The Beacon Community Cooperative Agreement Program grew out of a larger federal strategy to use health information technology (IT) as a foundation for improving the nation’s health care system. It was funded as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, and was administered by the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services. The Cincinnati, Ohio, metropolitan area was one of 17 U.S. communities to participate in the federal Beacon Community Cooperative Agreement Program to demonstrate how health IT could be used to improve health care.
In an article in Health Affairs May issue, I and my co-author Tara Trudnak, PhD describe Cincinnati’s efforts and the applicable lessons for other communities seeking to transform care and improve quality through the use of information technology. (Additional team members include Rhonda Christopher , M.Ed., OTR/L, PCMH-CCE who led quality improvement for the diabetes population at Cincinnati, and Keith Mandel, MD, MS, FAAP and Mona Monsour, MD, MS, FAAP, leaders in the asthma initiative.)
Given $13.7 million to spend in 31 months, the Cincinnati project involved hundreds of physicians, 87 primary care practices, 18 major hospital partners, and 7 federally qualified health centers and community health centers. The thrust of the project was to build a shared health IT infrastructure to support quality improvement through data exchange, registries, and alerts that notified primary care practices when a patient visited an emergency department or was admitted to a hospital. A special focus during this project was on applying these tools to patients with adult diabetes and pediatric asthma.
Despite some setbacks and delays, the basic technology infrastructure was built, the alert system was implemented, 19 practices focusing on diabetes improvement were certified as patient-centered medical homes, and many project participants agreed that the project had helped transform care. However, the experience also demonstrated that the ability to transfer data was limited in electronic health record systems, that considerable effort was required to adapt technology to support quality improvement, and that the ambitious agenda required more time for planning, training, and implementation than originally thought.
The successes and challenges experienced by the Cincinnati Beacon Community have yielded important lessons that will inform other communities embarking on a similar path. Of note, some of these challenges will require resolution at the federal level, such as strong standards for interoperability as part of Meaningful Use requirements.
The future of care transformation in a community or health system through interventions such as the one described here depends on the ability to sustain the transformation within practices and to expand it beyond them. Technology and quality improvement are essential ingredients in such transformations, and payment reform is also needed to provide the incentives for improvement. These final ingredients have been added in Cincinnati in the form of a recently-approved Accountable Care Organization and a community-wide initiative to pilot a payment reform model.
The article was written by Gerry Fairbrother, Ph.D. a senior scholar at AcademyHealth and an Adjunct Professor of Pediatrics at the University of Cincinnati.