Enter the Internet
The community health information movement was in serious jeopardy.
CHMIS, the public sector, and CHINs had all sounded great in their promises
and then failed to deliver much of substance. The intra-enterprise advocates
were saying, “I told you so.” The movement was at best moribund. Most
604 Part V. Case Studies: Applications of Information Systems Development
community stakeholders did not see a need for a community health information
infrastructure. Those that did see the need could not see a way to make it
happen. Then, a new trend emerged that changed everything—the Internet.
The Internet revolution has been thoroughly documented and chronicled.
This chapter will not revisit this subject. Suffice it to say that the importance
of the Internet revolution to the community health information movement
cannot be overstated. The rapid deployment and adoption of Internet technology
rescued the movement from the brink and offered immediate benefits:
Taking the “Why” Question off the Table
Community health information advocates spent much of their time on “missionary”
work. They needed to convince increasingly skeptical healthcare
communities that connectivity would and should happen. As long as the
debate raged around the why question, little concrete progress could be made
on implementation. By the end of 1997, the long-running debate of interenterprise
versus intra-enterprise had been decisively resolved in favor of
inter-enterprise. It was clear that simply connecting up within the four walls
of the enterprise would not cut it in a “wired” world. The Internet was demonstrating
the benefits of the seamless network the “community” missionaries
had always described.
Providing the Means
Although the primary struggles of the movement to date were more political
than technological, the absence of a means to execute the vision, even for
those who were convinced of the need, was problematic. Internet technology
offered a relatively cheap, increasingly ubiquitous, standards-based means to
link community stakeholders. The Internet answered the most important aspect
of the “how” question. It was clear that some form of Internet technology
was going to be the ultimate community health information network.
Leveraging Investment
For a community health information initiative to succeed, there had to be a
supporting infrastructure. Individual enterprises had to invest in automation,
move data from paper to electronic form, and train and provide incentives for
users. The lure and the promise of the Internet brought forth significant levels
of information infrastructure investment. Hospitals, health plans, physicians,
and government began to see health information technology as a key strategic
investment. Similarly, on the commercial side, risk capital began to flow
to the healthcare information technology (IT) vendor community.
This convergence of the Internet and the community health information
movement spawned a new breed of initiatives. Tyler Chin, of Faulkner &
Gray, described them as “CHINInternets” (T. Chin, personal communication,
27. The Community Health Information Movement 605
1997). These initiatives have seized on the promise of the Internet in many
different ways to meet the shared health information needs of their communities.
In many cases, the sponsors of these efforts explicitly acknowledged the
problems of the past and sought to build their new models on a firm foundation
of lessons learned. Before reviewing specific initiatives, it is helpful to
consider the key lessons learned.
Lessons Learned in the Community
Health Information Movement
As can be seen from the history described, there were many lessons to learn
from the CHMIS, CHIN, and public sector experience. Although the learning
experience varied across markets, it is possible to distill a set of the most
salient lessons that seem to predominate in all settings:
• The need to differentiate between needs and wants and to target needs. A
want is defined as something nice to have. A need is something that someonewill pay for. Targeting needs is critical. Even in the not-for-profit
environment, someone has to pay in order for progress to be made. Many of
the community health information initiatives that failed never adequately
appreciated the distinction between needs and wants. They generated
considerable excitement by discussing all the functionality that frustrated
health industry stakeholders had long wanted but were largely unwilling
to invest in. Then, when the call came for funds, the sponsors heard the
refrain, “I assumed someone else would pay for it.” These initiatives ended
up trying to fulfill big dreams with small budgets, a recipe for failure.
Savvy community health information operators have learned to cut through
the wants and to focus on the needs.
• The need to build the business case for a concept. Much of the early workin the community health information movement was related to sharing the
vision. The need was so profound that it seemed more important to solve
the systematic problems rather than quibble over how to fund the solutions.
This ignored the day-to-day reality faced by the enterprises participating
in the community endeavor. These enterprises faced demands for IT
solutions well out of proportion to the budget dollars available to fund
them. The enterprises tended to prioritize those solutions that addressed
urgent needs and could be justified on a business basis. To secure
community investment required a clear delineation of the benefits that
will be generated. Long-term vision might inspire, but a good return on
investment is more likely to engender support and participation.
