HRSA’s Office of Health Information Technology

1. HRSA’s Office of Health Information Technology Cheryl Austein Casnoff, MPH U.S. Department of Health and Human Services Health Resources and Services Administration Office of Health Information Technology

2. Challenging our Health Care System • We need to use our health care resources more effectively than we do today • We need to focus on quality and value • We can achieve real change and far-reaching results when HIT is in place Carolyn Clancy, M.D., Director Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services

3. Why We Need HIT The best evidence suggests: • People receive only half the preventive care recommended • People with acute or chronic conditions receive about two-thirds of the care they need • About one-fifth to one-third of both acute and chronic care is unnecessary “Taking the Pulse of Health Care in America,” Mark A. Schuster, Elizabeth A. McGlynn, Robert H. Brook, Rand Corporation, 1998

4. Real Time Results • HIT can facilitate measurement of outcomes and evaluation of interventions in real-time rather than from a retrospective perspective • HIT can facilitate communication and coordination of care among care team participants • HIT allows tracking of patient health indicators over time Sarah Chouinard, MD and Jack L. Shaffer, Jr., “Improving Patient Health Outcomes at Primary Care Systems in Clay, WV Using and Electronic Health Management System,” 12/02/2007

5. HIT and Systems Savings - Efficiency • Properly implemented and widely adopted, HIT would save money and significantly improve health care quality • Annual savings from efficiency alone could average $77 billion or more per year in both inpatient and outpatient care • Largest savings come from reduced hospital stays resulting from increased safety and better scheduling and coordination, reduced nurses’ administrative time, and more efficient drug utilization Rand Health, Research Highlights, “Health Information Technology, Can HIT Lower Costs and Improve Quality ?” 2005

6. HIE Enabled Chronic Care Management • Improves diagnostic accuracy by providing prompts, alerts and reminders built around evidence based guidelines and real time clinical knowledge • Reduces adverse drug interactions and dosing complications, permits the PCP to monitor script refills, avoid hospital utilization, and improve treatment plan adherence “Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions.2007

7. HIE Enabled Chronic Care Management • Facilitates interaction between the provider and the patient by providing real-time knowledge about a patient between visits and reducing avoidable complications and costs from unmanaged chronic conditions • Allows all team providers to work with the physician and patient to determine the best course of self-care management and to share information to better coordinate care, monitor outcomes and avoid complications “Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions.2007

8. Lower Costs for Chronic Care Management • HIT can improve diagnostic accuracy, enhance coordination among members of the care team, enable regular and frequent patient coaching, and avoid hospital admissions and emergency room visits • This will lower overall health care costs and has the potential to produce a substantial ROI for a community or organization “Coordinating Chronic Care Management through HIEs,” Deloitte Center for Health Solutions.2007

9. Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors Using the EHR to Support Population- Based Care in Health Centers Source: The Institute for Family Health, Dr. Neil Calman, CEO (New York)

10. Savings from Telehealth • Reduced face-to-face visits and redundant and unnecessary tests could save $3.61 billion/year • Of the 142 million referral visits in the US per year, reduction in patient travel from mileage costs could save $912 million • Nationally implemented telehealth systems could save $4.28 billion annually “The Value of Provider-to-Provider Telehealth Technologies ,” Center for Information Technology Leadership, 2007

11. Savings from Telehealth • Reduced emergency department transfers • Avoid 850,000 transfers with a cost savings of $537m/yr • Reduced transfers from correctional facilities to emergency departments and physician offices • Avoid 40,000 transports with a cost savings of $60m/yr • Reduced transfers from nursing home facilities to emergency departments and physician offices • Avoid 370,000 transports to ERs with a cost savings of $327m/yr and 6.8 m transports to physician offices with a cost savings of $479m/yr “The Value of Provider-to-Provider Telehealth Technologies ,“ Center for Information Technology Leadership, 2007

