State and Local HIT Sites
National Health Care Innovations Program
The National Governors Association has called on Congress to establish a National Health Care Innovations program to support state-led demonstrations in healthcare reform. Some of the demonstration programs would focus on deploying information and communications technology to improve services and improving quality of care. (National Governors Association, Feb.10, 2005)
Alaska
Alaska Federal Health Care Access Network
The AFHCAN project will attempt to bring better health care to Alaskans in rural areas, using telemedicine technologies. The 248 sites mobilized by AFHCAN to participate in the Alaska telemedicine project will include military installations, Alaska Native health facilities, regional hospitals, small village clinics, and state of Alaska public health nursing stations. AFHCAN designed a standard telehealth platform of which nearly 300 have been deployed in Alaska. AFHCAN also developed a robust enterprise-wide software solution that is hosted on 42 connected servers throughout Alaska, built a statewide satellite-based IP network reaching to nearly 200 sites, and developed support and training services to implement and sustain telehealth at the AFHCAN sites.
Southeast Alaska Regional Health Consortium
SEARHC, one of the oldest and largest Native-run health organizations in the nation, is a non-profit tribal health consortium of 18 Native communities which serves the health interests of the Tlingit, Haida, Tsimpshean, and other Native people of Southeast Alaska through a network of health care services spanning from prevention and education to outpatient clinics to inpatient hospital services.
Arizona
Arizona e-Health Connection Roadmap
The Arizona Health-e Connection steering committee will develop a roadmap for health care IT that will utline directions and goals for care providers, insurers and consumers. The committee will also identify resources to help with technical standards, including possible funding, and recommend patient privacy and security measures.
Arizona Telemedicine Program
The Arizona Telemedicine Program is a large, multidisciplinary, university-based program that provides telemedicine services, distance learning, informatics training, and telemedicine technology assessment capabilities to communities throughout Arizona. it was funded in 1996 by the Arizona legislature, which mandated that it provide telemedicine services to a broad range of healthcare service users including geographically isolated communities, Indian tribes, and Department of Corrections rural prisons. Currently the Arizona Telemedicine Program is providing medical services via both real-time and store-and-forward technologies in 20 communities.
Arkansas
University of Arkansas for Medical Sciences Telemedicine Program
Telemedicine technology gives community physicians the ability to instantly share visual and audio information with specialists at the University of Arkansas for Medical Sciences. Using telemedicine, doctors at the affiliate rural hospitals can consult with specialists in maternal-fetal medicine, endocrinology, exchange x-rays, EKGs, heart and lung sounds, and a wealth of information vital to making medical decisions with specialists hundreds of miles away. Forty-one affiliates in the Rural Hospital Program now have this technology and are part of the UAMS Telehealth network.
California
Alliance for Rural Community Health
Alliance for Rural Community Health provides policy, collaboration, project management and technology services to Community Health Centers in Northern California, covering 3,500 square miles and serving 37,000 patients. A current technology project is Mendocino SHARE (Securing Health Access and Records Exchange), a three-year development program designed to improve health outcomes and reduce costs associated with caring for uninsured and underinsured chronic disease patients accessing multiple healthcare sites.
California Regional Health Information Organization
The California Regional Health Information Organization - CalRHIO - is a collaborative, statewide effort to support the use of information technology and the creation of a secure health information data exchange system that will improve the safety, quality, and efficiency of healthcare for all Californians. It serves as an umbrella organization that brings together healthcare stakeholders to jointly develop all of the common elements - such as governance, operational processes, technology, and financing - that are required for the formation of one or more RHIOs within the state.
California Telemedicine & eHealth Center
CTEC, formerly known as the California Telehealth and Telemedicine Center (CTTC), has made significant contributions toward increasing the technological expertise of California health care organizations through capacity building, training, education, and regranting. In particular, CTEC has emerged as the primary source for hospitals and clinics in promoting the use of telemedicine and eHealth within underserved communities.
Northern Sierra Rural Health Network
NSRHN serves health care professionals, organizations and agencies covering more than 30,000 square miles of Northeastern California. Major services and activities of NSRHN since its inception in 1996 include managed care for isolated communities, telemedicine, videoconferencing and development of regional technology services.
