Health Information Technology Issues for Rural, Small & Safety Net Facilities

1. Health Information Technology Issues for Rural, Small & Safety Net Facilities Minnesota Rural Health Association February 23, 2007 Mark Schoenbaum Office of Rural Health and Primary Care Minnesota Department of Health

2. Consumer Benefit Examples • I save time and worry because there is no need to fill out lengthy forms or explain my health history (and possibly forget something important) when I go to the doctor. • My electronic health records willnot be lost, even in the event of a disaster. • No matter where I go to the doctor, my providers have health information about me.

3. Consumer Benefit Examples (continued) • I get test results quickly and can understand them. • I can securely communicate electronically with my health care provider if I chose to. • I have greater confidence that public health agencies and healthcare providers are prepared to help in the event of a health emergency.

4. About Rural Health Care • 80% of land area, 30% of population • Demographics & health status • Age & income, health status, health coverage, diversity • Distance • Time to emergency care • Travel to specialty care • Workforce & Infrastructure Challenges • Low volume • Rate of transfers • History of creativity/innovation/collaboration • 80 Critical Access Hospitals, 71 Rural Health Clinics, 10 rural FQHC sites, Migrant Health sites, SNFs, home care, EMS, etc

5. Systems MeritCare Dakota SMDC/Benedictine Sioux Valley Avera McKennan Mayo Good Samaritan/Beverly North Ambulance ACMC Catholic Heath Initiative CentraCare etc Networks SISU Wilderness North Region MN Rural Health Cooperative Lac qui Parle Northern Minnesota Network Medisota etc About Rural Health Care, cont.Small, medium, largeIndependent, affiliated, owned

6. Institute of Medicine Strategy to Address Quality Challenges in Rural Communities 1. Adopt an integrated, prioritized approach to addressing personal and population health needs at the community level. • Establish a stronger quality improvement support structure to assist rural health systems and professionals. 3. Enhance human resource capacity of rural communities: • healthcare professionals (including IT staff) • rural residents • Monitor and assure that rural healthcare systems are financially stable. 5. Invest in building an information and communications technology (ICT) infrastructure.

7. EHR & Exchange Pharmacy Lab Imaging QI Data Management Benchmarking QI Collaboratives EMS & Trauma data Billing / e-business, practice management Telehealth Medicine : Emergency, specialty Mental Health Home Care Long Term Care Telepharmacy Communications: Continuing Ed Patient Education Videoconferencing Components of Rural ICT

8. The Rural IT Infrastructrure • Internet • Broadband • 80 Telephone Companies • IT equipment and support

9. Rural MN Businesses • Source – Blandin Foundation Get Broadband Program

11. Electronic Health Record Adoption - Progress & Need Progress • Clinics: 46% fully or in process for EHR (2005 MN Survey, 300/651) • Hospitals: 72% are fully Implemented or in process (2005 AHA survey) Continuing Need / Emerging Themes • Infrastructure in small/rural/underserved clinics and hospitals, long term care, local public health departments • Variation on implementation and use • Diffusion of provider acceptance and knowledge

12. Stratis Health Primary Care Clinic Survey

13. Proportion of Minnesota Clinics with either fully or partially implemented EHRs Stratis Health.

14. Some Differences in the Adoption of Electronic Health Records Stratis Health.

15. Recommendations: Four Focus Areas, 17 Priority Projects • Empower Consumers • Accelerate the availability and use of accessible, portable “My Personal Health Record.” • Inform and Connect Healthcare Workers • Fund and implement interconnected health information technology statewide, focusing on secure health information exchange. • Protect Communities • Improve population health and protect communities through accessible prevention resources, widespread knowledge of community risks, and rapid detection of and response to public health threats. • Provide Infrastructure • Ensure the e-Health vision and mission are fulfilled.

16. Minnesota Privacy and Security Project Purpose: • Identify privacy and security barriers to information exchange for health care • Propose and implement practical solutions, while preserving privacy and security protections.

