Auto Repair Promotions - Link to a Charity and Get Noticed
When it comes to auto repair promotions; did you know that you can link your auto repair shop to a charity to market your business? There are many savvy small businesses doing the very same thing so why should it be any different to an auto repair shop? The truth, however, is that there are many different auto repair promotions you can use, but since linking your business to a charity is so effective, why not give it a try?
Auto repair promotions requires time, resources and linking your auto repair company to a charity could save on the latter while making a difference to your charity of choice. Before getting into the benefits of linking to a charity, it is important to remember that the primary goal should be the charity and your promotion secondary. Surely the two can co-exist, but taking advantage of this opportunity is an easy slip.
Having said that, charities are not oblivious to the marketing motive behind linking with them and so they have significant experience in helping your business receive its returns on the charitable investment. The selection of a suitable charity is of high order since linking with a charity that you can truly affiliate to alleviates the strain of the work involved. Working with charities can be very time consuming so enjoying working with your chosen charity makes for a promising relationship and better returns. Great exposure and networking opportunities with influential people is also a great perk of this venture.
There are a number of ways in which your auto repair promotions can be heightened. The key here is to attract attention to potential customers. Use the local media to gain more exposure. Press releases with photos of events your shop has sponsored and being involved in high profile events that would attract the media are great promotional boosters. Also, in the case of a sponsored event, make sure your target market is likely to participate. A mini-race car event with the logo of your auto repair shop on one door and the charity on the other help to put you on the stage.
Get involved in your charity. The more your business shows face, the more exposure it receives. Making an appearance at Charity events that may not be sponsored by your business is a good way of networking with like-minded people and extending you database. Maintaining contact with influential parties is even more likely to put you on the map to a wider base of clientele. All these people surely drive something, what better way to extend your services than to your newly found people of influence? Involve yourself in other engagements that may be of mutual interest. Another productive way of including your charity is involving the staff, encourage active involvement in the organizing or assistance of events, include a symbol of your charity in the uniforms and even have posters and signs promoting your charity in your place of business. Including the charity in company slogans is a clever way of both affiliating with and promoting the charity and in turn, promoting you auto repair shop.
Get your charity involved with you by making it part of your business. Exposing your charity exposes you as well, so advertise them wherever you can. Get charity member to sell your coupons in the neighbourhood and let them keep the returns. That both lifts auto repair promotions and gets them much needed funding. Designate charitable products, i.e. donating service time to the charity. So that would include something like a percentage to your charity for every third oil change of the day. Charity members can inversely be your promoters when you have an event of your own such as a grand opening, sale or local celebrity endorsement campaign. The charity could be the ticket sellers and keep a percentage or all of the proceeds while you benefit form the increased exposure and potential clientele.
Sponsoring a mass vehicle with the brand as a paint job will get your auto repair shop a wider promotional reach. It is your name on wheels driving a charity. This has multifold advantage because the charity gets transport and you get endless exposure. It would be a huge consideration as a promotional caution to make sure that the vehicle never breaks down on a high way...
Charity linking can be a highly fruitful venture in auto repair promotions. The idea is to be true to the cause while benefiting your business rather than using the charity solely as a promotional tool, good relations with your charity is tantamount to that of your customers. Ultimately, the public likes associating with charities and those that assist them...it's even better when it's you.
The Life Insurance Quote Business is Booming, but is the Insurance Quote Accurate?
The life insurance quote business online is booming. Not only are life insurance agents quoting a more diverse portfolio of companies, but consumers are also now able to quote life insurance online for themselves. In this article, I will analyze the impact of the life insurance online quote on the insurance industry, the insurance broker, and the consumer looking for insurance.
In the not so distant past, life insurance was sold, not bought. The typical agent would travel door to door, network locally, and perhaps meet with potential policyholders for dinner at their home. The "debit" agent was also a common profession. These agents would actually go to their clients and collect the premium on a weekly basis. The life insurance quote came from a person back then, not a computer.
