
The centerpiece of the program was the creation of a health information exchange infrastructure to help improve care in the region and notify primary care physicians when their patient visited a local emergency department or was admitted to a hospital. The project included 87 primary care practices, 18 hospitals and seven federally qualified health centers.
The 31-month effort to create a viable health information exchange platform revealed the following four lessons, according to a study in Health Affairs.
1. Providers' data security concerns can hinder health information exchange. To have the HIE work as intended, it was important participating providers allowed their patient data to be transmitted to the central platform and then be shared with others in the community. However, during the development process many hospitals raised concerns about data security, making it more difficult for the Beacon leaders to get the exchange up and running. It took the Beacon leaders 10 months to secure the necessary agreements from participating hospitals, much longer than expected.
2. HIE use requires providers to have additional resources. The HIE and its alert system that let physicians know when their diabetes or asthma patient visited a hospital or ED proved useful, but required the participating practices to have enough staff members to go through the alerts and follow up with patients. The practices also needed resources and training from the Beacon community on how to maximize the effectiveness of the HIE.
3. Electronic health record systems' limitations can hinder HIE use. The Beacon community found that even EHRs that had met meaningful use criteria were not always able to send and receive patient data in a structured, useful way. The Beacon leaders had envisioned the creation of a summary patient record that would follow a patient between care settings, a vision that had to be abandoned in light of the limited capabilities of EHRs currently on the market. Many of the EHRs also had difficulty extracting information on a population health level — physician practices had to manually go through records to manually report outcomes every month.
4. Other projects often take priority for HIE participants. Providers participating in the HIE development often had other responsibilities and initiatives of their own, including installing or upgrading an EHR system and working to meet the demands of a changing healthcare industry. This means providers didn't always have the time or resources needed to dedicate to the project, causing delays in the HIE project.
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