Santa Barbara County Care Data Exchange
The Santa Barbara County Care Data Exchange (SBCCDE) operates as a public utility and allows patient-specific clinical information to be securely and readily accessible to any authorized person, including the patient. It serves the County of Santa Barbara as a peer-to-peer health information exchange, including the sharing of reports, results, and personal health information.
Colorado
Colorado Health Information Exchange
The Colorado Health Information Exchange (COHIE) project involves four major health centers in the development of a technical prototype for statewide health information exchange. In addition, throughout the state, several local projects are underway to implement health information exchange among a variety of local providers, hospitals and agencies.
Denver Health Telemedicine
Since its inception in 1995, Denver Health telemedicine specialists have been providing consultations to inmates at several jails and prisons throughout Colorado. Denver Health is the first and only Colorado program to furnish ongoing EMS/trauma consultations.
High Plains Rural Health Network
High Plains Rural Health Network was established in 1989 to provide economies of scale for rural hospitals in frontier and medically underserved areas of Northeast Colorado. In 1994, the Network expanded into Western Kansas and the Panhandle of Western Nebraska. After receiving a three-year grant from the Office of Rural Health Policy (ORHP) in 1995, the Network transitioned into a Telemedicine Network utilizing two-way interactive video conferencing technology to deliver specialty medical care, continuing medical education, and administrative business services to member hospital facilities throughout the region. HPRHN is now a totally member supported Telemedicine Network.
Delaware
Delaware Health Information Network
The Delaware Health Information Network (DHIN) was created by an act of the General Assembly and signed into law in 1997 as a public instrumentality of the state to advance the creation of a statewide health information and electronic data interchange network for public and private use. The DHIN organization falls under the purview of the Delaware Health Care Commission. The development of a clinical information sharing utility is the primary focus of DHIN at this time.
Florida
Florida Telehealth Work Group
The mission of the Department of Health Telehealth Work Group is to lead and provide strategic direction for the department's efforts as it relates to telehealth and telemedicine. The group works collegially to facilitate the use of advanced telecommunications technology in the enhancement of the mission, goals and objectives of the department by assuring coordinated, educated, and comprehensive deployment of services and resources.
Georgia
Medical College of Georgia Center for Telehealth
The Center for Telehealth at the Medical College of Georgia is involved in a variety of different projects and services. The Patient Data Management System (PDMS) simplifies and organizes the collection of all consult-related information, tracking administrative details, such as the time of the consult, the patient and providers' names and the names of the sites involved. Patient images and heart and lung sounds associated with telemedicine consultations can be captured and added to the patient's electronic record.
Hawaii
Hawaii Health Information Corporation
Hawaii Health Information Corporation is Hawaii's leading health care information organization which collects, analyzes and disseminates statewide health information to support efforts to improve the quality and cost-efficiency of Hawaii's health care services. It maintains one of Hawaii's largest healthcare databases, which contains nearly one million inpatient discharge records collected from Hawaii's 22 acute care hospitals for each year since 1993.
Indiana
Indiana Health Information Exchange
The Indiana Health Information Exchange (IHIE) is a non-profit venture backed by a unique collaboration of Indiana health care institutions. The strategy for achieving this vision is to "wire" health care - first in Central Indiana and eventually across the entire state - by creating a common, secure, electronic infrastructure that expand s communication and information-sharing among participating providers , hospitals, public health organizations, and other health care entities. Ultimately, the system will give providers better information for treatment purposes at the point-of-care, and it will give researchers a richer pool of data to guide more far-reaching treatment improvements over the longer run.
Kansas
University of Kansas Center for Telemedicine and Telehealth
Beginning in 1991 with a single connection to a community in western Kansas, the Kansas telehealth network has grown to more than 60 sites across the state. One of the functions of the KUCTT is to research telemedicine and telehealth applications, comparing the effectiveness of telemedicine to traditional health care delivery.
Kentucky
Kentucky e-Health Network
The Kentucky e-Health Network was created to help develop a secure statewide electronic network through which patients, physicians and other health care providers can access and transfer medical information.
Kentucky Health Care Infrastructure Authority
Senate Bill 2 (SB 2) calls for the development of a statewide program to reduce medical costs and improve health care by establishing the Kentucky Health Care Infrastructure Authority, a joint venture between the University of Kentucky and the University of Louisville. The program would investigate ways to use information technology and other means to improve health care. The authority is also aimed at implementing pilot projects to improve patient care and control costs.