• The need to focus on more than a network. Prior to the Internet revolution,most of the community health information initiatives focused most of their
energies on developing a network capability. The emergence of Internet
technology as a network solution allowed community organizers to expand
their vision. Whereas some community groups leveraged Internet
606 Part V. Case Studies: Applications of Information Systems Development
technology to deploy private networks (Intranets or Extranets), many other
groups focused their energies in other complementary areas—for example,
development and implementation of standards, security and privacy
practices, education and training, applications, etc. The presence of Internet
technology has freed the community health information movement to go
beyond CHINs and offer more than just a network.
• The need to use the competitive versus the collaborative model. Idealistsin the community health information movement cherished the hope that
much of the health information infrastructure would be built on a
cooperative basis. The growth of the commercial IT sector has proven this
belief false. In addition, many of the enterprises that comprise the local
health services community have their own electronic strategy. These
enterprises are not looking to either a community group or a commercial
entity to meet their needs. Rather, they plan to do it themselves. In fact,
many of these enterprises explicitly reject a collaborative strategy because
they see their electronic-health (e-health) initiatives as a means to
competitively distinguish themselves. This has forced community health
information groups to acknowledge a fundamental truth: most of the health
information infrastructure will be built under the competitive model. The
challenge for community groups is to prioritize those limited collaborative
components of the overall infrastructure that most effectively leverage
and support the competitive investments being made.
• The need to define roles. The early community health informationinitiatives perceived the need to “do it all.” They saw few ready partners at
hand and assumed that if they did not address a key component of the
community infrastructure, it would not get built. To some degree, this
perception placed community groups into a competitive situation with
others working to achieve similar objectives. As the movement matured,
community groups recognized that they could not and should not attempt
to build the entire health information infrastructure. There are roles for
many different types of players. Linking and leveraging the amalgam of
talent and resources devoted to improving the health information
infrastructure makes far more sense then working at cross-purposes. The
community groups need the enterprises, and vendors to be successful in
their work. The vendors and enterprises can accelerate what they are trying
to achieve with the help of the community groups. Clearly defining roles
and constantly seeking to build and strengthen partnerships are now seen
as crucial aspects of the work of a community health information group.
• The need to narrow project scope and to avoid creeping incrementalism.Trying to live down the claim of being “too big to be true” has dogged
many of the more ambitious community health information efforts. Focus
has become an important element of success. Most current community
health information initiatives have narrowed the scope of their work
considerably from the halcyon days of CHMIS. Taking slow, measured,
clearly defined steps that address urgent business needs of key stakeholders
27. The Community Health Information Movement 607
is widely seen as the most likely path to success for community health
information initiatives.
• The need to address privacy matters. The concerns about health informationprivacy first encountered by CHMIS have continued to proliferate. The
gradual automation of the health industry, coupled with highly publicized
security failures, have sensitized many policy makers, media people, and
ordinary consumers to the need to protect the privacy of personal health
information. For many people, their health records are the most sensitive
data they have. Although the community health information movement
has always seen itself as a force for social good, privacy advocates see any
aggregation of health information as a potential threat. Privacy and security
concerns are here to stay, at least for the immediate future. Addressing
these concerns is both an obligation and an opportunity for the movement.
The Community Health Information
Movement in Action
The lessons described are best understood in the context of specific initiatives.
Listed below are six leading community health information initiatives.
Together, these six organizations illustrate the past, present, and future of the
community health information movement.
Minnesota Health Data Institute
The Minnesota Health Data Institute (MHDI) is a unique public/private partnership
in the state of Minnesota. MHDI operates as a private, not-for-profit
organization; yet, it was created by the Minnesota legislature in 1993. The
21-member board, comprised of purchasers, providers, payers, the public sector,
and consumers, works closely with the Minnesota Commissioner of Health
to accomplish its mission:
“To design and implement an integrated state wide health care data system to supportthe information needs of health care consumers, purchasers, providers, payers, policymakers,
and researchers in measuring and improving the quality and efficiency of
health care services in Minnesota.”2
MHDI has programs in quality measurement, electronic commerce, and
privacy. MHDI has lived through the evolution of the community health
information movement. It was originally a CHMIS site, and it sought to execute
its mission on the comprehensive scope of the CHMIS vision. However,
early on, the community leaders recognized that the full-scale CHMIS approach
would not work in Minnesota. They sought instead to create a CHINlike
approach. Their solution was a private Intranet called MedNet.2
MedNet sought to match the community governance of CHMIS with the
“network-of-networks” CHIN concept.
