Health information exchanges

November 2010
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Health Information Exchanges
Pro f i l i n g fo u r e f fo r t s

Today’s HIEs are succeeding where previous ones failed.
Here’s how four of them are getting doctors to share
patient data to improve care and cut costs.
By Marianne Kolbasuk McGee

Report ID: S2201110

A n a l y t i c s . I n f o r m a t i o n We e k . c o m


CO NTENT S 3 Author’s Bio
4 Executive Summary
5 HIEs Get Doctors Sharing Data and Boost Efficiency
6 A Network for Everyone
7 Louisiana Rural Health Information Exchange
8 State Exchanges Under Way
F

10 HealthBridge
O

10 Where to Learn More
11 Michiana Health Information Network
E

12 Chesapeake Regional Information System for Our Patients
L

12 Five Key HIE Vendors
B

14 The Beacon Communities
A

15 More Like This
T

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2 November 2010 © 2010 InformationWeek, Reproduction Prohibited



Marianne Kolbasuk McGee has been reporting and writing
about IT for more than 20 years. She joined InformationWeek in
1992 and covers a variety of issues, including IT management,
Marianne careers, skill and salary trends, and H-1B visas. McGee also
Kolbasuk McGee
closely follows healthcare IT issues, including the federal govern-
ment’s stimulus spending program for expanding the adoption of electronic
medical records systems. McGee holds a B.A. in communication arts from
Long Island University’s C.W. Post campus. She can be reached at
mmcgee@techweb.com.




Executive Summary
There are about 200 health information exchanges in the United
States today, and that number is growing fast, particularly now that the
federal government is expected to make the ability to exchange patient
data electronically part of the “meaningful use” criteria that physicians and
hospitals have to meet to get funds to help them deploy electronic health
record systems.

HIEs feed data into patients’ EHRs from doctors and hospital visits, as well
as lab and other medical tests done at outside facilities. They alert doctors
when information is available, helping speed decision-making by provid-
ing faster access to data. They also cut down redundant testing and help
ensure patient safety by letting all caregivers know what medications a
patient is taking and other pertinent information. Most important, HIEs
ensure that all doctors providing care to a patient have the most up-to-
date and comprehensive information.

While there’s a lot of enthusiasm for these networks, not everyone is com-
fortable. There is a steep learning curve, and physicians are having to get
beyond petty concerns about how other doctors might use patient data to
steal patients and that patients could use easier access to their data to
change doctors more frequently.

HIEs aren’t new. Many were launched over the last decade without solid
business models and didn’t succeed. Now, with big money behind getting
healthcare providers to install and use EHR systems, it’s possible that HIEs
will have a better chance of surviving. This report looks at four that
appear to be off to a solid start.




HIEs Get Doctors Sharing Data and Boost Efficiency
The push to get doctors using electronic health records is well underway. In tandem with that
effort is one that will ensure that healthcare providers are able to share patient records—not
just doctors in the same city or region, but ones across the country. To meet that need, health
information exchanges are quickly being developed.

These networks give doctors fast, easy access to information about tests and lab results, and
other doctors’ diagnoses. They ensure that all doctors providing care to a patient have the most
up-to-date and comprehensive information on the patient’s condition. They also speed deci-
sion-making by providing faster access to information; cut down redundant testing by provid-
ing results of all tests a patient has had; and ensure patient safety by letting all caregivers know
medications a patient is taking and allergies he or she has.

Many HIEs enable the sharing of electronic health information among providers in a local
community. Others connect providers across a region. And, more recently, HIEs are being
developed across entire states and among neighboring states. The federal government is estab-
lishing standards to link local and regional HIEs into a national network (see “A Network for
Everyone,” page 6, for more on the national effort).

Some HIEs focus on sharing specific kinds of data that comes from patients’ EHRs, such as
their problem and allergy lists, drug histories, hospital discharge summaries, and radiology and
lab reports. Others are more comprehensive, providing a platform to share many different
kinds of patient data.

The broader goal for these HIEs is to make it easier for health information to follow patients
wherever they get care, letting healthcare providers securely access data in order to make more
informed clinical decisions.

