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The Massachusetts eHealth Collaborative and the New York City Primary Care Information Project have provided financial subsidies and extensive support to help hundreds of independent medical practices successfully adopt electronic health records. Their efforts address overcoming key barriers such as the amount of start-up funds needed, productivity lost during implementation, and the difficulty of choosing the right system. Their approaches differ: the Massachusetts project emphasizes continuity of care within selected communities; New York emphasizes improvements in preventive care and chronic disease management across a population. Both, however, offer valuable insights that can be applied elsewhere.

Health information exchange (HIE) offers tremendous potential for the future, but its widespread adoption and sustainability depend upon engaging patients and earning their trust. Patients' willingness to allow their data to be shared will drive the usefulness of HIE and therefore the sustainability of regional health information organizations (RHIOs H e a lt h i n f o r m at i o n t e c h n o l o gy (IT) and health information exchange (HIE) are increasingly viewed as key steps in improving the quality, safety, and efficiency problems that plague U.S. health care delivery. A linchpin of these efforts is patient engagement. The promise of health IT-electronic health records (EHRs), HIE, and, more recently, personal health records (PHRs)-has been "just around the corner" for a number of years now. Most studies have concluded that considerable value would accrue to all stakeholders if regional HIE was realized in the United States.1 Despite this, RHIOs continue to struggle with establishing a sustainable business model. 2A necessary but not sufficient condition for RHIOs' sustainability is that they bring together enough clinical information to be valuable. Patients' decision making could play an increasingly important role in determining how much information is shared and how it is shared. As patients awaken to their role as stewards of their medical information, HIE will only be as good as patients' willingness to allow their data to be shared in ways that clinicians find valuable.There are approximately 130 active HIE initiatives in the country today. The number of operating HIE organizations, however, is much smaller (forty-two), E n g a g i n g P a t i e n t s

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The Massachusetts eHealth Collaborative (MAeHC) was formed to improve patient safety and quality of care by promoting the use of health information technology through community-based implementation of electronic health records (EHRs) and health information exchange. The Collaborative has recently implemented EHRs in a diverse set of competitively selected communities, encompassing nearly 500 physicians serving over 500,000 patients. Targeting both EHR implementation and health information exchange at the community level has identified numerous challenges and strategies for overcoming them. This article describes the formation and implementation phases of the Collaborative, focusing on barriers identified, lessons learned, and policy issues.