Kentucky Telehealth Network
The Kentucky Telehealth Network's goal is to provide quality health care to individuals in rural areas without regard to time or distance. It's overseen by a nine-member Board of Directors and includes all three medical schools in the state and nearly 70 rural healthcare facilities.
Louisiana
Louisiana Rural Health Information Technology Partnership
The Louisiana Rural Health Information Technology Partnership developed a project to implement an electronic medical record system in the emergency departments of 10 critical access hospitals. The grant will also allow electronic information to be shared with other community-based health care providers such as federally qualified health centers and rural health clinics. As a partner in the project, the Louisiana Department of Health and Hospitals - Bureau of Primary Care and Rural Health will assist in the implementation of the project.
Maine
Maine Health Data Organization
The mission of the Maine Health Data Organization is to create and maintain a useful, objective, reliable and comprehensive health information data base that is used to improve the health of Maine citizens and that will be publicly accessible.
Maine Health Information Network
The Maine Health Information Network Technology (MHINT) Steering Committee has begun the Phase II Planning and Development process necessary to establish a statewide interconnected clinical information sharing system for Maine. Phase II plans call for quickly assembling key clinical and IT leaders to address the many technical issues that need to be resolved. The leadership of consumer groups also will be convened early in Phase II. In mid-June 2005 a group of stakeholders from across the state will meet at the Hanley Leadership Forum at Bowdoin College to begin the process of developing an implementation plan and discuss system governance, financing, consumer engagement and other important elements of the MHINT project.
Maine Telemedicine Services
Maine Telemedicine Services is a statewide professional and technical service of the Regional Medical Center at Lubec that supports health care, mental health, social service, education, government and industry, to increase access throughout Maine to high quality services delivered through interactive video-conferencing and other electronic systems. MTS provides this support to about 100 sites throughout the State greatly through its sponsored telemedicine networks (as well as through consultation services). It currently support participants in three telemedicine networks: DownEast Telemedicine Network, Maine Telehealth Network and the Northeast Maine Telemedicine Network
Maryland
Maryland/D.C. Collaborative for Healthcare Information Technology
The Collaborative's long-term goal is to implement and "operationalize" a secure, HIPAA-compliant, regional healthcare information organization (RHIO) for the State of Maryland and Washington, D.C. region. The RHIO will ultimately link all the components in the Maryland/D.C. healthcare delivery chain.
Massachusetts
Massachusetts eHealth Collaborative
The mission of the Collaborative, formed in 2004, is to improve the safety, cost effectiveness, and quality of health care in Massachusetts through the promotion of widespread implementation and use of secure and confidential electronic clinical information systems, including electronic health records, medical decision support, and clinical data exchange capabilities. The Collaborative will also evaluate and promote reimbursement and other financial mechanisms to facilitate widespread adoption and continued use of electronic clinical information systems technology by all health care professionals and provider organizations.
Massachusetts Health Data Consortium
The Massachusetts Health Data Consortium was founded in 1978 by the state's major public and private health care organizations to be a neutral "honest broker," independent of special interests, to collect, analyze and disseminate health care information. The Consortium's information products, services and special projects support health policy development, technology planning and implementation, and improved decision making in the allocation and financing of health care. It recently launched MedsInfo-ED, an electronic health information exchange that uses the internet to make patient prescription history information more accurate and accessible to healthcare providers in hospital emergency departments (www.mahealthdata.org/consortium/news/PR_20041027.html).
Michigan
Michigan Electronic Medical Record Initiative
MEMRI's goal is to build an EMR from the data generated from standard healthcare transactions. Aggregated and de-identified to protect patient privacy, the database of all EMRs will also allow purchasers, providers, and patients to make more meaningful comparisons among providers and health plans in terms of cost, quality, value, and availability of healthcare services. It would also enable government, academic, and public health research institutions to track diseases and infections and monitor, on a real-time, ongoing basis, the state of Michigan health, and thereby be in a position to derive more timely and effective policies and interventions.
Upper Peninsular Telehealth Network
What started in 1994 as a small effort to provide distance learning to physicians among five initial sites has led to a sophisticated 38-site network that provides over 6,000 annual connections to 9 Critical Access Hospitals, 4 community hospitals, a regional referral center, a tribal health center, a summer camp for handicap children, behavioral health clinics, and several medical clinics.