There are about 200 HIEs in the United States, according to the eHealth Initiative, a non-
profit group that advocates using IT to drive quality, safety and efficiency in healthcare.
That number is growing rapidly, particularly now that the federal government is expected
to make exchanging patient data electronically part of the “meaningful use” criteria that
physicians and hospitals must comply with to get funds under the American Recovery and
Reinvestment Act. Besides incentive money to get healthcare providers using EHRs, the
feds also are providing $564 million in ARRA funds to help states deploy HIEs and expand




existing ones. Earlier this year, the Department of Health and Human Services awarded
states or an organization designated by states grants ranging from $4.6 million to $38.7
million (see “State Exchanges Underway,” page 8).

While there’s great enthusiasm for these networks, everyone isn’t comfortable with them. Some
doctors don’t want to give up paper-based processes for digital ones, says Dr. Mark Sandock,
who recently retired from a medical practice in South Bend, Ind. As with EHRs, there’s going to
be a steep learning curve, says Sandock, who now works as a consultant.

Physicians also worry that sharing data makes it easier for colleagues to steal patients and for
patients to easily switch doctors. But those fears are fading as doctors start using HIEs. “People
are recognizing that it’s not as much a competitive issue. It’s a convenience issue,” says Tom
Liddell, executive director of the Michiana Health Information Network. With the meaningful

A Network for Everyone
The original vision of NHIN as a network of regional

O
n top of all the regional and local health in-
formation exchanges, the federal govern- networks made it difficult for individual doctors with
ment has a national exchange in the works. limited IT resources to be a part of the national ex-
The Nationwide Health Information Network change, says Bob Steffel, CEO of HealthBridge, a non-
is a set of standards, services and polices to enable se- profit organization that runs an HIE of 28 hospitals, 17
cure sharing of health data over the Internet. local health departments, and 700 physician offices and
NHIN, which is being developed by the Department clinics around Cincinnati. The new approach provides
of Health and Human Services with input from the more flexibility, Steffel says. “When NHIN was originally
healthcare industry and others, aims to let health infor- conceived, we scratched our heads and wondered how
mation follow patients as they move among caregivers are they going to pay for this, and why would you do
and institutions locally and around the country. The abil- this,” he says.
ity to electronically exchange data is expected to be one Smaller practices and individuals can download open
of the requirements healthcare providers have to meet source software, called Connect, to access NHIN and even
to demonstrate “meaningful use” of e-health records and set up their own HIEs. Connect was originally developed
qualify for federal incentive money. to let federal agencies share health data and includes a
NHIN, originally called the National Health Informa- core ser vices gateway, enterprise ser vice components
tion Infrastructure project, was started in 2002 with the and a universal client framework that lets users develop
goal of tying together regional health information or- applications using the enterprise service components.
ganizations. Today, it’s also bringing together state- and NHIN Direct is an offshoot of Connect that includes addi-
community-based HIEs—which in some cases are re- tional standards and specifications to support point-to-
placing failed or faltering regional groups— and even point interactions between organizations, such as labs
individual providers. and physicians offices.




use criteria now expected to include HIE use, “it will be more difficult for a provider not to
participate in a data exchange,” he says.

HIEs aren’t new. Over the last decade, regional health information organizations, known as
RHIOs, were launched with data sharing as a core part of their mission. Public and private
grants funded many of these earlier efforts, and they looked quite promising initially, but
fell apart when money ran out and healthcare providers didn’t want to fund these efforts
themselves.

One of the most notable ones that didn’t make it was the Santa Barbara County Health Data
Exchange. Launched in 1999, it aimed to get physicians in Santa Barbara County, Calif., using
EHRs and sharing data. That ambitious project shut down in late 2006 when the initial $10
million grant money ran out, and healthcare providers in the region failed to see the value in
paying to keep it going.

Santa Barbara and some other disappointing HIE efforts were launched years prior to the feder-
al government current effort. Now, with big money being used to encourage healthcare
providers to install and use EHR systems, e-prescribing, computerized physician order entry,
and other health IT systems, it’s possible health information exchanges will have a much better
chance of surviving. What follows is a look at four HIEs in different parts of the country, each
with different goals but all of them very promising efforts.

Louisiana Rural Health Information Exchange
The Louisiana Rural Health Information Exchange, or LaRHIX, was launched three years ago to
serve 1.3 million patients in north central Louisiana, a poor rural area underserved by primary
care doctors. It was formed by the Rural Hospital Coalition, a statewide non-profit organization
that gets funding from the state to work with Louisiana’s rural hospitals.