608 Part V. Case Studies: Applications of Information Systems Development
MedNet was not designed to be the sole network in the community. It was
envisioned as a means to link the existing networks of key health care enterprises.
MedNet enjoyed early success as some of the major market participants
connected to the network. However, usage was limited, and transaction
volumes suffered. In an effort to boost network usage and diversify its electronic-
commerce (e-commerce) offering, MHDI pioneered an eligibility application,
the central query system (CQS). The CQS was designed as a common
eligibility portal for public sector and private sector eligibility data. Minnesota
Medicaid was the initial source of eligibility content. In addition to the
CQS and MedNet, MHDI delivers educational services related to e-commerce
and recently to issues related to the Health Insurance Portability and Accountability
Act of 1996 (HIPAA).
MHDI has also grappled with the privacy issues. It played a key role in
helping Minnesota draft its health privacy laws. Since then, MHDI has expanded
its work in this area to include Public Key Infrastructure (PKI). Along
with groups in four other states (Washington, North Carolina, Massachusetts,
and Utah), MHDI participates in the national HealthKey program that is exploring
approaches for deploying PKI in health care.3
Recently, MHDI evolved its e-commerce offering in a new direction. MHDI
and the Pointshare Corporation entered into an agreement to outsource CQS and
MedNet. MHDI decided it was better able to achieve its objectives by leveraging
the capabilities of a private company. Pointshare saw MedNet and CQS as a costeffective
way to enter a market and deliver services. This type of partnership
highlights the creative approaches community health information initiatives are
taking to achieve their goals. MHDI is unique in structure, experienced in the
gyrations of the community health information movement and innovative in its
program design. Those interested in the progress and potential of the movement
will closely watch MHDI as it moves into the future.
Utah Health Information Network
The Utah Health Information Network (UHIN) is the only statewide CHIN that
really achieved success. Whereas the CHMIS sites struggled and most CHINs
never got off the ground, community leaders in Utah had the vision and
capability to organize and implement a statewide network. In 1993, UHIN
was incorporated as a nonprofit company with a mission to provide the consumer
of healthcare services with reduced costs and improved healthcare
quality by creating and managing an electronic value-added network, standardizing
healthcare transactions, and gathering and providing data to a statewide
repository. A board that is selected by the membership governs UHIN.
The UHIN membership capitalized the company and funds the operation of
the network. In addition, UHIN has received support from the state of Utah.4
UHIN understood early on the “wants versus needs” dilemma and the requirement
to make a business case. The organization focused tightly on a
limited scope of work and required anyone who wanted to play to have a
stake in the game. Although UHIN is a classic community health information
27. The Community Health Information Movement 609
network, it takes great pride in emphasizing that it runs the network as a
business. UHIN leaders know that community participation is voluntary and
predicated on the network’s capability to meet its customers’ needs.
Currently, UHIN offers an electronic data interchange (EDI) solution for
healthcare claims and remittances that serves all interested payers and providers
in Utah. As the organization looks toward the future, UHIN envisions
expanding its suite of services to include:
• Eligibility
• Referrals
• Patient records
• Lab tests
• Digital images
In the conduct of its business and in its role as community educator, UHIN
heavily emphasizes the importance of standards. UHIN has taken a leadership
role within the sate of Utah to help the healthcare community get ready for
HIPAA and the requirement to implement national standards for common
healthcare transactions. In addition, UHIN has diversified its work in two
other areas. First, like MHDI, UHIN is one of the five participating state organizations
in the HealthKey program. UHIN sees the emerging importance of
privacy and security and wants to explore ways to make it work on a costeffective
basis for all participants. Second, UHIN recently entered into an
innovative arrangement with the Utah Department of Health to collect data
that is legally required by statute. For those data sets mandated by law, members
may use UHIN to submit to the state. This arrangement highlights a
clever and efficient arrangement to meet public health information needs by
leveraging a community asset. UHIN will continue to explore creative ways
to keep pace with the changing face of e-commerce, serve its customers, and
apply its most valuable commodity—the commitment of its members.