These days, consumers can go online for a life insurance quote. The ability to readily compare the cost of life insurance among hundreds of life insurance companies has dramatically changed the environment.
The biggest impact to the insurance industry is the fact that the cost of coverage has decreased significantly. This is good for the client, but is in effect shutting smaller companies down as the claims to revenue ratio is converging.
Another impact is the fact that when consumers get an online life insurance quote, they are rarely coached as to what is the better deal for them. Often times, term life insurance is the only product that they are offered. The customer is not being told about the advantages of whole life insurance or the flexibility of universal life insurance...they are often just given a term life insurance quote as requested. The life insurance agent of past would have talked to the client and done some fact finding before selling them something that may not fit their particular situation.
The online Life Insurance Quote industry has also affected the independent insurance broker. Often times, the local broker is not trusted with the quote because the consumer has gone online and gotten a cheaper quote from an online quote service. Misquotes are usually the result of the lack of fact finding on the part of the online insurance quote companies. Customers would be much better off dealing with a licensed life insurance agent (who can broker any company out there; whatever suits the customer best) for their life insurance quotes.
So the next time you go online looking for the best term life insurance rate, consider that you may be making a mistake by dealing with a "call center". Consider that the life insurance quote that you are receiving is only from the companies that they carry. Consider calling on an independent life insurance broker for your term, whole life, and universal life insurance needs and information.
The Life Insurance Quote Business is Booming, but is the Insurance Quote Accurate?
The life insurance quote business online is booming. Not only are life insurance agents quoting a more diverse portfolio of companies, but consumers are also now able to quote life insurance online for themselves. In this article, I will analyze the impact of the life insurance online quote on the insurance industry, the insurance broker, and the consumer looking for insurance.
In the not so distant past, life insurance was sold, not bought. The typical agent would travel door to door, network locally, and perhaps meet with potential policyholders for dinner at their home. The "debit" agent was also a common profession. These agents would actually go to their clients and collect the premium on a weekly basis. The life insurance quote came from a person back then, not a computer.
These days, consumers can go online for a life insurance quote. The ability to readily compare the cost of life insurance among hundreds of life insurance companies has dramatically changed the environment.
The biggest impact to the insurance industry is the fact that the cost of coverage has decreased significantly. This is good for the client, but is in effect shutting smaller companies down as the claims to revenue ratio is converging.
Another impact is the fact that when consumers get an online life insurance quote, they are rarely coached as to what is the better deal for them. Often times, term life insurance is the only product that they are offered. The customer is not being told about the advantages of whole life insurance or the flexibility of universal life insurance...they are often just given a term life insurance quote as requested. The life insurance agent of past would have talked to the client and done some fact finding before selling them something that may not fit their particular situation.
The online Life Insurance Quote industry has also affected the independent insurance broker. Often times, the local broker is not trusted with the quote because the consumer has gone online and gotten a cheaper quote from an online quote service. Misquotes are usually the result of the lack of fact finding on the part of the online insurance quote companies. Customers would be much better off dealing with a licensed life insurance agent (who can broker any company out there; whatever suits the customer best) for their life insurance quotes.
So the next time you go online looking for the best term life insurance rate, consider that you may be making a mistake by dealing with a "call center". Consider that the life insurance quote that you are receiving is only from the companies that they carry. Consider calling on an independent life insurance broker for your term, whole life, and universal life insurance needs and information.
Asking Help Of Pc Fix Companies
Are you living in Portland but are still worried about getting your computer repaired? Throw your worries away since Portland has a stock of very good Portland computer repair companies. Whether you have to struggle with your slow computer or it hangs in the midst of your work or all of a sudden you face a bad computer crash, you don't need to pull your hair, as a number of different computer repair companies in Portland are there at your service 24/7.