Minnesota
Fairview University of Minnesota Telemedicine Network
Fairview University of Minnesota Telemedicine Network (FUMTN) has evolved from a small telemedicine network originally started by the University of Minnesota in 1994 to a network consisting of the University, which supplies the majority of specialty physicians, Fairview Health Services, owner of Fairview University Medical Center, the primary teaching hospital for the University, community hospitals, and the Ne-Ia-Shing clinic on Mille Lacs Reservation near Onamia, Minnesota. Available specialty services include dermatology, child and adolescent psychiatry, adult psychiatry, asthma and allergy, gastroenterology, neurology, orthopedics and wound care. FUMTN operations are funded by network members, patient fees, and a major grant from the federal Office for the Advancement of Telehealth, a division of the U.S. Public Health Service.
Minnesota e-Health Initiative
The Minnesota e-Health Initiative is a public-private collaborative effort to improve healthcare quality, increase patient safety, reduce healthcare costs and enable individuals and communities to make the best possible health decisions by accelerating the adoption and use of health information technology.
Minnesota Community Health Information Collaborative
The mission of the Community Health Information Collaborative (CHIC) is to plan and develop a shared information network linking hospitals, medical clinics, academic health programs, public health agencies and other appropriate organizations that will build connectivity between health care providers in the region in order to improve the qulity of, and access to, health care for citizens and to reduce costs for health care providers and consumers.
Mississippi
Mississippi TelEmergency
In response to a lack of emergency care and physicians in many rural areas of Mississippi, the University of Mississippi Medical Center has developed and will direct the operation of a rural health telemedicine initiative called TelEmergency, using nurse practitioners as the healthcare providers. The program is also linked to the Mississippi Department of Health which has funded access to electronic medical records generated by the nurse practitioners. This allows them to survey the state's rural areas and Jackson for potential trends in public health or bioterror.
Missouri
Missouri Telehealth Network
The targets of the Missouri Telehealth Network are rural communities in mid-Missouri, with a goal to provide high quality specialty care in participating rural communities through the use of digital telecommunications technology, and to evaluate the clinical utility and cost impact of telemedicine. Three of the project's counties are designated as Primary Care Health Professional Shortage Areas, but all of them lack specialty resources of the kind provided by MTN.
Montana
Montana Healthcare Telecommunications Alliance
The Montana Healthcare Telecommunications Alliance was formed in 1997 by individuals from healthcare organizations across Montana to share common interests and expertise, and to promote advancements in telecommunications through video-teleconferencing and telemedicine. Its goals include cost reduction for the operation of telemedicine networks, promoting Interoperability among and between systems by exploring the use of a state-wide network, promoting services, the pursuit of legislative activities, and the development of a reasonable approach for evaluation and research of telemedicine systems.
Montana Public Health Informatics
Public Health Informatics was formed as a work unit within the Public Health System Improvement & Preparedness Bureau during the Department of Public Health & Human Services' 2004 reorganization of State-level public health. The change was necessary due to the increasing number of systems Montana's public health community was being required to support at both the State and local levels. The need for these changes became apparent during the public health visioning process where it was concluded that Montana's public health programs had no unifying strategy for the creation of systems to support the public health "enterprise."
Eastern Montana Telemedicine Network
Eastern Montana Telemedicine Network is a consortium of not-for-profit medical and mental health facilities linking health care providers and their patients throughout Montana and Wyoming.
Nebraska
Nebraska Statewide Telehealth Network
The Nebraska Statewide Telehealth Network (NSTN) will provide the opportunity for all hospitals and public health departments in the state to connect, provide access to consultations with medical specialists, continuing medical education, transmission of digital clinical information, bioterrorism alerts and training for homeland security and other emergency issues. Connections between hub hospitals and connecting rural hospitals were initiated in August 2004, and all Nebraska hospitals and health departments will be connected to the NSTN in 2005-2006.
New Jersey
New Jersey Electronic Medical Records Network
The New Jersey Department of Banking and Insurance will develop a more efficient way of providing medical services through development of electronic health records system statewide, in the process also putting downward pressure on health insurance rates (May 11, 2005 statement).