New England Healthcare EDI Network
The New England Healthcare EDI Network (NEHEN) is a fairly recent entrant
to the community health information scene. It offers another interesting model
for how community efforts can evolve through partnership. In the mid-1990s,
the Massachusetts Health Data Consortium (another HealthKey participant)
brought together key stakeholders to explore how best to address shared ecommerce
needs. These enterprises were very clear that they did not want to
create what they deemed a CHIN. To them, a CHIN was a single network
solution for all. In contrast, they sought a means to keep their independence
and engage in collaborative activities of limited scope. In this context, the
Massachusetts Health Data Consortium created and operated the Affiliated
Health Information Networks of New England.
Initially, the affiliated group focused primarily on information and education
as it considered how best to work toward its vision of “non-CHIN” collaboration.
In 1997, the group hit on an idea for a network-of-networks model
610 Part V. Case Studies: Applications of Information Systems Development
that would meet the requirement to offer common benefits while preserving
individual discretion. This idea was NEHEN. NEHEN was created with five
key benefits in mind:
• A tool to achieve HIPAA compliance;
• Delivery of service efficiencies through EDI;
• Reduced time to implement EDI on a large scale;
• Maintenance of individual business flexibility; and
• Reduced cost of EDI implementation through coordination and
standardization.
The founding members of NEHEN included major healthcare payers and
providers in New England (Harvard Pilgrim Health Plan, Tufts Health Plan,
CareGroup, and others). The founders sought a private partner to staff the
effort, to bring it to fruition, and eventually to operate the network. They
selected Computer Science Corporation (CSC) for this purpose.5
To get buy-in, CSC embarked on an extensive communications effort with
key executives. CSC emphasized how NEHEN could address urgent business
needs and provide a positive return on investment. Once the decision was
made to proceed, CSC created the network infrastructure with a secure Extranet
and a thin layer of software at each enterprise location. The network initiated
operations with the eligibility transaction. As of 2001, NEHEN was generating
12,000 eligibility inquiries per day.5 NEHEN intends to move forwardwith other HIPAA-compliant transactions, including claims, referrals, remittance,
and others.6
NEHEN is a blend of the community model and the commercial IT world.
Incubated in a community not-for-profit setting, NEHEN has now incorporated
as a limited liability corporation. The network is governed by its member
participants and is open to any enterprise that wishes to join and adhere to
common practices. CSC operates the network at the behest of the members.
NEHEN is now being seen by other e-commerce companies as a cost-effective
platform to conduct their business. The possibility exists that NEHEN will
become the common health information network for both health industry
participants and the vendors that serve them.
Wisconsin Health Information Network
When knowledgeable people talk about CHINs and describe the failure of the
concept, they may add, “except for WHIN.” Just as UHIN is seen as the one
statewide CHIN that succeeded, the Wisconsin Health Information Network
(WHIN) is often seen as the one community-based CHIN that succeeded. WHIN
began where others ended up: as a partnership between Ameritech, a large
telecommunications company, and Aurora Health Care, a major integrated
delivery system based in Milwaukee. The genesis for this partnership was the
effort Aurora made in the 1980s to connect physician offices to Aurora’s hospital
information system (HIS). In working with the physician community
27. The Community Health Information Movement 611
and other stakeholders to connect and share information, Aurora began to
sense both the need for inter-enterprise connectivity and the challenge of
bringing it about. After surveying members of the community, Aurora and
Ameritech concluded that a single hospital solution was not the right way to
proceed. It made far more sense to develop an “all-community” solution.7
In 1992, Aurora and Ameritech responded to the community’s concern by
creating WHIN. Since that time, WHIN has enjoyed steady growth and a reputation
as the most visible and successful CHIN in the country. WHIN offers a
comprehensive list of services including:
• Network access
• Clinical information
• Eligibility data
• Referral processing
• On-line document retrieval
• Electronic forms
Because of its hospital roots, WHIN offers a deeper level of functionality to
hospital and physician participants than most other community health information
networks. The recipe seems to have worked. WHIN currently has over 1200
physicians and 3000 total subscribers generating over 100,000 transactions a
month. It is also worth noting that as a for-profit company, WHIN is profitable.7
As the CHIN market deteriorated nationally, Ameritech got out of the business.
WHIN is now owned and operated by Aurora. WHIN has worked hard to
justify the benefits of a community health information network. In 1994,
WHIN published an independent study conducted by the University of Wisconsin.