With passing years, our dependence on computer is also increasing. Many people are running businesses via this computer; while some require it to expand their business by marketing their products and some other need these computers for getting information and staying in touch with their friends and family. However, this ever increasing use of computer is not only giving us benefits but is also playing a vital role in flourishing the business of computer repair companies. A large number of different computer repair companies have established their setup around the globe offering a wide variety of services. However, still when our computer encounters a problem, we find ourselves clueless as whether this is an ailment enough to ask any computer repair company's help. Finally, when it is broken beyond our control or its system completely fails, we either think of replacing it or find ourselves confused as to which company we should take our computer to.
Computers can encounter several different kinds of problems which can be apparently small like slow computer, or big like virus-infected computer, system files getting corrupt, data loss, owing to any of the above problems or any other problem. But you should not take any of the ailments of your computer or laptop, lightly as your casual behavior might cost you heavy repair bills and of course data-loss, which you cannot afford to lose. So, you had better take good care of your computer's hardware and software and try to make it secure of viruses and spyware yet if it suffers from a trouble, get in touch with a computer repair company immediately.
So, if your abode is in Portland, try logging on to the internet and search Portland computer repair companies that not only offer competitive prices for repairing your computer but also offer an online computer service. Since an online computer service can save you of the drive to the repair company, holding your fat computer. In online computer service, the technicians will assist you to repair your computer online, in case your computer is not having a physical damage. In addition to it, you will find many of these companies providing the on-site and in-shop facility. Just on your one phone call, they will be there at your service in your home or office. These companies proclaim to provide services like, virus removal, data recovery, data backup, spyware-removal, web-hosting, e-mail-hosting, website designing, networking, system installation and more.
You should try to keep your computer or laptop secure by placing it in dust free environment and in optimal temperature. It must also have an updated anti-virus and anti-spyware program installed. If any time your system is infected, you can call online computer repair companies of Portland.
Are you living in Portland but are still worried about getting your computer repaired? Throw your worries away since Portland has a stock of very good Portland computer repair companies. Whether you have to struggle with your slow computer or it hangs in the midst of your work or all of a sudden you face a bad computer crash, you don't need to pull your hair, as a number of different computer repair companies in Portland are there at your service 24/7.
With passing years, our dependence on computer is also increasing. Many people are running businesses via this computer; while some require it to expand their business by marketing their products and some other need these computers for getting information and staying in touch with their friends and family. However, this ever increasing use of computer is not only giving us benefits but is also playing a vital role in flourishing the business of computer repair companies. A large number of different computer repair companies have established their setup around the globe offering a wide variety of services. However, still when our computer encounters a problem, we find ourselves clueless as whether this is an ailment enough to ask any computer repair company's help. Finally, when it is broken beyond our control or its system completely fails, we either think of replacing it or find ourselves confused as to which company we should take our computer to.
Computers can encounter several different kinds of problems which can be apparently small like slow computer, or big like virus-infected computer, system files getting corrupt, data loss, owing to any of the above problems or any other problem. But you should not take any of the ailments of your computer or laptop, lightly as your casual behavior might cost you heavy repair bills and of course data-loss, which you cannot afford to lose. So, you had better take good care of your computer's hardware and software and try to make it secure of viruses and spyware yet if it suffers from a trouble, get in touch with a computer repair company immediately.
So, if your abode is in Portland, try logging on to the internet and search Portland computer repair companies that not only offer competitive prices for repairing your computer but also offer an online computer service. Since an online computer service can save you of the drive to the repair company, holding your fat computer. In online computer service, the technicians will assist you to repair your computer online, in case your computer is not having a physical damage. In addition to it, you will find many of these companies providing the on-site and in-shop facility. Just on your one phone call, they will be there at your service in your home or office. These companies proclaim to provide services like, virus removal, data recovery, data backup, spyware-removal, web-hosting, e-mail-hosting, website designing, networking, system installation and more.
You should try to keep your computer or laptop secure by placing it in dust free environment and in optimal temperature. It must also have an updated anti-virus and anti-spyware program installed. If any time your system is infected, you can call online computer repair companies of Portland.
