National HIT Policy and Funding for Rural Health

1. National HIT Policy and Funding for Rural Health Minnesota Rural Health Association Annual Meeting Tom Morris Deputy Director U.S. Department of Health and Human Services Health Resources and Services Administration Office of Rural Health Policy

2. National HIT Policy and Funding for Rural Health Today’s Presentation Why the big push now Government role Rural issues and concerns

3. National HIT Policy and Funding for Rural Health HIT: The Big Issue Why now? Seen as a solution to some problems Quality Rising costs Long overdue One of the last major industries to take advantage of information technology

4. Identifying a starting point … HIT as a means to an end … Improving Quality National HIT Policy and Funding for Rural Health Quality Report finds that quality continues to improve at a modest pace across most core quality measures Disparities Report finds that disparities of and access to care were generally improving for racial minorities but not for Hispanics

5. National HIT Policy and Funding for Rural Health Electronic Health Record Adoption Gap: US vs. Others Source: "European Physicians Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use of Electronic Medical Records." Harris Interactive Health Care News 2(16).

6. Percent who say… Have you or a family member ever created your own set of medical records to ensure that you and all of your health care providers have all of your medical information? National HIT Policy and Funding for Rural Health The coordination among the different health professionals that they see is a problem They have seen a health care professional and noticed that they did not have all of their medical information Role of Health IT in reducing errors They had to wait or come back for another appointment because the provider did not have all their medical information Don’t know Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005).

7. National HIT Policy and Funding for Rural Health Current General Barriers and Challenges Privacy Incentives for data sharing in a competitive environment Experience level with HIT Cost/Rapid change in technology offerings Legacy systems Organizational change

8. National HIT Policy and Funding for Rural Health • Establish a Rural Quality Initiative to coordinate and accelerate efforts to measure and improve quality of personal and population health care programs in rural areas. • Expand experientially based workforce training programs in rural areas to ensure that all health care professionals master the core competencies…including informatics • Congress should provide appropriate direction and financial resources to assist rural providers in converting to electronic health records over the next five years. The IOM Quality Series: The Rural Report HIT is a key focus area

9. National HIT Policy and Funding for Rural Health 2006 Report by the National Advisory Committee on Rural Health and Human Services Includes a chapter on HIT Expand FCC funding Expand QIO HIT work Make VA software and TA widely available

10. National HIT Policy and Funding for Rural Health Rural Challenges Size and limited infrastructure mean that rural providers face unique HIT challenges Hardware and software may not exist Low rates of high-speed connectivity Capital to invest in and sustain HIT is limited Workforce limitations Technical assistance

11. National HIT Policy and Funding for Rural Health Rural HIT Is there an adoption gap? For hospitals, yes AHA survey and Flex survey For other rural providers?

12. National HIT Policy and Funding for Rural Health AHA survey Rural hospitals less likely to be investing

13. National HIT Policy and Funding for Rural Health AHA survey, continued Urbans using IT more than rurals

14. National HIT Policy and Funding for Rural Health AHA survey, continued System hospitals doing more

15. National HIT Policy and Funding for Rural Health 2006 Flex Survey Majority of CAHs have more than 20 computers in the facility More than 1/3 of CAH clinicians use PDAs All have internet access with 98 percent using high-speed Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health Information Technology Use in CAHs, May 2006

16. National HIT Policy and Funding for Rural Health Flex survey, continued Half of clinicians have electronic access to clinical guidelines 1/5 have some form of an EHR Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health Information Technology Use in CAHs, May 2006

17. National HIT Policy and Funding for Rural Health Flex survey, continued About ¼ use computerized prescription order entry Almost half use computerized screening for allergies and drug interactions Almost ¼ use telepharmacy Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health Information Technology Use in CAHs, May 2006

18. National HIT Policy and Funding for Rural Health Flex survey, continued Almost half use computerized clinical lab ordering Almost half can order and review radiographs More than 2/3 use teleradiology Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health Information Technology Use in CAHs, May 2006

19. National HIT Policy and Funding for Rural Health What does that mean for rural? Networking with other providers is key Models are out there Vendor interest in the rural sector growing but challenges remain Challenges remain in ensuring a rural voice in the larger policy discussions

20. National HIT Policy and Funding for Rural Health The current environment Private sector leading Government playing a supporting role Setting the context to allow the technology to diffuse A realization that the total adoption cost is large Not enough grant $$ to do more than create some models here and there

21. National HIT Policy and Funding for Rural Health Pending HIT Legislation HR 4157 (Reps. Johnson and Deal) Codifies ONC Standard-setting committee Push toward interoperability Anti-Kickback exception S. 1418 (Sens. Enzi, Frist, Kennedy and Clinton)

22. Federal Agencies and Departments involved in HIT National HIT Policy and Funding for Rural Health National Coordinator for Health Information Technology Agency for Health Research and Quality Health Resources & Services Administration Other Departments U.S. Dept. of Health and Human Services

23. National HIT Policy and Funding for Rural Health The Office of the National Coordinator on Health Information Technology Established in response to Executive Order 13335, April 27, 2004 Responsible for realizing the President’s vision of Healthcare IT: Widespread adoption of interoperable EHR within 10 years Medical information follows the consumer Clinicians have complete, computerized patient information Quality initiatives measure performance and drive quality-based competition Public health and bioterrorism surveillance are seamlessly integrated into care www.hhs.gov/healthit

