national hit policy and funding for rural health

National HIT Policy and Funding for Rural HealthNational HIT Policy and Funding for Rural Health

Minnesota Rural Health Association Annual MeetingTom MorrisDeputy DirectorU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationOffice of Rural Health Policy


Today’s Presentation Why the big push now Government role Rural issues and concerns


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


– Quality Report Quality Report finds that finds that quality continues to improve at quality continues to improve at a modest pace across most a modest pace across most core quality measurescore quality measures– Disparities ReportDisparities Report finds finds that disparities of and access that disparities of and access to care were generally to care were generally improving for racial minorities improving for racial minorities but not for Hispanicsbut not for Hispanics

Identifying a starting point … HIT as a means to an end … Improving Quality


Electronic Health Record Adoption Gap: US vs. Others

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Portugal

France

Spain

United States

Greece

Ireland

Luxembourg

Italy

Belgium

Germany

Austria

Finland

United Kingdom

Denmark

Netherlands

Sweden

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).


Role of Health IT in reducing errorsPercent who say…

The coordination among the different health professionals

that they see is a problem

32%

69%

48%

They had to wait or come back for another appointment

because the provider did not have all their medical

information

They have seen a health care professional and noticed that

they did not have all of their medical information

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?

32%

67%1%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).


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


The IOM Quality Series: The Rural Report HIT is a key focus area

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.


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


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


Rural HIT Is there an adoption gap?

– For hospitals, yes– AHA survey and Flex survey

– For other rural providers?


AHA survey Rural hospitals less likely to be investing


AHA survey, continued Urbans using IT more than rurals


AHA survey, continued System hospitals doing more


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

Health Information Technology Infrastructure in CAHs

(n=333) Number

(Percent) of CAHs

Number of Computers in hospital 5-10 5 (1.5%) 11-15 21 (6.3%) 16-20 31 (9.3%)

More than 20 276 (82.9%) Hospital Website 259 (77.8%)

Type of Internet Access Dial-up only 6 (1.5%)

Dial-up plus high-speed and/or wireless 9 (2.7%) High-speed only 257 (77.2%)

High-speed and wireless 60 (15.1%) Wireless only 11 (3.3%) Secure e-mail 264 (79.3%)

Clinician Use of PDAs for patient care 120 (36.0%) Physicians, PAs, NPs 109

Registered Nurses 21 Pharmacists 31

Others 6


Flex survey, continued Half of clinicians have electronic access to clinical guidelines 1/5 have some form of an EHR



Electronic Access to Guidelines and Patient Data in

CAHs (N=333)

Number (Percent) of CAHs

Clinicians have electronic access to clinical guidelines and pathways

170 (51.1%)

Guidelines and pathways are available on hospital computers/server

71 (21.3%)

Clinicians obtain guidelines and pathways as needed on the Internet

139 (41.7%)

Hospital has electronic medical records 69 (20.7%) For inpatients 60 (18.0%) For outpatients 49 (14.7%)

For emergency department patients 44 (13.2%) For inpatient, outpatient and ED patients 33 (9.9%)

Patient information is kept in electronic format Physician notes 57 (17.2%)

Medication administration records (MARs) 111 (33.4%) Recording of vital signs 64 (19.2%)

Nursing flow sheets 62 (18.6%) Computerized incident/error reporting 98 (29.8%)


Flex survey, continued About ¼ use computerized prescription order entry Almost half use computerized screening for allergies and drug interactions Almost ¼ use telepharmacy



Computerized Pharmacy Functions in CAHs

(n=333) Number

(percent) of CAHs

Prescriber order entry 85 (25.5%) Screening for patient allergies, potential drug interactions

157 (47.4%)

Dose recommendations/checks (e.g., based on weight and renal function)

138 (42.0%)

Obtaining up-to-date manufacturer and FDA information and alerts regarding drugs

181 (55.4%)

Use of automated dispensing machines 110 (33.1%) Telepharmacy (having a pharmacist at another site review medication orders via fax or electronic transmission)

78 (23.6%)


Flex survey, continued Almost half use computerized clinical lab ordering Almost half can order and review radiographs More than 2/3 use teleradiology



Computerized Laboratory and Radiology

Functions in CAHs (n=333)

Number (percent) of CAHs

Clinician ordering of lab tests 152 (45.7%) Tracking of lab specimens 170 Clinician review of lab test results 194 (58.4%) Clinician ordering of radiographs 140 (42.2%) Clinician review of radiology results 198 (59.5%) Teleradiology (transmission of radiographic images electronically to radiologists at another site)

267 (80.2%)


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


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


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)


National Coordinator for Health Information Technology Agency for Health Research and Quality Health Resources & Services Administration Other Departments

Federal Agencies and Departments involved in HIT

U.S. Dept. of Health and Human Services


The Office of the National Coordinatoron 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


Goal 1: Inform Clinical Practice•Incentivize EHR Adoption•Reduce Risk of EHR Investment•Promote EHR Diffusion in Rural and Underserved Areas

Goal 2: InterconnectClinicians•Foster Regional Collaboration•Develop a Nationwide Health Information Network (NHIN)•Coordinate Federal Health Information Systems

Goal 3: Personalize Care•Use of Personal Health Records,Enhancement of Informed ConsumerChoice, and Promotion of Telehealth 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

StrategicStrategicFrameworkFramework


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


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


ORHP and HIT A Policy and a Program Issue

– Programs: – Outreach, Network, Flex and SHIP

– Policy: – Ensuring a level playing field


ORHP programs Rural Health Care Outreach Services Grants

– Three-Year Demonstration Grants– Up to $375,00 over the project period


ORHP programs Rural Health Network Development Network Development

– Three-Year Demonstration Grants– Up to $540,000 over the project period


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


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


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


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

Advancing Advancing Excellence in Health Excellence in Health

CareCare

AHRQ’s Grantees


AHRQ’s HIT Website:


http:healthit.ahrq.gov


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


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


Distance Learning and Telemedicine Program– Offers Loans and Grants– Competition Expected in 2006

– Contact Information: (202) 720-0413 or [email protected]

http://www.usda.gov/rus/telecom/dlt/dlt.htm.


Universal Service Fund Rural Health Care Corporation Contact Information

–1-800-229-5476 (Monday-Friday; 8 AM-8 PM)– http://www.universalservice.org/rhc/


Commitments by Applicant Type

HCP Type 1998 1999 2000 2001 2002 2003 2004 2005Educational Inst 10 9 4 0 7 4 0 0Comm Health Ctr 34 75 78 88 137 132 190 42Local Health Dept. 3 10 21 185 208 247 322 59Com Mental Hlth Ct 50 43 30 82 87 128 172 13Hospital 199 275 302 370 495 534 670 110Rural Health Clinic 187 221 308 469 471 604 703 93Total 483 633 743 1194 1406 1649 2057 317 Year 2005 estimated 15% complete (1/30/06).


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 …


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


Questions or Comments?

Contact [email protected]

301-443-0835http://ruralhealth.hrsa.gov

national hit policy and funding for rural health

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