Implementing health information technology-enabled care coordination across a region: Lessons learned from a Beacon Community

In 2009 Congress authorized an investment of $19 billion in health information technology (HIT) through the American Recovery and Reinvestment Act's HITECH program. The HITECH funding included the Beacon Community program, out of the Office of the National Coordinator for Health Information Technology, which was designed to both demonstrate the value and characterize the complexities of HIT through large-scale, community-based initiatives. The Beacon Community of the Inland Northwest (BCIN), serving eastern Washington and northern Idaho, seeks to improve clinical outcomes for adult patients with type 2 diabetes (DM2). Through a combination of a foundational health information exchange (HIE), a cohesive approach to care coordination, and a population-based quality measurement framework, the BCIN is working to assure that patients with DM2 receive consistent, high quality care anywhere in the region. The BCIN consists of three tracks that are being implemented in parallel: • An HIE interfaced to different electronic medical record systems in hospitals, physician offices and other care settings to collect and standardize health data for inclusion in a clinical data repository which is accessible to all providers who care for a patient; • A care coordination and clinical transformation framework including a readiness assessment, quality improvement training, and a common disease management tool, driven by the clinical data repository, to support best practices in diabetes care; and • A set of standard quality measures and reports, derived from the clinical data repository, to give providers a comprehensive picture of their patients' health status and outcomes, regardless of where those patients receive care. The large geographic region of this project coupled with the varied level of readiness of the individual clinics and the complexities of implementing a comprehensive regional technology solution have yielded many insights which can inform efforts to transform the country's health care system.