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."

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