12. Savings from Computerized Physician Order Entry (CPOE) Nationwide adoption of CPOE is expected to: • Eliminate 2 million adverse drug events • Eliminate more than 190,000 hospitalizations per year • Save the US health care system some $44 billion/year in reduced medication, radiology, lab and adverse drug events “The Value of CPOE in Ambulatory Settings,” Center for Information Technology Leadership, March 2003

13. Using HIT to Measure Impacts on Patients • We can use HIT to measure the different effects of a treatment for different patients • We can spot unexpected patterns of success or unexpected safety concerns • We can identify and address health disparities • We can detect these patterns in real time and put what we have learned into effect Carolyn Clancy, M.D., Director Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services

14. Reductions in HgbA1c with Treatment by Race /Language Source: The Institute for Family Health, Dr. Neil Calman, CEO (New York)

15. 2007 HIT Adoption • Four percent of physicians reported having an extensive, fully functional electronic records system • Thirteen percent reported having a basic system • Physicians in large groups, hospitals or medical centers, and in the western region of the US were more likely to use electronic health records • Physicians reported positive effects of systems on quality of care and high levels of satisfaction • Financial barriers were viewed as having the greatest effect on decisions about the adoption of EHRs N Engl J Med 2008;359:50-60

16. 2007 HIT Adoption - Conclusions • Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems • However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems • The survey found that doctors who treat the wealthy and those who treat the disadvantaged use the technology at about the same rate N Engl J Med 2008;359:50-60

17. Electronic Prescribing • The American Medical Association estimates that only 6 percent of providers of ambulatory care use electronic prescribing although potentially half of all prescriptions could be made electronically • Although nearly all large-chain pharmacies have activated e-prescribing systems, only 27 percent of small neighborhood pharmacies have done so • Fifteen percent of U.S. physicians write half of all prescriptions, and 30 percent write 80 percent, an important factor in applying strategies to increase adoption and use

18. Health Resources and Services Administration (HRSA) • Helps provide a safety net of health care services to 20 million people each year - about 1 in every 15 Americans. Budget of approximately $7 billion in FY09. • Six bureaus: Maternal and Child Health, HIV/AIDS, Primary Health Care, Health Professions, Health Systems, and Clinician Recruitment and Service. • 14 offices including Offices of Rural Health Policy, Minority Health and Health Disparities, International Health, Health Information Technology, and the Center for Quality.

19. Office of Health Information Technology (OHIT) Formed in December 2005 Mission: The Office of Health Information Technology (OHIT) promotes the adoption and effective use of health information technology (HIT) in the safety net community. OHIT Includes: Division of Health Information Technology Policy Division of Health Information Technology State and Community Assistance Office for the Advancement of Telehealth

20. HIT Goals for the Safety Net Providers Bring HIT to America’s safety net providers which will: Improve quality of care Reduce health disparities Increase efficiency in care delivery systems Increase patient safety Decrease medical errors Prevent a digital divide Allow providers to participate in pay for performance

21. What OHIT Does • Award planning and implementation grants for telehealth, electronic health records, and other health information technology innovations • Provide technical assistance to HRSA grantees and staff (e.g., project officers and Office of Performance Review) related to effective HIT adoption and Federal and state policies and legislation • Provide leadership and representation for HRSA grantees with Federal and state policymakers, researchers, and other stakeholders

22. DSCA FY 09 Grant Opportunities Division of HIT State and Community Assistance offers the following grant opportunities in FY 2009: Electronic Health Record Implementation for Health Center Controlled Networks Grant 2. Health Information Technology Implementation for Health Center Controlled Networks Grant

23. HRSA Telehealth Grant Awards • First awards made by ORHP in 1989 • Awarded over $250 million in grants since 1989 • HRSA created Office for the Advancement of Telehealth as a focal point for Telehealth activities in 1998 • Competitive and Congressionally-mandated projects 23