Because of the shortage of doctors in rural Louisiana, patients often must wait three months or
more for appointments with specialists like cardiologists and pulmonologists. They frequently
must travel great distances to get to those specialists, a significant hardship for low-income
patients who don’t always have cars and can’t afford other means of transportation to get to the
medical center for in-person visits, says Jamie Welch, LaRHIX CIO. Many patients end up not
seeing specialists, and that often results in “a domino effect” of serious—sometimes deadly—
medical complications, Welsh says.




State Exchanges Under Way
The federal government recently awarded grants to states to develop health information exchanges.
Here are the 10 largest awards:

California Health and Human Services Agency
Received $38.8 million to create a statewide HIE as part of more than $101 million in American Recov-
ery and Reinvestment Act funding awarded to California for health IT efforts and healthcare job cre-
ation programs. The ARRA funding also included more than $31 million for two Regional Extension
Centers in California.
Texas Health and Human Services Commission
Received $28.8 million, part of which will go to support the development of a Medicaid-based HIE system.
New York eHealth Collaborative
Received $22.4 million. NYeC is a public-private partnership that serves to build consensus on state
health IT policy priorities, and to collaborate on state and regional health IT implementation efforts.
Florida Health Information Network
Received $21 million to provide health data exchange services to healthcare providers. It aims to pro-
vide timely information at the point of care and improve the coordination of patient care among
healthcare providers.
Illinois Department of Health Care and Family Services
Received $18.8 million to fund the creation of the Illinois Office of Health Information Technology,
which will develop and implement the state’s health information technology initiatives, including a
statewide HIE.
Pennsylvania Health Information Exchange
Received $17.1 million to create a secure statewide network for sharing e-health information among
healthcare providers and patients.
Michigan Health Information Network
Received $15 million to improve healthcare quality, cost, efficiency and patient safety through elec-
tronic exchange of health information.
Ohio Health Information Partnership
Received $14.8 million to develop an HIE as part of $43 million Ohio was awarded in ARRA funding to
develop healthcare IT, including job training and two Regional Extension Centers.
Missouri Office of Health Information Technology
Received $13.8 million to support the development of a secure, statewide HIE. MO-HITECH is part of
the state’s department of social services.
Georgia Department of Community Health
Received $13 million to develop and implement a statewide HIE to facilitate access and use of clinical
data to provide safe, timely, efficient and effective patient-centered care.




IBM’s Websphere and Carefx’s Fusion provide the infrastructure for LaRHIX’s Web portal,
which gives healthcare professionals real-time access to medical records from any provider
database connected to the network. Doctors associated with the 24 participating hospitals
are able to share patient information with each other and with the Louisiana State Univer-
sity Medical Center in Shreveport. The exchange allows specialists at the medical center
to review patients records and tests without requiring patients to make the long trip to
the city.

Authentication and single sign-on capabilities, policy-based authorization, identity federation
and auditing access are being provided by CA’s Identity and Access Management products.
Telemedicine technology, including Webcams, let specialists examine patient remotely. The ulti-
mate goal is for LaRHIX to serve the entire state, although a specific timeline hasn’t been estab-
lished for that, Welch says.

Hospitals participating in the exchange can use the EHR system they want, so they aren’t
forced into adopting a system that doesn’t work for their needs, Welch says. A federated data
model stores patient information at the source, but doctors have secure access to patient’s data
from any participating hospital.

Another service of the exchange is mobile digital mammography, where radiology equipment
and technicians are sent to the rural hospitals to conduct exams. Images can be sent to spe-
cialists at the Shreveport medical center for analysis. Before leaving the screening, a remote
radiologist reads a patient’s images, and informs the patient if any suspicious lesions were
spotted that need to be further examined or tested. “If you let a woman leave the screening
without a diagnosis, you may never see her again for treatment,” says Welch. LaRHIX recent-
ly received a $250,000 federal grant to expand to its mobile mammography to seven addi-
tional hospitals.

The state of Louisiana has provided LaRHIX’s $40 million in funding so far. It wasn’t difficult
to convince state legislators that there was a need for this type of service, Welch says. “The
hard sell was the money,” she says.