Asking Help Of Pc Fix Companies
Are you living in Portland but are still worried about getting your computer repaired? Throw your worries away since Portland has a stock of very good Portland computer repair companies. Whether you have to struggle with your slow computer or it hangs in the midst of your work or all of a sudden you face a bad computer crash, you don't need to pull your hair, as a number of different computer repair companies in Portland are there at your service 24/7.
With passing years, our dependence on computer is also increasing. Many people are running businesses via this computer; while some require it to expand their business by marketing their products and some other need these computers for getting information and staying in touch with their friends and family. However, this ever increasing use of computer is not only giving us benefits but is also playing a vital role in flourishing the business of computer repair companies. A large number of different computer repair companies have established their setup around the globe offering a wide variety of services. However, still when our computer encounters a problem, we find ourselves clueless as whether this is an ailment enough to ask any computer repair company's help. Finally, when it is broken beyond our control or its system completely fails, we either think of replacing it or find ourselves confused as to which company we should take our computer to.
Computers can encounter several different kinds of problems which can be apparently small like slow computer, or big like virus-infected computer, system files getting corrupt, data loss, owing to any of the above problems or any other problem. But you should not take any of the ailments of your computer or laptop, lightly as your casual behavior might cost you heavy repair bills and of course data-loss, which you cannot afford to lose. So, you had better take good care of your computer's hardware and software and try to make it secure of viruses and spyware yet if it suffers from a trouble, get in touch with a computer repair company immediately.
So, if your abode is in Portland, try logging on to the internet and search Portland computer repair companies that not only offer competitive prices for repairing your computer but also offer an online computer service. Since an online computer service can save you of the drive to the repair company, holding your fat computer. In online computer service, the technicians will assist you to repair your computer online, in case your computer is not having a physical damage. In addition to it, you will find many of these companies providing the on-site and in-shop facility. Just on your one phone call, they will be there at your service in your home or office. These companies proclaim to provide services like, virus removal, data recovery, data backup, spyware-removal, web-hosting, e-mail-hosting, website designing, networking, system installation and more.
You should try to keep your computer or laptop secure by placing it in dust free environment and in optimal temperature. It must also have an updated anti-virus and anti-spyware program installed. If any time your system is infected, you can call online computer repair companies of Portland.
Are you living in Portland but are still worried about getting your computer repaired? Throw your worries away since Portland has a stock of very good Portland computer repair companies. Whether you have to struggle with your slow computer or it hangs in the midst of your work or all of a sudden you face a bad computer crash, you don't need to pull your hair, as a number of different computer repair companies in Portland are there at your service 24/7.
With passing years, our dependence on computer is also increasing. Many people are running businesses via this computer; while some require it to expand their business by marketing their products and some other need these computers for getting information and staying in touch with their friends and family. However, this ever increasing use of computer is not only giving us benefits but is also playing a vital role in flourishing the business of computer repair companies. A large number of different computer repair companies have established their setup around the globe offering a wide variety of services. However, still when our computer encounters a problem, we find ourselves clueless as whether this is an ailment enough to ask any computer repair company's help. Finally, when it is broken beyond our control or its system completely fails, we either think of replacing it or find ourselves confused as to which company we should take our computer to.
Computers can encounter several different kinds of problems which can be apparently small like slow computer, or big like virus-infected computer, system files getting corrupt, data loss, owing to any of the above problems or any other problem. But you should not take any of the ailments of your computer or laptop, lightly as your casual behavior might cost you heavy repair bills and of course data-loss, which you cannot afford to lose. So, you had better take good care of your computer's hardware and software and try to make it secure of viruses and spyware yet if it suffers from a trouble, get in touch with a computer repair company immediately.
So, if your abode is in Portland, try logging on to the internet and search Portland computer repair companies that not only offer competitive prices for repairing your computer but also offer an online computer service. Since an online computer service can save you of the drive to the repair company, holding your fat computer. In online computer service, the technicians will assist you to repair your computer online, in case your computer is not having a physical damage. In addition to it, you will find many of these companies providing the on-site and in-shop facility. Just on your one phone call, they will be there at your service in your home or office. These companies proclaim to provide services like, virus removal, data recovery, data backup, spyware-removal, web-hosting, e-mail-hosting, website designing, networking, system installation and more.