24. OAT FY 09 Grant Opportunities • Office for the Advancement of Telehealth (OAT) offers the following grant opportunities in FY 09: • Telehealth Network Grant Program • Licensure Portability Grant Program • Telehealth Resource Center Grant Program 24

25. HRSA Health IT Toolbox A comprehensive online compilation of health IT planning, implementation and evaluation resources to support the implementation of health IT for safety net providers. The HRSA Health IT Toolbox is available to the public at: http://healthit.ahrq.gov/toolbox

26. HIT Toolbox Learning Modules -Eleven topic-specific learning modules cover the life cycle of a typical health IT implementation from learning the basics to evaluation and optimization of a system: 1. Introduction to Health IT 2. Getting Started 3. Opportunities for Collaboration 4. Project Management and Oversight 5. Planning for Technology Implementation 6. Organizational Change Management and Training 7. System Implementation 8. Evaluating, Optimizing, and Sustaining 9. Advanced Topics Open Source and Public Domain Software Privacy and Security

27. HIT Toolbox Learning Modules (cont) OHIT is currently working on developing the following learning modules to augment the HIT Adoption Toolbox in 2009. Network Development Personal Health Records E-prescribing Quality Improvement OHIT is also working with the Office of Rural Health Policy to develop a toolbox specific to Rural providers.

28. Children’s Health IT Toolbox Proposed “Starting Point” Modules Introduction to Children’s Health IT Developing Pediatric Friendly EMRS Building a Medical Home for Children Cross Sector Coordination and Planning for Children’s Health Facilitating Enrollment in Public Health Insurance Programs Involving Family Members in Their Child’s Healthcare Improving Quality with Children’s Health IT Advanced Topics on Leadership and Organizational Design

29. TA - HIT TA Center Provide consistent HIT TA to HRSA grantees. TA “One to Many" Webinars Slides, transcripts and recordings of calls are on the HRSA Health IT Community. Peer-to-peer technical assistance to obtain TA from an experienced peer in HIT. Consultant technical assistance to obtain TA from an experienced consultant in HIT. Small, regional, interactive workshops on HIT adoption with health center networks and other HRSA grantees that have implemented HIT as hosts.

30. Past HIT Webinars Over 3,000 HRSA grantees and staff have participated in a wide range of webinars including: HIT 101 Important Factors to Consider When Selecting an EHR System Collaboration (How do I collaborate with networks, other groups, state entities, etc.) Telehealth 101 Financing HIT Readiness Assessments for HIT HIE 101 HIT for Special Populations Using EHRs to Drive Quality Improvement

31. Past HIT Webinars • Webinars are all archived: http://healthit.ahrq.gov/login • A password and log in is required to access the portal. • To obtain this, email the request to healthit@hrsa.gov

32. Future Webinars April 2009 – Personal Health Records May 2009 – HIT and Sustainability for Rural Settings June 2009 – Due Diligence – What is it? Why should I do it? July 2009 – Disaster Recover Plans for HIT August 2009 – Public Health Informatics

33. HIT Workshops OHIT partners with Health Center Controlled Networks and other HRSA grantees who have implemented HIT to provide Regional workshops around the country to foster learning and network development among HRSA grantees who have not implemented HIT. In 2008 the following workshops were provided: 4 EHR implementation workshops hosted by Community Health Access Network and the Maine Primary Care Association in Portland, ME; Delta Health Alliance in Tunica, MS; Chicago Health Alliance in Chicago, IL; OCHIN in Portland, OR.

