Nearly 4 million Tennessee residents will get electronic medical records during the next 18 months through one of the nation's most ambitious electronic medial records initiatives.

The project, led by Shared Health, a subsidiary of BlueCross BlueShield of Tennessee, received a boost last week when the Tennessee state government's Medicaid program formally agreed to participate. About 700,000 TennCare members enrolled in Tennessee BlueCross are now getting the e-records, and another 300,000 or more will get them later this year.

Shared Health is marketing the program to insurers in other states, said Bill Steverson, BlueCross BlueShield public affairs director.

The Shared Health program, called Community Connection, gives physicians and other clinicians access to Web pages that list appointments history, lab results, medications, immunizations, claims records and other information. Enrollment is free but mandatory for doctors who want to access Shared Health's secure system, Steverson said.

The underlying software was developed by Cerner, a health care information technology company based in Kansas City, Mo. Steverson said Cerner's software was modified to meet Shared Health's requirements. "It's new stuff," he said.

Community Connection was tested in four Tennessee communities before Shared Health officials decided to apply it statewide. Steverson said the doctors who used it in the tests were enthusiastic about it.

He said one of the most popular features was the name and phone number of patients' primary care physicians. When other doctors see sick patients, they often cannot readily access that information, Steverson said.

The Bureau of TennCare can use the program for free for a year. Then bureau officials must pay a fee based on the number of enrollees.

Employers with BlueCross BlueShield of Tennessee contracts will not pay higher premiums for employees with online health records, Steverson said. The system more than pays for itself by eliminating duplicate treatments and increasing operational efficiency, he said.

BlueCross BlueShield of Tennessee estimates it will save $3 to $4 for every dollar invested in Shared Health Community Connection.

The TennCare program is at the center of a major controversy in Tennessee. State officials are cutting as many as 323,000 jobs this week to prevent the program from bankrupting the state government. A trial is under way in federal court to evaluate the legitimacy of the cuts, which have been challenged by some who will lose benefits. Protesters are in the midst of a two-week sit-in at the state capitol.

Participation in the Shared Health program is one element of the effort to control TennCare costs.