Editor's note: This story was updated at 2:25 p.m. July 19, 2007. Please go to Corrections & Clarifications to see what has changed.

Vermont's new public/private regional health information organization might soon offer a model for tackling the challenges of chronic diseases. The RHIO, called Vermont Information Technology Leaders (VITL), recently received a $7.5 million contract to create a statewide network to help physicians manage chronic diseases such as diabetes and heart problems.

The project calls for a disease-management system to perform direct interventions with patients to ensure that they are adhering to their treatment plans. In the process, it could help the RHIO form a more complete picture of each patient by integrating information from multiple sources.

VITL and similar organizations are also at the forefront of using the latest security technologies to make data quickly available to authorized users while locking out those who should not have access.

Greg Farnum, VITL's president, said joint RHIO/disease-management efforts could ease clinicians' transition from paper-based to electronic health records by providing an intermediate step to a more dynamic technology.

"Someday, when the electronic health records are sophisticated enough, doctors will be able to view all of the chronic-care triggers and alerts from right inside the electronic health record," he said. "There will be a single entry point for data and analysis."

Cost control
Public-sector groups in Kentucky and Calgary, Alberta, are also planning to combine a RHIO with a third-party disease-management tool. The groups work with insurance companies to connect their systems behind the scenes to gather, distribute, analyze and act on patient data.

Gathering information can be tricky because patients often go to more than one doctor, which means that individual clinicians might have an incomplete picture of a patient's condition and treatments. In addition, some primary care physicians are reluctant to engage in disease-management interventions because they don't want to appear to be second-guessing their colleagues.

Despite those problems, the promise of better outcomes and lowered costs is attracting insurers and public agencies to that type of approach to disease management, particularly as Medicare and Medicaid payments grow. BlueCross BlueShield of Vermont estimates that almost half of all Americans suffer from at least one chronic illness. Those illnesses account for 90 percent of all hospital days, 83 percent of prescriptions and 50 percent of emergency-room visits.

Because disease management considers how multiple caregivers treat a patient, a regional public-sector program might have more to gain from the practice than a single private hospital, said Dr. Chris Hobson, director of clinical consulting at Orion Health, which develops disease-management software.

"Disease management offers improved clinical outcomes and the chance to save money if you take a big-picture view of the whole health care system," he said. "That may involve shifting care from a hospital to a wellness program to see a reduction in total costs. We can use the RHIO platform to our advantage by building on its shared data."

By acting as intermediaries between health care providers and disease-management companies, RHIOs could become a central clearinghouse for data gathered from hospitals, clinics, physician offices and pharmacies.

Focus on outcomes
When Kentucky moved 230,000 public employees to a self-funded health care plan in 2006, officials wanted to keep a close eye on costs and outcomes. "We set in motion an investment in our employees and their health care," said Chris Corbin, exe
cutive director of Kentucky's Office of Health Policy.

But positive returns on that investment were by no means guaranteed. Kentucky ranks first in the country for adult smokers and fifth in obesity cases - two factors that often lead to chronic diseases and ballooning health care costs.

Officials tackled obesity head on with a weight-management program for health plan members called Why Weight Kentucky? The initiative tapped ActiveHealth Management's disease-management software and services, including nurses who offer obese patients support, education and follow-through on treatment plans.

"Our goal is to improve the quality of these individuals' lives and at the same time take more control over the economic side of our health insurance plan," Corbin said.

After less than a year, it's still too early to gauge results, he said, but what's already clear is the need for accurate and complete patient data. For now, ActiveHealth gets claims information on procedures and medication from Humana, the health plan's underwriter. But the company is exploring how RHIOs could play an important role in the future.

"In the world of data, more is really more," said Dr. Greg Steinberg, ActiveHealth's chief medical officer. "The better the data, the more we can do in terms of care considerations. It's better for everybody."

Long-term benefits
The Calgary Health Region RHIO uses Orion technology for its three-year-old Chronic Disease Management initiative, which tracks patients with heart disease, diabetes, hypertension, high cholesterol and respiratory illnesses. The system serves the city's three main hospitals, urban emergency-care centers and some rural hospitals.

The disease-management module mines data to generate alerts and to-do lists, said Pat Reader, the RHIO's director of continuum care in the advanced technology portfolio. "So if your rules say you need to see a patient again in three months, it will make that task come due at that time," she said. "We know from past work that if you keep a diabetic within [healthy] ranges for 10 to 12 years, you may avoid the need for kidney transplants and dialysis. You reduce the amount of intervention required in the long run."

Vermont's RHIO will add Orion Health's disease-management application to its health information exchange, which is under construction. "Orion offers a fairly flexible Web page tool that allows for care plans to display the latest data on a patient," Farnum said.

"The application relies on the [IT] architecture behind it to continuously query the database and displays results in an organized fashion to the doctors and care providers," he added. "Many care providers, especially those that don't yet have electronic medical records, can't assess how many chronic-care patients they have. Any tools we can provide to identify who is chronically ill in their patient population really help."