You should try to keep your computer or laptop secure by placing it in dust free environment and in optimal temperature. It must also have an updated anti-virus and anti-spyware program installed. If any time your system is infected, you can call online computer repair companies of Portland.
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The beauty of rock climbing is how serene and intense moments are interwoven together. You are in nature, focused on getting yourself up in a safe manner. Planning or following a route. Judging endurance left in your arms. Anticipating what it will take to make the next move. Then there are moments of rest and wonder, when you pause in a safe place. Stand semi-comfortable on your legs and let your arms loosely grab the hold. You can look around and be in awe of the surrounds. Out on an open cliff of a narrow chimney with nothing but the strength of your body moving you up. Rock climbing has come a long way to become the exciting sport that it is right now, and it has never ceased to be a great adventure for both young and old. Here are 3 reasons why everyone can enjoy this sport.
1. It can be enjoyed both indoors and outdoors. With much technological advancement, indoor rock climbing centres have been created for competitors to practice in and for beginners to get a taste of the activity. These facilities introduce novice climbers to the equipment and techniques of the sport. Amazingly, some centres can provide an almost too close resemblance to outdoor edifices, which provides adequate training for outdoors climbing.
2. Rock climbing is for all ages! It's an activity that can be enjoyed by children as young as 5 years old and as old as your body will allow you to enjoy this activity. Young participants of the sport often practice in indoor rock climbing centres where specific equipment for their body and age are available. Climbing walls are also provided for any skill and level of competency. Such facilities develop strength and discipline in the process. Height maybe a factor in this sport but it's mainly all about the degree of climb difficulty. An edifice may be only a few feet in height, but the slope and angles of the surface determines the climb's degree of difficulty. The variety of climbing walls available in an indoor facility means that no matter what age or skill level you are at there is something to challenge everyone.
3. Rock climbing is not just about great heights or fabulous sceneries, it is also an activity that builds confidence, discipline and a great respect for safety. Though an individual sport that involves a great deal of serenity, it's also a goal oriented activity that provides a lot of physical and mental challenges. Each climb is a milestone for the human spirit and will definitely get you hooked one achievement after the other. Apart from the physical benefits, discipline is something that is innately developed. Knowing when to push your limits and when to relax and logically continue. The discipline of keeping a healthy body and mind to ensure that you are always on top of your game. This discipline also involves awareness of the inherent risks that come with the sport. Rock climbing is a sport not meant to defy gravity, it involves safety measures to prevent gravity from working on a climber to result in a fall.
Rock climbing is a fun sport that everyone can enjoy. Years of development and innovation has made this sport an activity that can be enjoyed by any individual, young or old, skilled or not. With the convenience of indoor rock climbing centres, people need not break an arm and a limb just to experience the activity. It is a fun filled activity that is easy, safe and convenient for everyone.
Psychological Health
It would appear that at some point after World War I, real mental health became something of a luxury. The absence of any real mental disease like schizophrenia or dementia certainly is not an indicator of complete mental health any longer. The boom in knowledge of human psychology that began in the 1960s has made that eminently clear.
Truthfully speaking, even basic functionality can no longer be automatically assumed for a human being living in the present age. There are an unprecedented number of Americans and Europeans undertaking psychotherapy today - what started off as a fad now seems to have become a necessity of daily living. The pressures of the rat race are overwhelming. The number of situations and triggers for mental disorders has multiplied significantly. The stress levels are extremely high.
We are, therefore, reduced to defining acceptable mental health in very broad terms. A certain degree of aberration is to be expected in almost every post-modern human being. Reasonable mental health will, therefore, have to be defined by the lack of gross disorders. A good standard for judging this would be the one apparently employed by health insurance companies, who are reluctant to pay for mental disorders that do not result in complete breakdown of normal life for the individual.
