This is a sermonette on what can be accomplished absent EHRs and an HIE when there is a a strong leader in a leadable community.
In It Takes A Region CD-Rom: Improving Chronic Illness Care the Robert Wood Johnson foundation proselytizes work it sponsored on regional approaches to managing chronic disease by the Wagner model. I reside in Humboldt County, one of the two rural counties that comprise the region in the title. Indeed, I am proud to say that the strong leader featured in the CD-ROM is my own physician, Dr. Alan Glaseroff.
With nary an EHR in site the Humboldt Diabetes Project has brought down the A1Cs of at-risk diabetics, more than doubled follow-up on and achieved these improvements in the SP-12 scores of diabetics in the study.
The only Health IT enabler has been a Web-based community version of the open-source Chronic Disease Electronic Management System (CDEMS) registry. Physicians that started using it for diabetic care have extended their interest to other diseases.
In part, it has been seeing the work here that has directed my interest to interconnecting the community of physicians that have EHRs and the rest of the healthcare world. I actively support the roll out of EHRs and the full-bore, carefully managed exchange and look up of patient information through HIEs. At the same time the success of Alan and this community makes it clear that IT-enabled progress does not need to wait and it will be necessary to support the interface between the two communities for many years.
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