Proposed Massachusetts e-health network gets $50 million boost

BlueCross BlueShield of Massachusetts will spend up to $50 million to wire doctors and other health care personnel in three communities in the hope that its investment will spark the creation of a statewide e-health network.

The health plan is donating the money to the Massachusetts e-Health Collaborative, a nonprofit organization that was formed in September.

The organization's 28 members, representing a wide cross section of health care stakeholders in the state, have agreed to collaborate on the pilots and the creation of a statewide community health information network to lower costs and improve patient safety and care.

Members of the collaborative include the Blues plan, the Massachusetts Medical Society, the state chapter of the American College of Physicians, Tufts Health Plan, the Massachusetts Hospital Assn. and Bayside Health System.

The Massachusetts e-Health Collaborative will use the $50 million to buy and install interoperable electronic medical records software with clinical decision support in physician offices, said Carl Ascenzo, the Blues' chief information officer. The money also will pay for hardware, implementation services, system integration services, technology support and maintenance, and linkages between doctors, hospitals and other health care professionals.

The initiative is one of many around the country aiming to get doctors and hospitals to share patient information electronically through community health information networks (or CHINs), which the Bush administration views as an essential building block toward a national health information network.

For example, the federal government awarded a $1.4 million grant to SAFE Health Info (Secure Architecture for Exchanging Health Information), a community health information network initiative in central Massachusetts.

The grant will support the development of the network, said a spokesperson from the Fallon Clinic, a 240-doctor multispecialty group that is sponsoring the CHIN initiative with Fallon Community Health Plan and UMass Memorial Health Care, all of Worcester, Mass.

The three organizations expect the network, which will enable physicians and hospitals to electronically exchange patient information with each other, to go live in 2005.

But most of these initiatives haven't advanced beyond the development stage for lack of financial, community or political support.

"What's been holding up implementation of all these e-health initiatives is that the financing [of EMRs] has not been coming from the parties that stand to benefit [the most] financially," said Allan H. Goroll, MD, an internist at Massachusetts General Hospital in Boston and interim chair of the Massachusetts e-Health Collaborative. "The financing has been put on the backs of physicians and practices, but the financial benefits accrue predominantly to the purchasers [of health care] and insurers."

If the collaborative is to succeed in getting doctors in Massachusetts to integrate EMRs into their practices, it must devise ways to make the systems affordable for physicians, Dr. Goroll said.

Thus, a major goal of the pilots is to quantify the clinical and financial benefits of using EMRs, and the cost of implementing a statewide network, Ascenzo said.

Several studies estimate that up to 30% of the health care dollars spent in the United States could be saved by using EMRs and other technologies, but the truth is "you're not going to get 30% and you're not going to get 0% either," Ascenzo said. "We all as a community would like to know where that in-between is ... to determine where different sources of funding may be to complete a full-scale rollout [within seven to 10 years]."

The collaborative also will use data gathered from the pilots to craft a financing or payment mode to address the high start-up as well as the ongoing costs that deter physicians from adopting EMRs.

Over the past two years, several insurers have offered annual bonuses or higher reimbursement rates to encourage doctors to use information technology, but the collaborative will not necessarily follow that path. "There are all kinds of ways [to do this]," Dr. Goroll said. "We may [for example] just go ahead and say the payers will put X number of dollars into a common fund that will be available for the purchases of these things, and the physicians may never own the stuff."

The sites for the pilots, which will begin in 2005 and last 18 months to 24 months, will be selected within the next several months, Dr. Goroll said.