From The Field F E B R U A R Y 2 0 , 2 0 1 2 Making the Connection with HIT KELLY DUNKIN Vice President of Philanthropy, Colorado Health Foundation H ealth information technology (HIT) is now widely Health Network (a nationally recognized regional health regarded as a promising tool for improving the information network conceived by physicians and based in quality, safety, and efficiency of the health care Colorado’s Western Slope), the Colorado Health Foundation delivery system – largely due to a major influx of federal began to explore ways to promote and mobilize HIT funding and the Affordable Care Act (ACA). Despite its throughout the state. newfound prominence, the benefits of HIT were only In 2007 the foundation launched Healthy Connections, a championed by a small cadre of health care professionals a multiyear, multimillion-dollar initiative designed to use HIT mere six year ago. to increase the number of Coloradans who receive quality, As the vice president of philanthropy for The Colorado integrated care. Healthy Connections, the largest single Health Foundation – one of only a handful of early “champi- investment the foundation had made up to that time, ons” of HIT – I have personally seen how this emerging represented a significant departure from the organization’s technology can positively influence the way health prior work. organizations function. The foundation works to make Colorado the healthiest state For the uninitiated, HIT uses computer hardware and in the nation by increasing the number of Coloradans with software to store, protect, retrieve, and transfer clinical, health insurance; ensuring they have access to quality, coordi- administrative, and financial information electronically within nated care; and encouraging healthy living. Prior to Healthy health care settings. Studies by the RAND Corporation and Connections, the majority of our funding was used for “direct the Center for Information Technology Leadership estimate services.” Some within the organization questioned how an the net savings for implementing HIT nationwide at $80 bil- investment in HIT would advance our vision. After much lion a year. Another study shows that 95 percent of avoidable input (and scrutiny), the initiative was approved because the tests could be eliminated through the deployment of fully foundation board of directors agreed it aligned effectively interoperable HIT systems in the United States. with our newly adopted goals of improving quality and While automated processes and connectivity have been coordination while reducing costs in health care. commonplace in other sectors, many in the health care field continue to labor under the weight of printed medical records NEXT STEPS and paper charts when it comes to managing and sharing Through Healthy Connections, the foundation focused fund- information. Until recently most HIT focused on administra- ing efforts on safety net organizations with an emphasis on tive and financial transactions, rather than on improving the patient-centered primary care. Phase One of Healthy quality of care delivered. Connections centered on health care providers who already Despite proven benefits, attempts to push HIT into the 21st had HIT systems in place and wanted to leverage their tech- century were met with little support. For example, in 2005 nology further. We invested $2.5 million to encourage and President George W. Bush proposed dedicating $100 million support innovative efforts from “early adopters” in HIT. to finance HIT – only $50 million was ultimately approved (a Phase Two reached out to rural health care providers who mere fraction of the $17 billion later allotted to HIT as part of could not obtain the equipment or the expertise to implement the federal stimulus act). While few others ventured into the electronic health records (EHRs) without support. (An EHR is field, the California HealthCare Foundation laid much of the an electronic record of health-related information that con- groundwork for other foundations by investing significant dol- forms to nationally recognized coordination standards, which lars in HIT. can be developed and managed by authorized clinicians across more than one health care organization.) In total, the founda- SEIZING THE INITIATIVE tion invested $9.4 million to build and support Inspired by the California HealthCare Foundation’s efforts HIT – issuing 75 grants to 43 organizations in Colorado. and the visionary work of organizations such as the Quality Healthy Connections provided funding for a wide range of HIT-related projects. The foundation not only provided efforts, Colorado’s safety net clinics have made significant money for hardware and software, but also for support and gains in adopting HIT throughout the state. In fact, the professional expertise to help grantees develop an HIT plan Colorado Community Health Network reports that 12 of that enabled them to use the technology to maximum 15 federally qualified health centers in the state have fully success. implemented a certified EHR system, while the remaining Under the four-year initiative, we supported organizations three are in the process of implementing systems. at different stages of readiness for HIT. Some of our grantees According to evaluation results conducted by Full Circle had implemented systems that completely eliminated paper Projects, Inc. (an independent consulting firm) in late 2010 charts and were looking to build their capacity. Some and early 2011, 100 percent of the Healthy Connections required “practice management” software to capture patient grantees surveyed had implemented an EHR system or demographics, schedule appointments, and generate reports. planned to do so. The firm also estimated that 439,321 Others were starting from scratch. Coloradans now benefit from EHR systems in large measure due to the Healthy Connections initiative. CHALLENGES AND OPPORTUNITIES Robyn Leone, director of the Colorado Regional Extension Center, credits the foundation for deploying HIT in more As Healthy Connections evolved, the foundation streamlined safety net clinics throughout Colorado and for positioning its support of clinics adopting HIT, meeting our grant part- many of those centers ahead of the curve nationally. Along ners where they were on the HIT continuum and providing with accelerating the adoption of HIT in Colorado, Healthy support tailored to their needs. For example: Connections established the use of HIT as the “standard” • An alliance of safety net health providers, the North among many of the organizations we fund. Colorado Health Alliance, already had embarked on a $1.8 Read more about Healthy Connections’ success stories in million project to improve its HIT systems. The organiza- Healthy Connections in Colorado: A Primer for HIT Success, a tion used its Healthy Connections grant to bring three new report published by the foundation late last year. organizations into the fold and added comprehensive behavioral health to the mix. LOOKING AHEAD • Another grantee, Mountain Family Health Centers, As patients and health professionals realize the promise of developed a “data warehouse” to store data extracted from improved outcomes and greater efficiencies through HIT, actual patient EHRs that would allow them to keep track there is still much work to be done. Despite great strides in of chronic disease population trends and monitor health recent years, health care is still well behind the information outcomes. technology curve in Colorado and throughout the nation. As evidenced by the Health Connections experience, however, • Yet another grantee, High Plains Community Health there is increasing promise and evidence that HIT adoption Center, received funding to support the salary of an HIT and refinement is accelerating. resource manager to manage clinical outcome reports, Though Healthy Connections concluded in mid-2011, the support implementation of the center’s quality improve- initiative continues to make a difference in Colorado as the ment plan, provide training for new and existing staff, and state’s health care providers increasingly share health data support optimization of HIT systems. across different organizations through health information exchange. The Colorado Regional Health Information Though we knew HIT was emerging as a powerful and Exchange, another foundation grantee, is collaborating necessary tool in the future of health care, we had not antici- with partners throughout Colorado with the goal of pated that the federal government would make a significant facilitating the adoption of HIT in every community in the investment. Through the Health Information Technology state by 2015. for Economic and Clinical Health (or HITECH) Act, the Working with our partner organizations, the foundation is government earmarked $17 billion for providers that apply committed to supporting HIT as an essential technology that “meaningful use” of EHR systems to improve health care helps our grantees meet their missions of providing high- quality and delivery. Simply put, meaningful use means quality health care. Investment in HIT is one that will reap providers need to show that they are using certified EHR benefits for individuals throughout Colorado and technology in ways that can be measured in terms of quality nationwide. and quantity. HITECH positioned many foundation grantees to take advantage of federal incentive payments. As additional testimony to its importance in delivering quality care, incentives for HIT adoption were included in the ACA. MEASURING RESULTS Thanks to the pioneering work of our grantees and other Views from the Field is offered by GIH as a forum partners through Healthy Connections and other statewide for health grantmakers to share insights and experiences. If you are interested in participating, please contact Faith Mitchell at 202.452.8331 or fmitchell@gih.org.