The study was designed to assess the impact of the CHIN. Sample
findings about the impact of WHIN include8:• Savings of $5.10 for medical record requests handled by WHIN for the
hospital
• Savings of $1.00 for referral requests and $2.50 for clinical informationrequests handled by WHIN for physician offices
• Benefits such as rapid response time, fewer lost charges, and decreased
patient stays in hospital
WHIN now seeks to consolidate its gains and potentially expand its offering to
neighboring markets. It endures as the role model for a successful CHIN.
Healtheon/WebMD
Many people would not consider Healtheon/WebMD as a community health
information initiative. Instead, they would see the company as a vendor or a
“dot.com.” However, an examination of the objectives of the company in light of
the evolution of the community health information movement makes it clear that
Healtheon/WebMD may be the ultimate end-state of the movement.
612 Part V. Case Studies: Applications of Information Systems Development
Healtheon/WebMD (recently renamed WebMD) describes itself as follows:
“WebMD provides connectivity and a full suite of services to the healthcare industrythat improve administrative efficiencies and clinical effectiveness enabling high quality
patient care. The Company’s products and services facilitate information exchange,
communication and transaction between the consumer, physician, and healthcare
institutions.”9
Change the names and this could easily be a statement from the early days
of CHMIS. Indeed, it could be argued that WebMD has an even more ambitious
plan than CHMIS and the CHINs. WebMD seeks to wire up the healthcare
industry “end-to-end” on a national basis.
WebMD is really an aggregation of health information technology companies
that have been acquired over the years by Healtheon, the original organization.
This national conglomeration of companies includes physician practice management
systems, consumer health information sites, claims processors, network
service providers, and others. Its breadth of offering, matched with strategic partnerships,
has positioned WebMD as the dominant player in its market space.
This dominant position provided the company with enormous capital resources
after it went public. Even with current market fluctuations, the total market valuation
of WebMD is well into the billions. WebMD’s list of corporate partners and
investors reads like a who’s who of industry. The result is a war chest that most
community health information groups could only dream about. However, the
clout and scope of the company has also caused problems. Some have been
concerned by the potential for WebMD to overwhelm, dominate, and
disintermediate healthcare enterprises. The creation of a rival organization,
MedUnite, by major health plans was a direct response to WebMD. The company
has also struggled to seamlessly integrate the component companies into a single,
efficient, operating entity. As a consequence, WebMD’s fortunes and the prospects
of the e-health sector it leads have been depressed recently.
The question for the community health information movement is whether
WebMD and other e-health companies will displace the movement, push enterprises
closer to community-based alternatives in a defensive reaction, or eventually
emerge as a powerful partner and enabler. Many on Wall Street and on main
street will be watching with great interest to see how the story plays out.
Pointshare
Like WebMD, Pointshare is a commercial organization. However, it has a very
different strategy. Pointshare derives its strategy from the premise that health
care is a local service. The company believes that in order to deliver value, it
must operate at the community level. Pointshare positions itself as a national
leader in connecting healthcare communities with secure online business
services that enhance communications, improve the delivery of patient care,
and increase operating efficiency. To achieve this objective, Pointshare provides
the following offering:
27. The Community Health Information Movement 613
• Connectivity• Eligibility
• Referrals
• Clinical messaging
• Access to medical content
Pointshare also carries other value-added services on its network, including
access to an Internet-based immunization tracking system operated by
public health and a private company.10
Pointshare is smaller and more regionalized than WebMD. It is interesting
to note that Pointshare is based in Washington State and also operates in
Minnesota. These are two of the states discussed as leaders of the community
health information movement. This overlap is not coincidental. Pointshare
has long supported and participated in community health information efforts.
The company sees such community groups as blazing a trail for adoption and
use of its services. Where communities have come together to address shared
information needs, Pointshare believes it will find a more receptive market
for what it sells.
Specifically, in Washington State, Pointshare is working with a community
collaborative called the Network Advisory Group (NAG). NAG is a consortium
of major payers and providers dedicated to coordinated
implementation of HIPAA. Pointshare is the initial intermediary that links the
payers and providers together. In Minnesota, as previously mentioned,
Pointshare has partnered with MHDI to operate its network. Like WebMD and
other e-health companies, the challenge for Pointshare will be to deliver on
the promise of e-health in a less favorable investment climate. Pointshare is
trying to demonstrate that community health information networks are not
only a social good, but that they can also be good business
The Future
Using a circle as a metaphor for the community health information movement
means we come back to our starting point or near to it as we examine the
future and the implications for public health:
“Do it all together” is not going to work. The original vision whereby a
small group of community leaders in a top-down model wired up the world
and governed a unitary system is not palatable to the health industry or to
community stakeholders. Furthermore, it is not consistent either with the
nature of Internet technology or the nature of the commercial organizations
seeking to harness it. The health information infrastructure must permit discretion
at the individual enterprise level and perhaps even at the individual
user level.