34. HIT Workshops 2009 In 2009 OHIT is planning to provide 12 regional workshops including: EHR implementation HIE Open source EHR solutions EHR that focuses on child health and pediatric EHR functionality E-prescribing or tele-pharmacy “Meaningful use” of EHRs to improve quality and patient outcomes Sustainability, personal health records, and other advanced topics for operational networks Critical Access Hospitals and other Rural HIT Telehealth for rural and urban communities and health centers

35. President Obama’s Pledge • On January 8, 2009, President-elect Barack Obama pledged to have electronic medical records for all Americans within 5 years: "To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that within five years, all of America's medical records are computerized," Obama said. "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. But it just won't save billions of dollars and thousands of jobs, it will save lives by reducing the deadly but preventable medical errors that pervade our health care system." 35

36. Summary of American Recovery and Reinvestment Act (ARRA) HIT Funding Total $19.2 billion for HIT, including: $2 billion for ONC $17.2 billion for incentives through Medicare and Medicaid reimbursement systems Providers must demonstrate meaningful use of certified EHR technology Codifies: ONC; HIT Standards Committee; HIT Policy Standards Provides grant and loan programs to assist providers and consumers in adopting/utilizing HIT Privacy and security provisions in HIPAA for electronic health info

37. Summary of ARRA HIT Funding (cont) Additional HIT funding $4.7 billion for Broadband Technology Opportunities Program (NTIA) $2.5 billion for US Department of Agriculture Distance Learning, Telemedicine, Broadband Program $500 million for Social Security Administration $85 million for Indian Health Service $50 million for Veterans Administration

38. HRSA ARRA • The Recovery Act has directed $2 billion to HRSA to expand some of our primary health care programs • Another $300 million is intended to support the National Health Service Corps • An additional $200 million will support our health professions programs

39. HRSA ARRA • On March 2, HRSA announced grants worth $155 million to establish 126 new health centers • Those grants mean another 750,000 people in 39 states and two territories will have access to health care

40. HRSA ARRA • On March 27, HRSA released $338 million to expand services offered at the nation’s community health centers • The grants -- titled Increased Demand for Services (IDS) grants -- will be distributed to 1,128 federally qualified health center grantees  • Health centers will use the funds over the next two years to create or retain approximately 6,400 health center jobs • Later this year, HRSA will award about $1.5 billion in health center grants to fund capital improvements and support health information technology investments

41. HRSA ARRA • Today, more than 3,800 Corps physicians, dentists, advance practice nurses and mental health professionals treat 4 million patients in underserved communities nationwide, about half of them in health centers • With the Recovery Act dollars, we are projecting the ability to place another 4,000 clinicians this year, which will effectively double the number of clinicians we have in the field

42. HRSA and Health Reform • The expansion of the health center network is a major element in President Obama’s plan to reform health care. He wants the following principles to be reflected in any health reform legislation he signs: • It must protect families’ financial health; • It must assure affordable, quality health coverage for all Americans; • Its insurance options must be portable and guarantee choice of doctors; • It must invest in prevention and wellness; • It must improve patient safety and quality of care; • It must end barriers to coverage for people with pre-existing medical conditions; and • It must reduce the long-term growth of health care costs for businesses and government.

43. CHIP Reauthorization • $20 million for <10 grants to conduct demonstration projects to evaluate promising ideas for improving the quality of children's health care • Eligible: States and child health providers • $5 million for development of model EHR for children enrolled in SCHIP or Medicaid • Secretary to establish program to encourage development and dissemination

44. Future of OHIT Promote effective HIT adoption in the safety net to improve quality of care, patient outcomes, and access to care in support of ARRA activities Provide oversight, monitoring, and technical assistance to grantees to promote successful adoption of HIT Continue to develop and promote effective technical assistance tools such as toolbox modules, webinars, and workshops Promote the adoption of CCHIT-certified, interoperable, and fully functional HIT Continue to build partnerships internal to HRSA, with external organizations, and within the granteecommunity

45. Contact Information Cheryl Austein Casnoff, MPH Associate Administrator DHHS/HRSA/OHIT 5600 Fishers Lane, 7C-22 Rockville, MD 20857 Phone: 301-443-0210 Fax: 301-443-1330 Caustein-casnoff@hrsa.gov http://www.hrsa.gov/healthit/