Sparking HIE in Rural Appalachia

Non-profit regional health information exchange CareSpark, based in Kingsport, Tenn., serves the central Appalachian region, in a service area encompassing 34 counties in southwest Virginia and east Tennessee. Since 2005, the rural HIE has gotten half of the population (400,000 people) on_board to participate and has doubled EMR adoption and e-prescribing in the region. CareSpark’ Provider Relations Coordinator Pat Pope spoke with HCI Associate Editor Jennifer Prestigiacomo about CareSpark’s population health initiatives and sustainability model.

HCI: Can you tell me a little bit about the background of CareSpark and its grassroots approach?

Pat Pope: CareSpark was established in 2005 following two years of research and planning to explore ways to share health information securely, efficiently, and cost-effectively. CareSpark was initiated by volunteers with the Community Health Improvement Partnership (CHIP) who had been working together for more than a decade through a local non-profit organization, Kingsport Tomorrow, to develop a collaborative process to improve the health of the community. CareSpark began its first pilot in 2006, and became operational in the fall of 2008.

HCI: Can you tell me a little about the consumer education program that led to nearly half of the population electing to participate?

Pope: When we surveyed consumers, they indicated they valued the providers’ decision to participate with CareSpark. Education outreach has primarily been community-wide, but with emphasis placed on physician groups and at the individual physician level. It consists of a top down education effort.

Our board consists of a wide cross-section of community leaders, including healthcare, and other large employers that assist in the community outreach.

HCI: How have you encouraged EMR adoption within the region?

Pope: As we recruit providers to participate with CareSpark, they are educated regarding the value of electronic health information exchange. We explain that part of the value of interoperability is to provide a more complete health record for their patients for continuity of care. CareSpark has also partnered with the Tennessee Regional Extension Center (tnREC)[based in Nashville], a division of QSource [the Memphis-based non-profit healthcare consulting firm dedicated to improving the quality of care provided to Medicare and Medicaid populations], to support physicians in our region in selecting an EMR and achieving meaningful use.

HCI: Do you have a preferred vendor partner list?

Pope: We do not. We will work with any that work with us. We have actually done an extraction of data from a homegrown EMR system, one that the doctor actually designed himself. We were able through an interface to extract the data and complete a CCD [Continuity of Care Document] out of his EMR.

HCI: Can you tell me about CareSpark's Nationwide Health Information Network (NHIN) gateway?

Pope: We use the open-source CONNECT Gateway developed as part of the NHIN project, and we are currently in the process of on-boarding our NHIN gateway with ONC [the Office of the National Coordinator for Health Information Technology]. We will be the first HIE testing with the new ONC driven testing system scheduled to begin Wednesday, October 6. It’s a four-week project, with two weeks of ghost testing.

HCI: Besides state funding, what other revenue streams do you have?