Many of the rural hospitals participating in LaRHIX have been able to deploy EHR systems with
LaRHIX funds and are already HIMSS stage 6 or 7, the highest stages of EHR adoption, Welch
says. Now with the federal government’s $20 billion-plus EHR incentive program underway,




more Louisiana hospitals will likely begin rolling out Where to Learn More
these systems, and that will make it easier to expand
the network statewide in the future, she says. > Interactive online map of state HIEs
across the country
informationweek.com/hc/02/map
LaRHIX “has done so much with so little money, in
only a couple of years,” says Jennifer Covich > National Information Health Network
Bordenick, chair of eHealth Initiative. There’s evi- (NHIN) specification, forums, and other
resources
dence that it’s already helping lower the incidents of
informationweek.com/hc/02/nhin
breast cancer among underinsured patients, she says.
> Community Portal for Connect, the
HealthBridge open source software to develop an HIE
There are two models for health data exchanges. or link to one that supports NHIN
informationweek.com/hc/02/connect
Regional ones like LaRHIX provide a broad health
information exchange that often involves state and local
governments, while smaller exchanges often serve a more defined community.

The large efforts typically rely on government funding to keep going and that money, like the
ARRA funds, is often in the form of grants. Once the money is spent, the question is whether
local and state governments have the money to keep the exchanges going. If they don’t continue
to fund these efforts, who will?

HealthBridge, a non-profit organization covering a 50-mile area near Cincinnati, is one of those
smaller efforts. The 13-year-old HIE is one of the oldest in the country, and it’s profitable. It
wasn’t created with a one-time grant and, until recently, hasn’t relied on government money.
Instead, HealthBridge took out loans that it’s still repaying. “It’s run like a business,” says CEO
Bob Steffel, and that’s the secret to its success.

HealthBridge is leading the Greater Cincinnati Beacon Collaborative, which has received a
$13.8 million federal Beacon Community grant that will fund its initiative to improve care for
asthmatic children and diabetic adults.

HealthBridge uses Axolotl’s HIE technology to connect more than 28 hospitals, 17 local health
departments, 700 physician offices and clinics, as well as nursing homes, independent labs, radiol-
ogy centers and others healthcare providers in the region, Steffel says. Although it covers a small
geographic area, the exchange operates one largest community-based secure clinical messaging sys-




tems in the country, delivering about three million clinical messages to more than 5,500 physicians
a month, Steffel says. Doctors get free subscription to the service that provides them with lab and
radiology reports, as well as hospital admission and transfer records, and electronic notifications
when patients visit emergency rooms and are admitted or discharged from hospitals. They can sign
up for other services, such as e-prescription services for less than $100 a month.

HealthBridge works with 30 EHR vendors, and patient information is sent directly to whichev-
er EHR system that a participating doctor uses. Physicians who don’t use EHRs, can receive the
patient information via fax, e-mail and even snail mail. HealthBridge delivers information to
every doctor in its region, and 96% of what it delivers is done electronically, Steffel says.

Hospitals, labs and other large data providers pay for the services because the exchange saves
them time and money. “If you faxed 20,000 reports per month, the question is whether the
doctor got it. With our services, you can answer that question,” Steffel says. HealthBridge rein-
vests the money it makes in expanding its services, including upgrading its infrastructure and
helping other communities launch HIEs.

The idea behind HealthBridge is that “healthcare is local,” Steffel says. While patients move,
travel and sometimes seek specialty care outside the HealthBridge region, “the bulk of health-
care is within a small radius,” he says.

Michiana Health Information Network
The Michiana Health Information Network, or MHIN, covers parts of Michigan and neighbor-
ing South Bend, Ind. Like many of the HIEs that so far appear to be most successful, 10-year-
old MHIN doesn’t use public money and is run like a business, says executive director Tom
Liddell. Labs, healthcare organizations and doctors that participate in MHIN pay fees for the
service, he says.

Data is stored and distributed from a central repository. Doctors pay $49 to $59 a month to
have their EHR systems automatically populated. It’s important for data users, like doctors, to
pay even a small fee, Liddell says. Otherwise, they can easily fall into the mindset that since it’s
free, “its worth is somehow devalued,” he says.

MHIN uses a Web-based real-time messaging product from Axoloti to send information to
practices that don’t have EHRs. Currently, the exchange has about 100 data sources, including




hospital admission and discharge data, and radiology and lab results. MHIN plans to add out-
patient surgical and endoscopy centers.

The system is used by approximately 3,500 providers, including 1,000 physicians. About 140
of those doctors already use EHRs and are able to contribute patient data to the exchange. The
goal for the next two years is to have 300 to 400 doctors contributing to the exchange.