17. Minnesota Public Health Information Network (MN-PHIN) “Improve the health of Minnesotans through the strategic application and management of health information.” MN-PHIN Vision State-local public health working together to improve practice through informatics

18. Minnesota Health Care Connection

19. Financing Principles • Financially “able” entities are expected to make investments as part of their regular budget and IT planning • State financing will complement, not displace, private or federal investments • Public financing will: • Support small, rural, or underserved communities • Require resource commitments from recipients • Require interoperable system investment

20. Examples of Some 45 Projects Emerging Statewide • Exchange Projects • MnHCC – Statewide coordination • CHIC/SISU – Northeast MN • Shared Abstract: (AHRQ grant) • MIIC – Immunization registry • Medications – e-prescribing through the HIPAA Collaborative • Winona community exchange project • Itasca County Health Network • HIT-based Regional Medication Mgmt Pharmacy System • Telehealth • University of MN • Personal Health Records • Fairview • HealthPartners • Children’s • Public Health • MN Public Health Information Network • Informatics Education • St. Scholastica • University of MN

21. Minnesota Privacy and Security Project • In May, 2006, Minnesota was one of 34 states awarded a HIPSC grant • AHRQ funded; administered through NGA and RTI • Grant supports Minnesota to conduct an assessment of the legal and businesses practices related to privacy and security in patient data exchange

22. Grants/Loans for HIT • MN Rural Hospital Capital Improvement Grant Program • MN Rural Hospital Planning/Transition Grants • MN Community Clinics Grant Program • Healthier MN Community Clinic Fund • USDA RUS Telemedicine Grant Program • US Office for Advancement of Telehealth • Universal Service Fund – ~25% internet discount for rural health organizations • DOQ-IT • Loans – various sources • Iron Range Resources

23. 2006 Governor’s Initiative for e-Health Grants • The Governor recommended $18,500,000 to invest in the use of Interoperable Electronic Health Record Systems and related Health Information Technology for: • Matching Grants to Communities for interoperable EHR • Provide resources for technical support with the projects and statewide • In 2006, Legislature appropriated $1.5 million in one time funding for grants to rural and underserved communities • 12 Grants awarded

24. Candidates for Barrier Elimination (IOM) • Deficiency of broadband in rural America • Prohibitive costs of some telecommunication lines • Excessive charges by local area telecommunications access networks , especially across regions • Limitations of the Universal Service Fund’s Rural Healthcare Program • Absence of clear and consistent definitions and policies (licensure, credentialing, payers)

25. Rural & Small Practice Challenges • No IT support let alone an IT Department • Hard to find M.D. or Adm leaders / change agents • Other business priorities i.e. “surviving” • No business case for connectivity / linkages to other institutions (stand-alone EHRs ?) • No aggregate buying power (hence pooled vendor selection processes) • Referral pattern issues • Stark (self-referral), anti-kickback, antitrust, etc source: HealthTech Strategies

26. Recent National Developments • National Rural Health Association, Policy Brief on Rural Health Information Technology, March 2006 • Selected Recommendations: • Establish regional networks in rural areas • Assure that rural communities have the technology infrastructure necessary to support regional networks, HIT and telehealth • Liberalize the Stark laws • Create funding mechanisms to support infrastructure and health information technology in rural areas • Create job training programs that will provide a skilled technology workforce in rural areas

27. Recent National Developments • National Advisory Committee on Rural Health and Human Services, Report to the Secretary Recommendations on the infrastructure to support HIT, a rural research agenda for HIT, Federal support for HIT activities, the need for rural representation at HIT forums • American Health Information Community • Sec. Leavitt calls for EHR accessible to first responders – March 7, 2006

28. On the Horizon • 2007 MN session • Funding • Policy proposals • Implementing eHealth Advisory Committee Recommendations • HHS – certifying products, establishing standards • Telehealth

29. Focusing Attention On Rural Communities “Efforts to develop local and national health information technology infrastructures should focus specific attention on rural communities" Further, the benefits of HIT "may be even more substantial in rural communities" ("Quality Through Collaboration: The Future of Rural Health Care”, Institute of Medicine, November 2004).

30. For More Information • Minnesota e-Health Initiative • www.health.state.mn.us/e-health • Office of Rural Health and Primary Care • http://www.health.state.mn.us/divs/chs/orh_home.htm Mark Schoenbaum 651.201.3859 mark.schoenbaum@health.state.mn.us

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