The diseases that indicate a major disruption in mental health would today include Bipolar Disorder, Schizophrenia, or a major depressive disorder. Further mental disorders that may or may not be considered as mere a lack of fine tuning by authorities may include obsessive-compulsive disorders, alcohol or drug addiction, or stress-induced nervous breakdown.
Mental health in the twenty-first century means a reasonable quality of life and functionality in individuals, despite the overwhelming odds against them.
Mental Health
It would appear that at some point after World War I, real mental health became something of a luxury. The absence of any real mental disease like schizophrenia or dementia certainly is not an indicator of complete mental health any longer. The boom in knowledge of human psychology that began in the 1960s has made that eminently clear.
Truthfully speaking, even basic functionality can no longer be automatically assumed for a human being living in the present age. There are an unprecedented number of Americans and Europeans undertaking psychotherapy today - what started off as a fad now seems to have become a necessity of daily living. The pressures of the rat race are overwhelming. The number of situations and triggers for mental disorders has multiplied significantly. The stress levels are extremely high.
We are, therefore, reduced to defining acceptable mental health in very broad terms. A certain degree of aberration is to be expected in almost every post-modern human being. Reasonable mental health will, therefore, have to be defined by the lack of gross disorders. A good standard for judging this would be the one apparently employed by health insurance companies, who are reluctant to pay for mental disorders that do not result in complete breakdown of normal life for the individual.
The diseases that indicate a major disruption in mental health would today include Bipolar Disorder, Schizophrenia, or a major depressive disorder. Further mental disorders that may or may not be considered as mere a lack of fine tuning by authorities may include obsessive-compulsive disorders, alcohol or drug addiction, or stress-induced nervous breakdown.
Mental health in the twenty-first century means a reasonable quality of life and functionality in individuals, despite the overwhelming odds against them.
Does Your Community Have Good Mental Health
The community mental heath team are there to help those who are suffering from mental health problems. The first port of call for anyone who thinks that they are suffering from some kind of mental health problem is your doctor who will be able to recommend the right sort of help.
The community mental health team consists of a number of professionals who are trained in their specific areas and can include psychiatrists, psychologists, occupational therapists, social workers, and of course the community psychiatric nurse or CPN. Some specific problems or issues that can arise in addition to existing mental health problems or which can exacerbate or trigger mental health problems and which might need extra consideration include:
o Financial problems
o Physical disabilities
o Housing issues
o Divorce or relationship problems
o Childcare issues
Certain kinds of mental health problems may result in different needs and may therefore require some specialist help to deal with and these can include:
o Elderly depression and dementia
o Child or Teen depression
o Postnatal depression
o Bipolar disorder
o Schizophrenia
Obviously, finding one person fully qualified and skilled in all of these areas just isn't possible so the community mental health team work together in order to ensure that the best advice and support is available as many of the professionals involved will be trained in specialist areas that allow them to offer a better service to people suffering from specific problems. So who is likely to be involved in the community mental health team?
Psychiatrist
Patients can be referred to a psychiatrist by their doctor. After an initial assessment, the psychiatrist will recommend a suitable course of treatment and medication. If a mental health problem is particularly severe then they are also able to recommend that the individual be detained in hospital for a period of time. However, this is a last resort and also requires the approval of another doctor and a social worker who all agree that this is the best option for an individual concerned either for the individual's safety or for the safety of others.
Psychologist
Psychologists have an understanding of human behaviour, emotions and how the mind works and although they cannot prescribe medication they can offer various types of psychological therapies. Patients can be referred to them by the doctor or other members of the community health team.
The Key Worker
People suffering from mental health problems will usually be assigned a key worker, which can be anyone in the community mental health team. The key worker ensures that the individual gets the right kind of help that they need. They will regularly assess the progress of an individual and report back to the rest of the team.
Community Psychiatric Nurse or CPN
The key worker will often be a CPN who will usually make regular visits to people with mental health problems in their own homes. They offer an important lifeline for people who are feeling isolated and alone with their mental health problems or who are experiencing particular difficulties. They are aware of the many issues surrounding mental health and can listen as well as help people talk through their problems in a setting in which they feel comfortable.