When South Bend, Ind., physician Sandock’s practice signed up for MHIN’s services several years
ago, five doctors in the internal medicine part of the group saved a $1 million in transcription
costs in the first year alone. They no longer had to dictate reports on lab and other medical test for
the hundreds of patients who were tested at outside facilities each week and whose test results
were previously sent back on paper. Instead, the MHIN network sends the doctor an e-mail alert
when a patient’s lab results are available, and it automatically feeds the results into the patient’s
EHR. “Quality of care is improved, and you’re saving money at the same time,” Sandock says.

Chesapeake Regional Information System for Our Patients
Maryland’s Chesapeake Regional Information System for our Patients, or CRISP was started in 2006.

Five Key HIE Vendors
clinical information are sent to physician in real-time.

T
here are dozens of vendors offering health infor-
mation exchange products, but only five are con- 3) RelayHealth. McKesson’s connectivity business is
sidered in more than 10% of buying decisions, considered in 16% of HIE buying decisions. Its SaaS prod-
according research firm KLAS. Those five are: ucts interoperate with more than 20 EMR and practice
1) Medicity. This company was considered in 23% of management systems.
HIE buying decisions. Its products include NovoGrid, a 4) Informatics Corporation of America. ICA, is con-
deployable, intelligent network with vendor-neutral sidered in 11% of HIE buying decisions. Its CareAlign
technology connecting hospital systems to any EHR, hos- products provide standards-based interoperability and
pital or ancillary system. Medicity also offers iNexx, an include clinical portal, secure messaging, order and re-
open, modular platform for plug-and-play healthcare IT sult automation, population management and report-
app design and delivery. ing, and patient matching capabilities.
2) Axolotl. It’s considered in 22% of buying decisions. 5) Epic. This vendor is evaluated in 11% of HIE buying
The company’s products are based on open standards, decisions, but its data exchange products are considered
with cloud-based infrastructure and software-as-a-service mainly for Epic-to-Epic links. However, its HIE offerings inter-
applications. Axolotl’s Elysium Express products provide face with non-Epic systems. Epic’s products include Care
hospital-to-physician and physician-to-physician connec- Everywhere, an interoperability framework that allows the
tivity. Lab results, transcribed reports, referrals and other data exchange between Epic and non-Epic EMR systems.




Its first phase will launch this month, letting healthcare practitioners and other providers in
Montgomery County, Md., exchange patient data, including demographic information, lab and radi-
ology results, hospital discharge summaries, and other reports.

Using a $10 million state grant and a $9.3 million federal grant, CRISP is expanding statewide, brin-
ing in hospitals and other community healthcare providers that have already set up their own HIEs.
It also will set up direct links to its exchange for healthcare providers that haven’t already joined an
HIE. In the meantime, CRISP has been chosen as Maryland’s Regional Extension Center to help area
healthcare providers deploy EHR systems.

The nonprofit is using Axolotl’s HIE technology to create the infrastructure for the secure
exchange of data under a model where content from hospitals, such as discharge reports, is stored
in edge devices either hosted by the hospitals or third parties, says Scott Afzal, CRISP’s program
director. This content will be automatically pushed to a patient’s primary care doctor. Other
authorized clinicians, like emergency room doctors, would be able to query the exchange as to
whether any data is available about a patient arriving in the ER.

Hospitals and doctors won’t be charged to use the data initially. Once there’s enough data in the
HIE for the value to be clear, they’ll have to pay a still-undetermined subscription fee that won’t be
based on transaction volume so as not to provide a disincentive to using the exchange, Afzal says.

Coming up with a sustainable model is a significant challenge, Afzal says. “We want to be sure
there’s enough data available to make it valuable to participants” before phasing in subscription
fees, he says.

CRISP will work with EHR vendors and service providers, such as eClinicalWorks and
AthenaHealth, to ensure that continuity-of-care data can be exchanged on the Maryland HIE,
Afzal says. Such documents contain a patient’s clinical, demographic and administrative data.

CRISP’s overall mission is to make it so healthcare providers don’t compete based on the avail-
ability of information, Afzal says, but instead on the effective use of health IT to improve care
and make practitioners more efficient. Reducing readmissions to hospitals and promoting fol-
low-up care are among the goals, and doctors should expect that reimbursement models will
shift to encourage these sorts of improvements, he says. When that happens, health informa-
tion exchanges, like EHRs, will take off because everyone will benefit.




