Boston — A decade ago, Blue Cross and Blue Shield of Massachusetts started a series of small pilot projects to encourage providers to adopt information technology and electronically exchange data.

By 2004, the plan realized what it was doing was incremental tinkering and it needed to put up substantial funding to get the market going. "We knew it could work, but we couldn't do it ourselves," recalls Steven Fox, VP of provider network management. "And we knew 'incremental' wouldn't work."

Late that year, BCBS of Massachusetts committed $50 million to get the market going in large-scale pilot programs in three communities—Brockton, Newburyport and North Adams. Since then, nearly all of approximately 600 physicians in 200 practices in these areas have adopted electronic health records software, and have established health information exchanges with local hospitals, Fox says.

The Blues plan's financial commitment "obviously got people's attention," Fox says. But commitments from stakeholders, including other health insurers, to work cooperatively toward building health information exchanges, made it possible to use the money effectively. "You clearly need the capital," he adds. "You can get everyone in the room and agree, but without the capital they can't move forward."

The Blues funding runs out at the end of 2008 and the initiative faces two daunting tasks. First: keep the EHRs and HIEs operating in the first three communities. Second: replicate those programs across the state.

Mandates by the Medicare program to use electronic prescribing technology and a Massachusetts Blues mandate on hospitals to adopt computerized physician order entry systems by 2012 to participate in its pay-for-performance programs, give providers in the state extra incentive to automate, according to Fox.

Overseeing the statewide rollout, as it did with the initial three communities, is the task of the Massachusetts eHealth Collaborative, a statewide stakeholder governing organization.
The state government recently authorized $25 million a year for five years to assist in expanding EHRs and HIEs across the state, but proponents will have to work to make sure the money is actually appropriated each year. BCBS of Massachusetts believes there is sufficient commitment from other stakeholders to further fund the initiatives, Fox says. Whether the Blues will continue some degree of financial support hasn't been determined, he adds. Some issues will be easier for other communities as they launch their own initiatives, Fox predicts. Information technologies, for instance, have significantly improved in recent years. And vendors have learned the scope of the efforts and how to better integrate and work with each other. "There's more of a willingness among vendors to tie their systems together," he adds.

But the biggest challenge that faced Brockton, Newburyport and North Adams physicians was workflow issues. Those likely will bedevil others, as well, Fox contends. "I don't think anyone was prepared for how many workflow changes would be required," he explains. "The biggest early challenge was just getting the technology in. I think everyone underestimated how tough that would be."

If Massachusetts' stakeholders can successfully replicate the programs in Brockton, Newburyport and North Adams across the state, that will give a model to other states, Fox adds. "If we can do it here, you can do it anywhere."


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