How to start a community health network

There’s no question that using computers to handle patient records and clinical data goes a long way toward improving patient safety and health care quality. But getting started on making that happen is not easy regardless of how affluent your community is.

The challenge is to enable the community’s health care providers, payers, consumers, employers, first responders and government agencies to exchange health data on demand — whether it’s during a routine exam, after a natural disaster or after a terrorist attack. Several localities and states — including Tennessee, Massachusetts, Arizona, Indianapolis and Whatcom County, Washington — have already gotten started. Together their experiences represent a workshop on how to build and maintain a successful community health network.

Physicians and health experts familiar with such projects say the most important lessons they’ve learned include ensuring that as many stakeholders as possible are involved; focusing on a clear, common problem that can be improved or solved by exchanging information; and defining simple and early markers of success.

“You don’t want to try to boil the ocean,” said Dr. Scott Young, director of health information technology at the Agency for Healthcare Research and Quality (AHRQ) at the Department of Health and Human Services. “We advise folks to be very judicious in what they want their first information exchange to be and most importantly to remember that the ultimate goal here is to improve care — not just build networks and exchange data for its own sake.”

It’s also important to realize that there is no single approach to achieving success with such initiatives, said Emily Welebob, vice president of program knowledge delivery at the eHealth Initiative, a nonprofit organization focused on improving health care via IT. “The starting points are different, the paths are different,” she said. “But the one common thing is that it is local factors that really shape these information exchanges, which is why it’s important for the community to get involved and collaborate and develop consensus.”

Pick a convener
A few early steps are critical to long-term success. The first is to get as many stakeholders on board as possible, including hospitals, small physician groups, nursing homes, ambulance providers, pharmacists, emergency medical technicians, government agencies, public health advocates, insurance companies, employers and consumers.

Dr. Mark Frisse, director of regional health initiatives at the Vanderbilt Center for Better Health, said it’s necessary to have a convener, preferably someone with a strong belief in the value of the initiative, high community visibility and the ability, if necessary, to prod or even coerce other stakeholders.

For example, the convener for the MidSouth e-Health Alliance, which is focused on developing a comprehensive health information infrastructure in three Tennessee counties, was Gov. Phil Bredesen. In other larger projects, the convener has been state government, but large businesses, nonprofit organizations, universities or, in smaller initiatives, community leaders can also take charge.

Frisse said that although many stakeholders will participate out of a sense of concern and altruism, “that feeling is often clouded by the short-term exigencies that each stakeholder feels. So often these community initiatives are viewed as just another add-on to these people’s already heavy workloads because there seems to be, at first glance, little immediate benefit for them.”

For that reason, the convener must focus on a problem that creates a sense of urgency among the stakeholders — one whose solution through information exchange would create value for everyone.

For some communities, that problem could be inefficiencies in sharing lab or administrative data or in easing transitions in care between hospitals and nursing homes. It could be a large public health focus such as immunizations, substance abuse or the uninsured. Or it could be a specific health care issue: the Whatcom Health Information Network in Washington, for example, uses data and records exchange to support a long-term care plan for patients with chronic diseases.

Deal killers
Stakeholders must be guided properly if they are to remain enthusiastic, experts say. For starters, they — not the convener — should always govern the project, and all decisions and goals must be made by consensus. “If unilateral decisions are made, it’s a deal killer,” Young said.

Participants also need to define early measures of success and identify how those successes will contribute to the initiative’s sustainability. Those measures should be simple and easily attainable, Welebob said. Examples include establishing a technical advisory panel, developing a communication plan, or identifying the fiscal or efficiency benefits for each stakeholder. “Whatever it is, when you reach that goal, make a big deal out of it,” Young said. “And then set new goals.”

At some point in the process, the initiative also needs to obtain funding. “These things take a lot of effort and a lot of money, and we’re finding that these initiatives are nobody’s full-time job,” Welebob said.

Funding vs. risk
Funding is also critical to managing risk, and a lack of it has kept many physician practices from adopting electronic records, said Dr. David Bates, chief of general medicine at Brigham and Women’s Hospital in Boston. Bates is helping develop the Massachusetts e-Health Collaborative, a physician-led effort to enhance the quality, efficiency and safety of care in the state.

“The biggest barrier is that at this point physicians are expected to assume all of the economic burden, yet they receive only about 10 percent of the returns,” he said. He added that by essentially eliminating that risk, the state’s pilot project has garnered enthusiastic support from small providers.

Welebob said a growing number of grants are now available for community health IT initiatives from sources interested in improving health care quality, including philanthropic organizations, quality improvement groups and federal agencies. And then there are the unexpected sources: the Massachusetts e-Health Collaborative received $50 million from Blue Cross Blue Shield of Massachusetts to fund its demonstration project phase.

Once participants define the problem and set goals, they must develop a governance structure and begin a dialogue on ongoing issues such as privacy, security and data standards. At that point, they can also start developing strategies for exchanging information and choose technologies to support those strategies.

Frisse suggests looking for examples of what has already been accomplished and adapting them. “There’s no point in reinventing the wheel,” he said.

Case studies and project contacts are widely available through organizations such as the eHealth Initiative Foundation, AHRQ and the Markle Foundation’s Connecting for Health initiative.

Finally, Young said everyone involved should be optimistic but realistic. Do successful community health IT initiatives magically improve patient care? “No,” he said. “But I don’t think we can make it better without them. Our improvements in health care delivery are going to be limited until we start seeing more data being exchanged.”