The Beacon Communities
I
n addition to providing funds for the deployment of million to enhance care of pulmonary and congestive
e-health record systems, the American Recovery and heart patients.
Reinvestment Act includes $235 million awarded to G HealthInsight in Salt Lake City, Utah, received $15.7
17 organizations that are serving as Beacon Communi- million for diabetes management projects.
ties. These are programs and projects that serve as role G Indiana Health Information Exchange was awarded
models and pilot programs in their use of health IT and data $16 million to expand into additional communities.
exchange for improving quality of care for chronically ill pa- G Inland Northwest Health Services in Spokane, Wash.,
tients. Many Beacon Community efforts rely on the estab- got $15.7 million for diabetes preventative services.
lishment of a solid health information exchange to work. G Louisiana Public Health Institute in New Orleans,
The Beacon Community grants—averaging about $15 was awarded $13.5 million to improve diabetes control
million each—were awarded by the U.S. Department of and smoking cessation rates.
Health and Human Services to 15 communities in May, and G Mayo Clinic in Rochester, Minn., received $12.3 mil-
two more in September. The funding is to help these ef- lion grant for projects aimed at reducing hospitalization
forts build out their health IT infrastructure and data ex- costs and emergency room visits by diabetics and asth-
change capabilities. matics, and improving health disparities in rural and un-
Among the two latest Beacon Communities selected derserved communities.
by HHS is Greater Cincinnati HealthBridge, an HIE pro- G Rhode Island Quality Institute in Providence, R.I., was
filed in the main section of this report. HealthBridge was awarded a $15.9 million grant for improving manage-
awarded $13.8 million to advance its health information ment of diabetic patients and immunizations rates.
exchange program by developing new quality improve- G Rocky Mountain Health Maintenance Organization
ment and care coordination initiatives focusing on pedi- in Grand Junction, Colo., got $18.9 million for projects
atric asthma patients, adult diabetics and smokers. that include improving blood pressure control in dia-
The other Beacon Community recently named was betic and hypertension patients and reducing unneces-
South-Eastern Michigan Health Association, which was sary emergency room visits.
awarded $16.2 million. SEMHA and its partners in the G Southern Piedmont Community Care Plan in Con-
greater Detroit area will use health IT tools and strate- cord, N.C., was granted $15.9 million for coordination of
gies to prevent and better manage diabetes. care projects for chronically ill patients.
Here’s the list of 15 Beacon Communities chosen by G The Regents University of California in San Diego,
HHS in May: was awarded $15.3 million for projects including ex-
G Community Services Council of Tulsa, Okla., received panding pre-hospital emergency field care using elec-
a $12 million grant for a community-wide health infor- tronic data transmission and improving continuity of
mation system for doctors to monitor and improve care care for military personnel and veterans.
of diabetic and obese patients. Tulsa has one of the high- G University of Hawaii at Hilo received $16 million to
est rates of cardiovascular disease deaths in the nation. implement a regional health information exchange to im-
G Delta Health Alliance of Stoneville, Miss., was prove care of patients with chronic diseases and in areas
awarded a $14.6 million grant for diabetes management. where there are shortages of healthcare professionals.
G Eastern Maine Healthcare System in Brewer, Me., got G Western New York Clinical Information Exchange in
$12.7 million for telemedicine projects to help elderly Buffalo, N.Y., was awarded $16 million for project involv-
patients in long-term care facilities and at home. ing clinical decision support tools and telemedicine for
G Geisinger Clinic in Danville, Pa., was awarded $16 diabetic and heart patients.




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houses more than 900 reports and briefs, and more than 100 new reports are slated for
release in 2010. InformationWeek Analytics members have access to:

Strategy: Electronic Health Records—Time to Get Onboard Four healthcare organiza-
tions are taking different approaches to implementing EHR systems, but their goals are
the same: to help the practices they work with make the transition.

Strategy: EMR-Ready Servers In this report, we advise midsize practices on how to get
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selecting software to deciding the in-house vs. outsourced question.

Research: Salary Survey 2010—Healthcare Health IT talent is in demand as healthcare
providers of all sizes rush to deploy electronic medical records. But pay in this industry
is on the low end and isn’t growing as fast as you’d expect, given demand.

Strategy: Securing EMR Systems As healthcare providers start implementing electronic
medical records, security must be a top priority. Here’s what you need to do to ensure
lock down your system.

Best Practices: IP Telephony in Healthcare Settings Best practices for healthcare
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