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Sparking HIE in Rural Appalachia

October 6, 2010
by Jennifer Prestigiacomo
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Interview: Pat Pope, Provider Relations Coordinator, CareSpark

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?

Pope: CMS recruited CareSpark to pilot a PQRI [Physician Quality Reporting Initiative] project to deliver physician quality reporting measures electronically. As a subcontractor to CGI [CGI Federal RAC Region B] on this pilot, proof of this concept would provide a sustainable revenue service sending PQRI data to CMS and returning the PQRDA reports to the providers.

HCI: What’s your sustainability model?

Pope: Sustainability is at the top of all health information exchange’s priority list. The eHealth Initiative 2010 report on health information exchanges states there are 234 active HIE initiatives in the U.S., of which, there are 73 operational programs. Only 18 HIEs have broken even through operational revenues alone and are not dependent on federal funding.

Market analysis determined that secure messaging would be a key service for multiple revenue streams including:
1. Order and results delivery
2. Discharge scripts to pharmacies
3. Case management communication
4. Ask-A-Nurse programs
5. Providing clinical information to patients
6. Secure electronic provider-to-provider communication

[The Warminster, Pa.-based] MobileMD has been selected as CareSpark’s secure messaging vendor. We are in the process of piloting secure messaging. ]

HCI: What’s CareSpark’s relationship with other HIEs and RECs?

Pope: CareSpark is a subcontractor under the tnREC coordinating the outreach efforts to providers in our region. This is a great opportunity for collaboration with HIEs across the state. CareSpark representatives also serve on the HIP TN [Health Information Partnership for Tennessee] Board and committees; HIP TN is the state-designated HIE. In addition, we have collaborated with multiple HIEs on projects related to NHIN; the most recent being a medication management exchange with the Bronx Health Information Exchange [N.Y.]. We continue to be active on NHIN committees and plan to pilot for the NHIN Direct project.

HCI: What are your goals currently?

Pope: First, CareSpark is excited to participate with the state planning process and support development of HIE connectivity across the state of Tennessee. We feel this experience can provide valuable insight and guidance to all involved. [We also] provide support to our regional extension center partners Virginia and Tennessee. [We’d also like to] continue to expand CareSpark’s infrastructure to enable the continued expansion of services and volume.

HCI: What are CareSpark’s main population health initiatives?

Pope: Exchange of multi-state immunization registry data; chronic disease management like cardio-metabolic syndrome and diabetes; medication management, including controlled substance and medication reconciliation; and development of metrics to measure effectiveness of these projects.

HCI: I noticed another initiative was surrounding prescription drug misuse. You don’t see that one on the top many HIEs’ lists.

Pope: I think that’s where CareSpark is unique; we border two states. We really do see prescription drug abuse in our region. It is a growing concern. And what we have found in speaking to one of our local pharmacists—the problem is the time it takes to check a drug registry. She said that if she suspects misuse it can take her 45 minutes by the time it takes to check the Tennessee, North Carolina, and Virginia registries to see if there is misuse. So, we want to be able to provide one location that would have the medication use.

HCI: What are some lessons that you’ve learned in building this rural HIE?

Pope: CareSpark elected to follow a standards-based approach and even participated in the development of the standards. This required continual evaluation and alignment of our technology to ensure conformance with these standards.

Carespark also has benefited from the decision to use the “best-of-breed” approach in our technology solutions. This approach requires additional technical/architectural design and implementation, but allows us to understand the cutting-edge approach and potential for emerging technology. These approaches have required the same level of commitment and support from our technical partners.

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