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Beacon communities discuss grants, collaboration with HIEs and RECs

Jean DerGurahian

Providers trying to figure out what they should have in place to comply with federal health information technology requirements can turn to a large number of programs. With the awarding of the Beacon communities

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grants, the U.S. Department of Health & Human Services (HHS) now has a trio of programs it hopes will expedite and streamline doctors' adoption of health IT.

The three programs involve the development of state health information exchanges (HIE), regional extension centers (REC) to help doctors purchase electronic health record (EHR) systems and now, the Beacon communities.

While states are building their HIE infrastructure, the RECs will work with doctors to explain the functions of EHRs, help them decide what they need and provide education for implementation. Meanwhile, the organizations serving as Beacon communities will conduct targeted quality improvement projects that incorporate EHR systems, data analytics and information exchange to boost care and efficiency.

Building sustainable information exchange is a key goal of the Beacon program, said Sharon Donnelly, vice president of development for HealthInsight. The Salt Lake City-based organization, which was operating already as that state's Medicare Quality Improvement Organization, received a Beacon grant for more than $15 million that it will use to create a diabetes management program and improve performance reporting tools.

In addition to receiving the grant, HealthInsight was designated as the region's REC. Heading a Beacon community while helping physician practices adopt EHR systems will allow HealthInsight to address patient and provider needs across the continuum of care, Donnelly said. She calls it "community reengineering."

As a Beacon leader, once practices are up and running, HealthInsight can demonstrate how they can use EHR effectively, Donnelly said. Once doctors have learned how to enter the data in EHR systems, "you can act on it." (Some doctors, however, are concerned that the Beacon communities may simply implement health IT, not help address the need to alter clinical workflows to accommodate that technology.)

Part of that workflow redesign is physician payment reform. Where RECs are straightforwardly about helping doctors comply with federal meaningful use requirements, Beacon grants start to demonstrate other ways to reimburse doctors for the care they give. When payment is based on the quality of that care, physicians are rewarded for doing the right thing. When that rewards process is tied to technology, "the physician is going to be much more incentivized to use the EHR," Donnelly said. And if doctors are more eager to use EHR systems, the payment model will be considered a success, she added: "If that works in the demonstration, that's the sustainable portion."

Sustainability might be considered achieved if all three pieces-- EHR adoption, information exchange and data analytics -- work in tandem. Toward that end, one organization in the country was lucky -- or unfortunate -- enough to receive all three federal grants. The Rhode Island Quality Institute (RIQI) is responsible for overseeing the state HIE, helping doctors through its REC and building physician quality through the Beacon communities program.

In Rhode Island, outreach is the name of the game. RIQI focuses on building a medical home that connects patients to providers in the home and at physician offices, clinics, hospitals and other facilities, said Laura Adams, the institute's president and CEO. "We don't want to just install any certified EHR."

The physician is going to be much more incentivized to use the EHR.

Sharon Donnelly, vice president of development, HealthInsight

The three-pronged approach is not cheap. It will cost $50 million to $60 million to achieve the vision of having every doctor connected and every patient participating in an electronic portal, Adams estimated. The three federal grants total about $27 million.

Time is tight, as well. Rhode Island's REC has to be operating this summer, and it must help 1,000 doctors in the next two years. "There's no waiting at all," Adams said. "I think the outreach efforts are going to be absolutely critical."

Outreach and collaboration will be needed to transcend technology and turn the programs into a pathway for changing health care. The Indiana HIE hopes to use its $16 million Beacon communities grant to foster partnerships across the state and collaborate with Indiana Health IT Corp., the organization running the state HIE. In many ways, the Beacon program is the "capstone" on the various initiatives to establish measureable, better care of patients, said Marc Overhage, a physician who is president and CEO of the Indiana HIE.

The Indiana exchange, through its Quality Health First program, will focus on reducing readmission rates for chronically ill patients, by targeting home monitoring techniques, adherence to medication plans and data analysis. "It's one thing to have the information; it's another to change your work," Overhage said.

The Beacon communities have been given a 30-month deadline to demonstrate their effectiveness. The organizations said they are fine-tuning their plans and setting their milestone expectations now and will submit those to the Office of the National Coordinator for Health Information Technology, which oversees the program for HHS, within the next few weeks.

Let us know what you think about the story; email Jean DerGurahian, News Writer.


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