The CPN will liaise with and work closely with other members of the team to make sure that any practical support and assistance is offered when needed. They monitor medication, make sure the individual knows how to take their medication and they also look out for additional symptoms or side effects of that medication. The family and loved ones of a person suffering from mental health problems often need additional support in order to understand mental illness and to be able to cope with it, the CPN can offer practical advice and guidance.
Occupational Therapists
Occupational therapists help individuals to cope with practical issues on a day to day basis in areas such as dressing, toileting and feeding themselves and can help individuals regain some control of their lives.
Social workers
Social workers can ensure that an individual gets access to various social services that will improve their quality of life and that they may be entitled to such as home help, respite care and perhaps admission to day or residential centres. They can also offer assistance in dealing with housing needs, financial difficulties or other social problems.
The best care
Many other people can be involved in the community mental health team including various support workers, therapists, counsellors, and of course loved ones. Together they all make sure that the individual suffering from mental illness gets the best care possible. Each team member can make a valuable contribution to the individual's quality of life and can help them not only to cope with their illness on a day to day basis but to regain control over their lives and integrate with the rest of the community in a positive and productive way.
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Posted: May 18, 2012 |Comments: 0 |
Health Information Management Programs
Find Health Information Management Programs in the United States and Canada. Today, health information management programs are essential to candidates aspiring for job opportunities in physicians' offices, home healthcare businesses, outpatient clinics, hospitals, nursing homes and other medical facilities.
While no two health information management programs are alike, it is essential to review course offerings at schools and career-training institutes that offer this and related programs. Though the majority of health information management programs are offered as degreed courses, a number of educational facilities may extend medical office specialist training, which can be completed as a job-specific course that results in a diploma or certificate.
Health information management programs are often accredited, and require successful completion of certification from the American Health Information Management Association. Common studies in health information management programs include liberal arts, and comprehensive health services administration training.
Graduates of health information management programs will have gained the knowledge and skills to successfully plan, direct, coordinate and supervise overall healthcare administration duties. Because healthcare managers (or medical and health service managers) must maintain client/patient records, it is critical that these healthcare workers continue education in computer technology and medical software to keep up with business demands.
Though States vary in regulations, students who desire to work in nursing care facilities as health care administrators must complete one of several health information management programs and have obtained a minimum of a Bachelor's degree. In addition, a licensing examination is also required.
According to the U.S. Bureau of Labor Statistics, growth in this field is expected to be positive; and individuals who have successfully completed all studies in any one of a number of health information management programs have the potential to achieve annual earnings of over $117k.
Find your dream job! Let education within fast-growing industries like massage therapy, cosmetology, information technology, healthcare, business, and others get you started! Explore career school programs near you.
Health Information Management Programs
©Copyright 2007
The CollegeBound Network
All Rights Reserved
NOTICE: Article(s) may be republished free of charge to relevant websites, as long as Copyright and Author Resource Box are included; and ALL Hyperlinks REMAIN intact and active.
Health Information Management Programs
Find Health Information Management Programs in the United States and Canada. Today, health information management programs are essential to candidates aspiring for job opportunities in physicians' offices, home healthcare businesses, outpatient clinics, hospitals, nursing homes and other medical facilities.
While no two health information management programs are alike, it is essential to review course offerings at schools and career-training institutes that offer this and related programs. Though the majority of health information management programs are offered as degreed courses, a number of educational facilities may extend medical office specialist training, which can be completed as a job-specific course that results in a diploma or certificate.
Health information management programs are often accredited, and require successful completion of certification from the American Health Information Management Association. Common studies in health information management programs include liberal arts, and comprehensive health services administration training.
Graduates of health information management programs will have gained the knowledge and skills to successfully plan, direct, coordinate and supervise overall healthcare administration duties. Because healthcare managers (or medical and health service managers) must maintain client/patient records, it is critical that these healthcare workers continue education in computer technology and medical software to keep up with business demands.
