CareSpark: Liesa Jenkins, Executive Director

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Innovative, unprecedented and cooperative- those are a few of the words that describe CareSpark, the unique health care collaborative focused on opening up the lines of communication between health care providers through shared health information in the central Appalachian region. There are many things that make this effort groundbreaking. First, this is a service that spans state lines, covering areas of both Virginia and Tennessee–17 counties to be precise. This means that CareSpark needs to be able to meet numerous state and local guidelines while serving the area’s 750,000 residents, 21 hospitals, and 1,200 physicians. Currently the system has about 175,000 participants and 200 clinicians and doctors. But CareSpark works with more than just patients and doctors; the system also partners with public health departments, private practices, nonprofit organizations and at this moment three hospitals and one health insurance company, UnitedHealthCare. By the close of 2009, CareSpark projects to be serving 1 million patients and approximately 500 physicians.

Filling a Void in Rural Health Care

The Appalachian region of the US is particularly in need for improvements in the health care. High rates of unemployment, low literacy rates along with poor diet and exercise, make this population poised for health care disaster. “Our reason for existence is because in this region we have some pretty significant health issues compared to the rest of the US,” says Liesa Jenkins, Executive Director at CareSpark. Jenkins says the Appalachian area has a high rate of premature death from chronic diseases, such as diabetes and heart disease, plus premature stroke. “We are very concerned about that because we are seeing people earlier and earlier getting these conditions and dying from them. We are also seeing a high number of deaths from prescription drug overdose.”

In an effort to improve the delivery of health services to this underserved population, CareSpark was formed so that each patient will have access to the best care and physicians will have access to all the patient information they need, all at a low cost. Health care access can be complicated in this region due to the rural landscape, where patients often have to travel two or three hours in order to visit a specialist.


As a new organization, CareSpark’s number one challenge is getting the word out about their services and getting local health care organizations connected. This means doing major outreach to inform patients and physicians about how to sign up and use the system. Jenkins says CareSpark has a four-step plan of action which details critical steps that need to be taken in order to make the endeavor a success. First, Jenkins said CareSpark needs to get the information about their mission into the hands of physicians and patients at the point of care where they are together making decisions about health care. Second, CareSpark must ensure that they can provide not just individual health information, but also information on an aggregate level to support population health improvement.

Additionally, the group must inspire patients to become more involved in their health and decision making. “We currently have a passive health care consumer who may not be aware of the impact of making informed decisions. Right now they do what the doctor tells them and if they can’t afford it or don’t agree they just don’t do anything.” Finally, and perhaps most importantly, CareSpark needs to guarantee they can deliver their services in an affordable manner. “If it’s not affordable to the patient and physician, with fair distribution of savings and costs, then it’s not going to work.”

Unconventional Collaboration

To make these goals a reality, CareSpark is looking to take a new approach to health information, joining the public and private sector together to blend the best from both arenas. The group also must maneuver through privacy restrictions since they’ll be handling sensitive information, like medication lists, diagnostic tests, lab results and perhaps comparative information and research. “You can control everything and no one will have access to your information. Or you can find a middle ground where you protect privacy, but make useful information available.” To do this, CareSpark is relying on a broad collaboration between hospitals, physicians, insurance companies, public health organizations and even community organizations concerned about the uninsured or interested in preventative medicine.

“We’ve been working on how to exchange information and testing how to develop and exchange information through the Nationwide Health Information Network gateway, and bringing that live is a major focus.” CareSpark has partnered with industry leaders who have nationwide appeal to ensure that what the business builds will be compatible with various systems, certifications and standardizations. “We don’t want to build something here that just doesn’t work with the rest of the country.”

For software, CareSpark wanted to work with market leaders who played well with others. “A track record of collaborating with peers and competitors was desirable; we looked for companies who weren’t trying to take over the world.” The group chose to work with numerous companies including Initiate Systems, to provide software that matches patients to their health records in multiple organizations, Oracle for the database, Cisco for security infrastructure, Healthvision as the interface engine and CGI for systems integration. CareSpark was also able to align with local businesses to create a ripple effect of beneficial results. “We worked with many local resources and local people that know what needs to be done. Small local businesses were able to partner with these larger companies to offer product support, and local economic development turned out to be a very important side benefit from this project.”

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