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
National HIT Policy and Funding for Rural Health
Today’s Presentation
 Why the big push now
 Government role
 Rural issues and concerns
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
National HIT Policy and Funding for Rural Health
Identifying a starting point …
HIT as a means to an end … Improving Quality
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
National HIT Policy and Funding for Rural Health
Electronic Health Record Adoption Gap: US vs. Others
Sweden
Netherlands
Denmark
United Kingdom
Finland
Austria
Germany
Belgium
Italy
Luxembourg
Ireland
Greece
United States
Spain
France
Portugal
0%
10%
20%
30%
40%
50%
60%
70%
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).
80%
90%
100%
National HIT Policy and Funding for Rural Health
Role of Health IT in reducing errors
Percent who say…
The coordination among the
different health professionals
that they see is a problem
69%
They have seen a health care
professional and noticed that
they did not have all of their
medical information
They had to wait or come back
for another appointment
because the provider did not
have all 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?
48%
32%
Don’t
know
32%
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).
1%
67%
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
National HIT Policy and Funding for Rural Health
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.
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
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
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?
National HIT Policy and Funding for Rural Health
AHA survey
 Rural hospitals
less likely to be
investing
National HIT Policy and Funding for Rural Health
AHA survey,
continued
 Urbans using IT
more than rurals
National HIT Policy and Funding for Rural Health
AHA survey,
continued
 System hospitals
doing more
National HIT Policy and Funding for Rural Health
Health Information Technology Infrastructure in
CAHs
(n=333)
2006 Flex Survey
Number
(Percent)
of CAHs
Number of Computers in hospital
5-10
11-15
16-20
More than 20
Hospital Website
Type of Internet Access
Dial-up only
Dial-up plus high-speed and/or wireless
High-speed only
High-speed and wireless
Wireless only
Secure e-mail
Clinician Use of PDAs for patient care
Physicians, PAs, NPs
Registered Nurses
Pharmacists
Others
5 (1.5%)
21 (6.3%)
31 (9.3%)
276 (82.9%)
259 (77.8%)
6 (1.5%)
9 (2.7%)
257 (77.2%)
60 (15.1%)
11 (3.3%)
264 (79.3%)
120 (36.0%)
109
21
31
6
 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
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
Electronic Access to Guidelines and Patient Data in
CAHs
(N=333)
Number
(Percent)
of CAHs
170 (51.1%)
Clinicians have electronic access to
clinical guidelines and pathways
Guidelines and pathways are available on 71 (21.3%)
hospital computers/server
Clinicians obtain guidelines and pathways 139 (41.7%)
as needed on the Internet
69 (20.7%)
Hospital has electronic medical records
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%)
Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health
Information Technology Use in CAHs, May 2006
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
Computerized Pharmacy Functions in CAHs
(n=333)
Prescriber order entry
Screening for patient allergies, potential
drug interactions
Dose recommendations/checks (e.g., based
on weight and renal function)
Obtaining up-to-date manufacturer and
FDA information and alerts regarding
drugs
Use of automated dispensing machines
Telepharmacy (having a pharmacist at
another site review medication orders via
fax or electronic transmission)
Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health
Information Technology Use in CAHs, May 2006
Number
(percent)
of CAHs
85 (25.5%)
157 (47.4%)
138 (42.0%)
181 (55.4%)
110 (33.1%)
78 (23.6%)
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
Computerized Laboratory and Radiology
Functions in CAHs
(n=333)
Clinician ordering of lab tests
Tracking of lab specimens
Clinician review of lab test results
Clinician ordering of radiographs
Clinician review of radiology results
Teleradiology (transmission of
radiographic images electronically to
radiologists at another site)
Source: Flex Monitoring Team Briefing Paper No. 11, The Current Status of Health
Information Technology Use in CAHs, May 2006
Number
(percent)
of CAHs
152 (45.7%)
170
194 (58.4%)
140 (42.2%)
198 (59.5%)
267 (80.2%)
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
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
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)
National HIT Policy and Funding for Rural Health
Federal Agencies and Departments involved in HIT
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
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
National HIT Policy and Funding for Rural Health
Goal 1: Inform
Clinical Practice
Goal 3:
Personalize Care
•Incentivize EHR Adoption
•Reduce Risk of EHR Investment
•Promote EHR Diffusion in
Rural and Underserved
Areas
•Use of Personal Health
Records,Enhancement of
Informed Consumer
Choice, and Promotion of
Telehealth Systems
Strategic
Framework
Goal 2: Interconnect
Clinicians
Goal 4: Improve
Population Health
•Foster Regional Collaboration
•Develop a Nationwide Health
Information Network (NHIN)
•Coordinate Federal Health
Information Systems
•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
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
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
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
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
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
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
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
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
National HIT Policy and Funding for Rural Health
 The Agency for Health Research and
Advancing
Excellence in Health
Care
Quality Health Information Technology
Program
122 projects in 41 States
Six State and Regional HIT
Demonstrations
National Resource Center
National HIT Policy and Funding for
Rural Health
AHRQ’s
Grantees
National HIT Policy and Funding for Rural Health
AHRQ’s HIT Website:
http:healthit.ahrq.gov
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
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
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.
National HIT Policy and Funding for Rural Health
Universal Service Fund
 Rural Health Care
Corporation
 Contact Information
1-800-229-5476 (MondayFriday; 8 AM-8 PM)
http://www.universalservice.org/rhc/
National HIT Policy and Funding for Rural Health
Commitments by Applicant Type
HCP Type
1998 1999 2000 2001 2002 2003 2004 2005
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).
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 …
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
National HIT Policy and Funding for Rural Health
Questions or Comments?
Contact Information
tmorris@hrsa.gov
301-443-0835
http://ruralhealth.hrsa.gov