Though States vary in regulations, students who desire to work in nursing care facilities as health care administrators must complete one of several health information management programs and have obtained a minimum of a Bachelor's degree. In addition, a licensing examination is also required.
According to the U.S. Bureau of Labor Statistics, growth in this field is expected to be positive; and individuals who have successfully completed all studies in any one of a number of health information management programs have the potential to achieve annual earnings of over $117k.
Find your dream job! Let education within fast-growing industries like massage therapy, cosmetology, information technology, healthcare, business, and others get you started! Explore career school programs near you.
Health Information Management Programs
©Copyright 2007
The CollegeBound Network
All Rights Reserved
NOTICE: Article(s) may be republished free of charge to relevant websites, as long as Copyright and Author Resource Box are included; and ALL Hyperlinks REMAIN intact and active.
Health Information Management Programs
Find Health Information Management Programs in the United States and Canada. Today, health information management programs are essential to candidates aspiring for job opportunities in physicians' offices, home healthcare businesses, outpatient clinics, hospitals, nursing homes and other medical facilities.
While no two health information management programs are alike, it is essential to review course offerings at schools and career-training institutes that offer this and related programs. Though the majority of health information management programs are offered as degreed courses, a number of educational facilities may extend medical office specialist training, which can be completed as a job-specific course that results in a diploma or certificate.
Health information management programs are often accredited, and require successful completion of certification from the American Health Information Management Association. Common studies in health information management programs include liberal arts, and comprehensive health services administration training.
Graduates of health information management programs will have gained the knowledge and skills to successfully plan, direct, coordinate and supervise overall healthcare administration duties. Because healthcare managers (or medical and health service managers) must maintain client/patient records, it is critical that these healthcare workers continue education in computer technology and medical software to keep up with business demands.
Though States vary in regulations, students who desire to work in nursing care facilities as health care administrators must complete one of several health information management programs and have obtained a minimum of a Bachelor's degree. In addition, a licensing examination is also required.
According to the U.S. Bureau of Labor Statistics, growth in this field is expected to be positive; and individuals who have successfully completed all studies in any one of a number of health information management programs have the potential to achieve annual earnings of over $117k.
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Rebuilding the Tower of Babel - A CEO's Perspective on Health Information Exchanges
Defining a Health Information Exchange
The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.
This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective."
United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.
History of Health Information Exchanges
Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.
In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.
In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.
Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.
A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.
Regulatory Aspects of Health Information Exchanges and Healthcare Reform
The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.
The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.
History of Health Information Partnership TN (HIPTN)
In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.
By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper.
Current Status of Healthcare Information Exchange and HIPTN
Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.
A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.
The Future of HIP TN and HIE in Tennessee
Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.
One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.
The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.
Hospital Implications of HIP TN (A Call to Action)
From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.
Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!
Rebuilding the Tower of Babel - A CEO's Perspective on Health Information Exchanges
Defining a Health Information Exchange
The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.
This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective."
United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.
History of Health Information Exchanges
Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.
In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.
In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.
Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.
A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.
Regulatory Aspects of Health Information Exchanges and Healthcare Reform
The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.
The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.
History of Health Information Partnership TN (HIPTN)
In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.
By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper.
Current Status of Healthcare Information Exchange and HIPTN
Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.
A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.
The Future of HIP TN and HIE in Tennessee
Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.
One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.
The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.
Hospital Implications of HIP TN (A Call to Action)
From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.
Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!
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Defining a Health Information Exchange
The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.
This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective."
United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.
History of Health Information Exchanges
Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.
In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.
In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.
Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.
A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.
Regulatory Aspects of Health Information Exchanges and Healthcare Reform
The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.
The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.
History of Health Information Partnership TN (HIPTN)
In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.
By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper.
Current Status of Healthcare Information Exchange and HIPTN
Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.
A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.
The Future of HIP TN and HIE in Tennessee
Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.
One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.
The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.
Hospital Implications of HIP TN (A Call to Action)
From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.
Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!