New Mexico
New Mexico Center for Telehealth
The goal of the Center for Telehealth. based at the University of New Mexico, is to help improve the health of all New Mexicans through development of a highly visible and sustainable telehealth network, foster and develop telehealth alliances and collaborative activities, provide support to users, and conduct research, evaluation, and analysis of telehealth technologies and programs, and their impact on health outcomes.
New Mexico Telehealth Alliance
The New Mexico Telehealth Alliance will provide a forum for individuals and organizations to improve the health of New Mexicans through the collaboration and sharing of health resources statewide. The Alliance seeks to enable the development and delivery of technology assisted programs that promote access, utilization and affordability of Telehealth services.
New York
State University of New York Telemedicine Project
SUNY's Telemedicine Program was launched in 1994 with the first ever remote telepathology consult in Central New York and has successfully grown over the years providing a multitude of telemedicine services and specialty care to the rural communities.
Taconic Health Information Network and Community
The goal of Taconic Health Information Network and Community is to provide connectivity for the physician community in the Hudson Valley area of New York state and, longer term, to move physicians towards a community-based electronic health record.
North Carolina
North Carolina Healthcare Information and Communications Alliance
NCHICA was created in 1994 as a non-profit consortium by then Gov. James B. Hunt's executive order to improve healthcare through information technology and secure communications. Over 235 organizations in the state, including leading providers, payers, corporate partners, professional associations, and state and local government agencies have joined together to direct pilot projects and other programs. Projects include the Community Medication Management Project, Provider Access to Immunization Registry Securely, the North Carolina Emergency Department Database, and various projects on electronic health records.
North Carolina Immunization Registry
The current statewide North Carolina Immunization Registry (NCIR) has been used by all 100 local health departments since 1996. Health departments record all state-supplied immunizations in the NCIR, as well as immunization histories on children seen at the health department for other services (including WIC).
East Carolina University Telemedicine Center
Telemedicine at East Carolina University (ECU) began with the first consults with Central Prison (Raleigh) in 1992. Over the subsequent eleven years, services and infrastructure grew and evolved through the support of the University, University Health Systems, rural health facilities, and several grants and contracts.
Oregon
Oregon Health Policy Commission
The Commission identifies and analyzes significant health care issues affecting the state and makes policy recommendations to the Governor, the Oregon State Legislature and the state Office for Oregon Health Policy and Research (OHPR). Additionally, the Commission partners with health care experts and stakeholders around the state to develop projects focused on improving Oregonians' health status and access to effective and efficient health care services. It's HER & Health Data Connectivity Subcommittee recently produced a major report on Electronic Health Records & Data Connectivity.
Oregon Health Information Infrastructure
A multi-stakeholder collaboration to demonstrate the application of healthcare information and communication technology to improve the quality, safety, cost-effectiveness and accessibility of healthcare for all Oregonians.
Oregon Community Health Information Network
The Oregon Community Health Information Network is a collaborative project of stakeholders, safety net health care providers and CareOregon. The first phase of the OCHIN project is to design and implement a statewide data infrastructure that will offer practice management software to safety net project partners. The second phase of the project is the rollout of medical record software facilitating continuity of care for uninsured Oregonians. The final stage is the activation of a data warehouse on the health demographics of the populations served by the health safety net.
Pennsylvania
Pennsylvania e-Health Technology Consortium
A consortium of 28 health care organizations plan to build the Pennsylvania electronic patient data network that will be tied into a national system so that patients and their doctors can securely access medical records from any part of the country. The consortium started meeting on March 10, 2005 and hopes to have a statewide summit in Harrisburg in July 2005 to move the project another step forward. Details such as standardizing software and ensuring data security are important concerns for the group.
University of Pittsburgh Medical Center
UPMC, a $5 billion organization and the region's largest employer, has reshaped the health care landscape in western Pennsylvania. Among other things it has invested significantly in information technology to link and integrate electronic medical records across multiple hospitals and care settings.
Rhode Island
Rhode Island HIT Development Fund
Rhode Island Gov. Cacieri in 2004 signed into law an act aimed at setting up a Health Care Information Technology & Infrastructure Development Fund. The program seeks to jumpstart the healthcare industry's use of IT by creating a fund that could accept private, federal and state allocations to pay for health IT in the state.
Rhode Island Health Improvement Initiative
The goal of the Rhode Island Health Improvement Initiative, a four-year project that began in 2004, is to show that cost-effective care can be delivered across an entire medical community using clinical information systems and process improvements and by interconnecting physicians, hospitals and other providers.