“Do it all alone” is not going to work either. Those most deeply opposed
to the early vision of the community health information movement believed
614 Part V. Case Studies: Applications of Information Systems Development
there was no need for inter-enterprise connectivity or collaboration. They
expected to “own” on an exclusive basis all of their trading partners. These
trading partners would be connected directly to a single enterprise, and that
supposedly would solve the problem. The evolution of the healthcare market
place with many-to-many relationships already made this a questionable strategy.
The Internet revolution makes it a suicidal strategy. Like it or not, health
enterprises will be sharing data, customers, and trading partners for the foreseeable
future. The question is not if enterprises need to connect to others,
but how.
“Just let somebody do it for you” does not appear that it will work as a
concept. The commercial organizations moving into the community health
information space had high hopes that they would assume a role similar to the
one CHMIS identified 10 years ago. As the intermediary at the heart of the
network, they would sign everyone up, route traffic, extract data, and get rich
on the value they provided and the huge volumes of transactions they moved.
It is too soon to be definitive about this concept; however, the early returns
seem to indicate that this model won’t fly. Major health enterprises fear the
intermediary will either assume a monopoly role and mistreat them or assume
their role and disintermediate them. Furthermore, enterprises increasingly see
e-health as a means to competitively distinguish themselves. Therefore, they
are reluctant to turn it all over to a third party.
“Do it in partnership” seems to be the direction the market is currently
headed. The need for interoperability is a key driver of the partnership approach.
Health services is a many-to-many market place. This means there is
a tremendous cost to all participants if everyone does their work in isolation.
Interoperability is a critical component of any robust health information infrastructure,
just as it is in other industries. In this context, the enterprises, the
vendors, and the community groups are finding common ground. The enterprise
holds the data and sometimes the customers everyone wants access to.
However, the enterprise generally lacks the necessary capital, IT talent, and
field force to establish connectivity and get it used. The vendors have the
capital, the resources, and the incentive to execute on infrastructure development.
However, without the content and the customers, they have no way to
make the connectivity and applications valuable. The community group usually
lacks the capital, the content, and the resources. However, the community
group is often in the best position to build trust, foster collaboration, and
educate the stakeholders—all prerequisites for the successful pursuit of
interoperability. As can be seen with the examples profiled, enterprises, vendors,
and community groups are already finding exciting ways to partner.
What does this partnership approach mean for public health? It suggests
that public health needs to move aggressively to join the partnership. With
limited budgets and the requirement to assess populations, public health
organizations have wonderful opportunities to leverage the investments of
the personal health industry and the vendor community. Going it alone makes
no more sense for public health than it does for the healthcare enterprises.
27. The Community Health Information Movement 615
Specific partnership opportunities abound and are already under way in some
communities. These include:
• Immunization tracking. In Washington State, public health, Pointshare,and a company called HealthRadius are partnering with health plans and
providers to see if the same network used to transact the administrative and
clinical business of health care can be leveraged to track immunizations.
• Vital statistics. UHIN and the Utah health department are piggybackingreportable information on the same network developed for handling
administrative transactions.
• Lab results. Public health is attempting to extract and aggregatesurveillance information from clinical laboratory findings. Many
enterprises and the vendors that serve them have identified clinical results
reporting as a priority for the messaging services they are building and
deploying. This suggests a cost-effective partnership could be structured
to accommodate all users.
• Consumer information. Vast sums are being spent to attract consumers tothe Internet and particularly to medical content sites (WebMD, drkoop.com,
etc.). These initiatives offer public health a vehicle to disseminate
information on prevention.
As the community health information movement enters its second decade,
a different sort of promise beckons than was glimmering 10 years before. At
the beginning of the cycle, it was sharing grand visions and trying to make it
all come true at once. Now, the vision is entrenched, and the field is crowded
with those who want to help bring it about. The challenge for the community
health information movement is to make the right “picks”—pick an area of
focus, pick the right role, pick a good set of partners, and concentrate resources
to execute successfully. Over the next 10 years, the goals of the
movement’s founders can finally be realized.
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