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CareSpark was established in 2005, following two years of research and planning to explore ways to share health information securely, efficiently and cost-effectively. CareSpark was initiated by volunteers with the Community Health Improvement Partnership (CHIP), who had been working together for more than a decade through the local non-profit citizen organization Kingsport Tomorrow to develop collaborative processes to improve the health in the community. In December 2002, leaders from local and regional organizations met to consider the potential use of electronic systems and health information technology as a means of sharing information and coordinating care. Individuals with relevant expertise from local and national organizations researched and recommended ways to address the clinical, technical, legal, financial and communications challenges that inhibit collaboration and outcomes improvement. The group sought to learn from other communities and organizations that shared similar goals, and were one of nine communities to be awarded a grant for seed funding by the Foundation for eHealth Initiatives (funds provided by HRSA / OAT). These funds of $100,000 awarded in July 2004 were matched by nearly $500,000 from local organizations and their partners, allowing the group to conduct a thorough feasibility and planning process from August 2004 - April 2005. Consulting partners HealthAlliant, Inc. (fundraising and strategic business planning), Manatt, Phelps and Phillips (legal and regulatory guidance), CareScience / QuoVadx (technical inventory and technology planning) and n*tara (branding and marketing) assisted the 80 volunteers actively engaged throughout the planning process. The CareSpark planning process is recognized nationally as a model for its broad-based coalition, multi-state region, long-range and comprehensive scope, and development of a sustainable financial model. Dr. David Brailer, until recently serving as National Coordinator for Health Information Technology, recognized and encouraged this effort as one of the true grassroots community-based coalitions to develop a Regional Health Information Organization to advance the National Health Information Infrastructure framework. In May 2005, CareSpark adopted its initial Strategic Business Plan and Call to Action, and began working to develop the organizational structure, secure the human and financial resources required and implement technical infrastructure, clinical process improvement and financial incentives as proposed in the three-year strategic plan. The Strategic Business Plan is updated annually, with the most recent revision approved October 13, 2006. Since the initial business plan was approved in May 2005, the following progress has been noted:selection of a board of directors, staff and committee members to oversee implementation and operations of the infrastructure to improve health and achieve financial savingsapplication for designation by the IRS as a tax-exempt, charitable organization (application under review, determination pending as of December 2005)$2,065,000 in funding and $1,570,000 in-kind contributions committed to the effortformation of the CareSpark RHIO Consortium to assist with developing and operating the technical infrastructure required for health information exchangeparticipation with the Accenture Consortium as one of twelve local health care markets where prototypes of the National Health Information Network will be demonstrated in early 2007 adoption of Malcolm Baldrige criteria as the foundation for performance excellence throughout the organization, and application to the Tennessee Center for Performance Excellence as a Level 2 quality organization in the non-profit sectorcollaboration with State of Tennessee and Commonwealth of Virginia to plan for state-wide health information exchange initiativesoutreach and marketing to physicians and patients to encourage increased use of electronic health records, compliance with evidence-based guidelines and healthy lifestyle choicesoutreach and marketing to employers and health insurers to encourage transparency and alignment of financial incentives for acquisition and use of electronic health information to achieve improved outcomes