Tennessee
Tennessee Volunteer eHealth Initiative
The Volunteer eHealth Initiative will begin by providing a framework for hospitals, physicians, clinics, health plans and other healthcare stakeholders in Shelby, Fayette, and Tipton counties to work together to establish regional data sharing agreements. Although TennCare is a catalyst for this work, the effort is designed to improve the health care of all Tennesseans. The Volunteer eHealth Initiative is managed by the State of Tennessee in partnership with Vanderbilt University Medical Center.
Community Connection
Tennessee will allow its Medicaid (TennCare) patients to participate in an ambitious EHR project. Officially headed by BlueCross BlueShield of Tennessee subsidiary SharedHealth, the network is considered a major element of the effort to hold TennCare spending in check.
Texas
Utah
Utah Health Information Network
The Utah Health Information Network is a broad-based coalition of health insurers, providers and other interested parties, including state government, who have joined together to reduce health care administrative costs through data standardization of administrative health data and electronic commerce.
Utah Telehealth Network
The Utah Telehealth Network consists of a hub at the University of Utah Health Sciences Center directly connected to numerous sites throughout Utah, and is used to provide patient care, continuing education for health professionals and patients, and connections to facilitate business and administrative meetings. UTN can also link with most other videoconferencing sites across the country and internationally.
Vermont
Virginia
Virginia Task Force on Information Technology in Health Care
The Task Force, created in January 2005, is responsible for developing and implementing a state health information system that better uses technology and electronic health record (EHR) systems to improve the quality and cost-effectiveness of health care in Virginia. It's due to deliver a preliminary report to the Governor and the General Assembly by November 1, 2005.
Virginia Telehealth Network
The VTN presently has a membership of over 50 individuals representing 35 public and private agencies/organizations. During 2003 - 2004, the VTN Infrastructure Work Group assessed the current telehealth capacity and the anticipated future needs in the Commonwealth and identified weaknesses in the existing infrastructure, developing a white paper that recommends the development of a statewide integrated telehealth network.
MedVirginia
The goal of MedVirginia, established in 2000, is to organize, coordinate and serve provider interests in health care information technology by providing a system for community-wide clinical data and information exchange that enables and supports improved business and clinical transactions.
Washington
PeaceHealth
PeaceHealth is a non-profit, integrated healthcare system headquartered in Bellevue WA, which operates five hospitals, medical groups, a chemical dependency program, health care joint ventures and other services in Washington, Oregon, and Alaska. It's recognized nationally for its use of healthcare information technology, including a fully integrated electronic medical records network, and is considered a possible precursor for a regional healthcare information organization (RHIO).
Washington State Public Health Information Technology Committee
The Public Health Information Technology Committee provides a forum for coordination of IT planning across many separate public health entities so that communications and data transfer systems are compatible, reliable, secure and cost-effective. It's a part of the Public Health Improvement Partnership, which guides the development and implementation of a plan for collaborative action to bring about improved health in all the communities of Washington State.
Inland Northwest Health Services
INHS is a non-profit corporation formed in 1994 with the intent and purpose of bringing high quality, cost effective health care to Spokane and the region through innovative and successful collaborations of health care services, including through the use of its Northwest Telehealth network.
West Virginia
West Virginia Health Task Force
Gov. Joe Manchin appointed Dr. Julian E. Bailes, Professor and Chairman of the Department of Neurosurgery at West Virginia University School of Medicine, to oversee a statewide working group studying implementation of electronic medical records technology.
Wisconsin
Wisconsin Health Information Exchange
The Wisconsin Health Information Exchange, established in 2004, is a non-profit collaborative that includes public and private organizations whose goal is to provide timely and accurate access to information to improve the quality, safety, efficiency and accessibility of health care and public health. Its first phase is a three-year start-up of the organizational and technical framework for information exchange between members with electronic health information systems.
Wyoming
Wyoming Healthcare Commission
The State of Wyoming is working toward the development of a long-term, sustainable plan for supporting the effective, efficient and secure exchange of health information across the spectrum of healthcare stakeholders. The Wyoming Healthcare Commission, created in 2003, is charged with examining a wide range of healthcare issues and drafting specific recommendations designed to improve access to, and quality of, healthcare in Wyoming communities. A first report on electronic health records was recently published.
