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By Executive Order 35 on April 6, 2006, Governor Phil Bredesen created the eHealth Advisory Council to oversee the state’s efforts to allow providers to securely share information in an attempt to reduce medical errors, quickly transfer important medical data in an emergency situation, extend the reach of healthcare to rural areas through telemedicine, limit duplicative diagnostics by providing all partners with access to results from previous tests, improve communication, set up a safe way to ePrescribe, and ultimately, to improve access to quality healthcare.

With the stroke of his pen, Bredesen put Tennessee in the forefront of the nation’s eHealth efforts. Through a contract with AT&T, Tennessee is on the way to creating the necessary infrastructure to allow the smooth, HIPAA-compliant transfer of information envisioned by the governor to reduce costs and improve outcomes.

To lead the effort, the governor tapped Antoine Agassi, who has more than two decades experience in healthcare information technology, to serve as the founding director and chair of the eHealth Advisory Council. Agassi recently announced he would leave his state position for a return to the private sector as Chief Information Officer for Cogent Healthcare effective July 1. He will, however, remain active with the state’s eHealth plans as he continues in the role of chairman of the Council.

He stressed that eHealth must play a prominent role in the state’s overall healthcare platform if Tennessee is to improve the health, access and quality of care for all its citizens.

Agassi said the Council has implemented two important measures to ensure connectivity. The first is the creation of an eHealth Exchange Zone with protections specific to health information on the Tennessee Information Infrastructure (TNII), Tennessee’s existing statewide broadband network. The second is disbursement of state-funded seed grants to help providers get beyond initial cost barriers to getting connected on the Exchange Zone and implementing the necessary software to utilize available health information technology.“The Governor and the State of Tennessee are maximizing the capabilities of the State of Tennessee’s TNII Network by offering the eHealth Exchange to healthcare practitioners across Tennessee,” said Gregg Morton, president of AT&T Tennessee.
“We are pleased to provide the enhanced network, as well as our technological expertise, for this first-in-the-nation effort.”

AT&T already operates much of Tennessee’s connectivity and the Exchange Zone is built on the private, secure, high-speed broadband network that already exists in all 95 counties. Through the eHealth initiative, that network is being opened up to private entities, although firewalls will separate the various functions.

“This is nothing new,” Agassi pointed out. “We’re just leveraging state assets to accelerate eHealth.”

He added, “Regardless of for-profit or not-for-profit status, healthcare practitioners can buy off the state-negotiated contract and get substantially reduced rates for broadband connectivity.”

Technicians with AT&T explained there are numerous options. While some providers have been concerned that DSL is not available in their area, both AT&T representatives and Agassi said that was not a barrier to participation.

“One of the real benefits of the way we can deliver this service is our ability to scale it to meet the needs of solo healthcare practitioners, as well as entire healthcare systems,” commented AT&T’s Morton. “We can deliver the right-sized connection to any participating doctor, practice, clinic or hospital anywhere, anytime, across the state.”

In order to actually access information at a high rate of speed and to efficiently transfer large files such as radiology images, most practices would probably need a T-1 line, which is a step up the food chain from DSL. Agassi said AT&T is contractually obligated to make a T-1 line available anywhere in the state.

To make such an investment affordable, the Council is providing seed grants. Although the grants started with primary care physicians and pediatricians, the funding opportunity was expanded on June 15 to be available to any provider who is allowed under state law to write a prescription (including specialists, osteopathic physicians, advanced practice nurses and physician assistants). The focus, however, remains on rural areas. Agassi noted 67 of the state’s 95 counties are rural and that these areas typically have the fewest healthcare resources.

“We will fund awards on a first-come, first-served basis until the funds are depleted,” he said of the one-time grants of $6,000 per site and $3,500 per provider. Agassi added the overall budget for the initiative was close to $14 million.

The site grant allows a practice to secure broadband access and is limited to one per location. A three-physician practice with one location, therefore, would have the opportunity to secure $10,500 in state funding to install an eHealth system plus $6,000 for connectivity. Agassi said the state provides the safe zone to conduct eHealth but allows each entity to decide what applications make the most sense for their practice.

“But,” he continued, “this is not free money … there is a string attached. By accepting this money, they (providers) must ePrescribe for a period of two years.”

He added that when the practitioners see TennCare patients that are under 21 years of age, they are required to look up the patient’s record to see if there are any deficiencies in the EPSDT panel. If so, Agassi noted, “They must perform the necessary services to fill the gap and bring that patient up to speed.”

However, he added, the state isn’t asking providers to do this at no charge. Any services performed are billable at the standard TennCare rates.

To date, at least one practice in 80 of the 95 counties has received a state connectivity grant. Currently nearly 1,300 physicians have joined the ranks of ePrescribers and more than 835 sites have used state and federal grants to connect to the eHealth Exchange Zone.

Agassi called the state’s investment “tiny” in light of the expected returns in reduced adverse events and the empowerment of physicians to administer the necessary care to patients.

Once on the Exchange Zone, individual entities would have to agree to share information with each other. However, the envisioned route is much like the licensing agreements provided when new software is installed, with terms of the agreement determined by the participants. Ideally, a standard data sharing document would be easy to pull up with both parties clicking “agree” for almost instant access to information, which would be particularly important in an emergency situation. In any case, the entity sharing data will determine who has access to which data and under what circumstances.

While there is undeniably a long way to go before the state’s providers are fully connected, Agassi said Tennessee is leading the way in the process. Although other states are running similar pilots, they are almost all on a small regional basis tying together geographic neighbors.

“For us, we opted to do the heavy lifting and concentrate everything we do on all 95 counties,” he said.

Agassi pointed out electronic financial transactions, which are so ingrained into society today, also had to go through an incubation period similar to what the healthcare industry is now facing.

He added, “Healthcare tends to be a lagging market mover, and we’re trying to take away the barriers that kept us from adopting this technology.”



July 2008

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