24. Goal 1: Inform Clinical Practice • Incentivize EHR Adoption • Reduce Risk of EHR Investment • Promote EHR Diffusion in • Rural and Underserved Areas • Goal 3: Personalize Care • Use of Personal Health Records,Enhancement of Informed Consumer • Choice, and Promotion of Telehealth Systems • Goal 2: Interconnect • Clinicians • Foster Regional Collaboration • Develop a Nationwide Health • Information Network (NHIN) • Coordinate Federal Health • Information Systems • Goal 4: Improve Population Health • Unify PH surveillance architectures, streamline quality and health status monitoring, and accelerate research and dissemination of evidence into practice National HIT Policy and Funding for Rural Health Strategic Framework

25. National HIT Policy and Funding for Rural Health The Office of the National Coordinator on HIT Focus on strategic investments to support that the health IT market place evolves appropriately Standards (i.e. interoperability) Certification (to ensure protection for buyers) Privacy and Security Nationwide Health Information Network (i.e., setting the framework, health exchange) American Health Information Community (a key driver for these processes). www.hhs.gov/healthit

26. National HIT Policy and Funding for Rural Health The Office of Rural Health Policy What We Do Advise the Secretary of HHS on Rural Health Issues Administer 12 grant programs Staff the National Advisory Committee on Rural Health and Human Services

27. National HIT Policy and Funding for Rural Health ORHP and HIT A Policy and a Program Issue Programs: Outreach, Network, Flex and SHIP Policy: Ensuring a level playing field

28. National HIT Policy and Funding for Rural Health ORHP programs Rural Health Care Outreach Services Grants Three-Year Demonstration Grants Up to $375,00 over the project period

29. National HIT Policy and Funding for Rural Health ORHP programs Rural Health Network Development Network Development Three-Year Demonstration Grants Up to $540,000 over the project period

30. National HIT Policy and Funding for Rural Health ORHP programs Flex Grants to States, focusing on CAHs and small rural hospitals Increased focus on HIT and Quality Small Hospital Improvement Program Grants to States who then award @ $8K to each eligible hospital HIT and quality two of the key focus areas

31. National HIT Policy and Funding for Rural Health ORHP programs: New! Small Health Care Provider Quality Improvement Grants Two-year Grants; Up to 15 awards expected in 2006 $100,00 available for project period HIT angle: Disease registry

32. National HIT Policy and Funding for Rural Health Office for the Advancement of Telehealth New grant competitions in 2006 Three Programs Telehealth Resource Center cycle just closed Telehealth Network Grant program soon to be announced Licensure/Portability Program soon to be announced http://telehealth.hrsa.gov 301-443-0447

33. Advancing Excellence in Health Care National HIT Policy and Funding for Rural Health The Agency for Health Research and Quality Health Information Technology Program 122 projects in 41 States Six State and Regional HIT Demonstrations National Resource Center

34. National HIT Policy and Funding for Rural Health AHRQ’s Grantees

35. AHRQ’s HIT Website: National HIT Policy and Funding for Rural Health http:healthit.ahrq.gov

36. National HIT Policy and Funding for Rural Health Medicare and the Quality Improvement Organizations 8th Scope of Work focuses on “Transformational Change” with a strong emphasis on HIT DOQ-IT Program: Work with 5% of physician offices in each State to increase HIT adoption 80 percent will be small and medium sized practices

37. National HIT Policy and Funding for Rural Health The National Network of Libraries of Medicine http:nnlm.gov Knowledge Management/Applied Informatics Grants www.nlm.nih.gov/pubs/factsheets/infosystem.html Planning Grants for Integrated Advanced Information Management Systems http://www.nlm.nih.gov/ep/GrantIAIMSPlan.html

38. National HIT Policy and Funding for Rural Health Distance Learning and Telemedicine Program Offers Loans and Grants Competition Expected in 2006 Contact Information: (202) 720-0413 or dltinfo@usda.gov http://www.usda.gov/rus/telecom/dlt/dlt.htm.

39. National HIT Policy and Funding for Rural Health Universal Service Fund Rural Health Care Corporation Contact Information 1-800-229-5476 (Monday-Friday; 8 AM-8 PM) http://www.universalservice.org/rhc/

40. Commitments by Applicant Type National HIT Policy and Funding for Rural Health • HCP Type19981999200020012002200320042005 • Educational Inst 10 9 4 0 7 4 0 0 • Comm Health Ctr 34 75 78 88 137 132 190 42 • Local Health Dept. 3 10 21 185 208 247 322 59 • Com Mental Hlth Ct 50 43 30 82 87 128 172 13 • Hospital 199 275 302 370 495 534 670 110 • Rural Health Clinic 187 221 308 469 471 604 703 93 • Total 483 633 743 1194 1406 1649 2057 317 • Year 2005 estimated 15% complete (1/30/06).

41. National HIT Policy and Funding for Rural Health Back to the “Rural Adoption Gap” Reality is not so clear cut There are gaps but there are also rural successes Systems do better than “stand-alones” Networks do better than solo providers All of which begs a question How to create a floor and who creates it …

42. National HIT Policy and Funding for Rural Health HIT and Strategic Planning Meeting Rural HIT: A Roadmap to Quality Largest Rural-Specific HIT Meeting Ever Focus on Small Providers in the Early Stages of Planning or Implementation Sept. 21-23rd; Downtown Marriott Kansas City http://www.securemcking.com/hrsa/rural/ Physician in Mountain City, TN using the VA EHR

43. National HIT Policy and Funding for Rural Health Questions or Comments? Contact Information tmorris@hrsa.gov 301-443-0835 http://ruralhealth.hrsa.gov