Bringing Health Information to Life in Rural America

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Bringing Health Information to Life in Rural
America

• ELISABETH HANDLEY, MPA
• Deputy National Coordinator for Operations,
• Office of the National Coordinator for Health
  Information Technology,
• US Department of Health Human Services

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Todays Agenda

1. Health IT and Its Role
2. Barriers and Solutions
3. Rural Health Initiative
4. Questions and Answers

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Indiana A Leader in Health IT
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1. Health IT and Its Role
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A Familiar Story A Broken System

• COST
• Billions in unnecessary and wasteful spending
• QUALITY
• Despite rapid advances, thousands of patients die
  each year from medical error
• COVERAGE
• 51 million uninsured many more underinsured

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Chasing fees.
Its thornlike in appearance, but I need to
order a battery of tests.
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Moving past Hippocrates

• Information
• lifeblood of medicine.
• We manage information as
• Hippocrates did in 400 B.C.
• Health IT
• The circulatory system of modern health care.

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How many physicians learned to practice medicine
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How the next generation will practice medicine
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More practically
HIE Exchanging health information
EHR Electronically capturing and processing
information about patients

• CDS
• Improved care decisions

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2. Barriers and Solutions
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Major Barriers to EHR Adoption
Percent of physicians reporting a major barrier
Source DesRoches CM et al. Electronic health
records in ambulatory carea national survey of
physicians. N Engl J Med. 359(1)50-60, 2008 Jul
3.
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The Federal Governments Response HITECH ACT

• Part of American Recovery and Reinvestment Act of
  2009 (ARRA).
• Comprehensive approach
• Economic incentives
• Care improvement
• Quality measurement
• Reward Meaningful use of electronic health
  records

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Conceptual Approach to Meaningful Use
2015
2013
2011
Healthit.hhs.gov
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Meaningful Use Summary
Eligible Professionals (EPs) Eligible Hospitals (EHs)
Objectives and Measures 25 24
Measures requiring Yes/No Reporting 7 8
Measures requiring Numerator/Denominator Reporting 18 16
Core Set Criteria 15 14
Menu Set Criteria (must choose at minimum) 5 out of 10 5 out of 10
Reporting Period Year One of Application 90 days 90 days
Subsequent Reporting Period(s) 1 Year 1 Year
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Meaningful Use Examples for Eligible Health
Professionals and Eligible Hospitals

• Core Set

• Menu Set

• Use CPOE
• Implement drug-drug, drug-allergy, drug-formulary
  checks
• Maintain an up-to-date problem list
• Maintain active medication list
• Maintain medication allergy list
• Record demographics
• Record and chart changes in vital signs

• Incorporate clinical lab-test results into EHR as
  structured data
• Generate lists of patients by specific conditions
  to use for quality improvement, reduction of
  disparities, and outreach
• Report ambulatory quality measures to CMS

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HITECH ACT Addressing Barriers

• Bipartisan support for key components
• Addresses major barriers through
• Financial provisions, market reform.
• Technical assistance, support .
• Standards
• Health information exchange
• Privacy and security.

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HITECH FRAMEWORK MEANINGFUL USE
ADOPTION
Regional Extension Centers
Improved Individual and Population Health
Outcomes Increased Transparency and
Efficiency Improved Ability to Study and
Improved Care Delivery
Workforce Training
MEANINGFUL USE
Medicare and Medicaid Incentives and Penalties
State Grants for Health Information Exchange
EXCHANGE
Standards and Certification Framework
Privacy and Security Framework
Research to Enhance Health IT
Beacon Community Program
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Financial provisions

• Medicare/Medicaid incentives 9-27 billion
  starting 2011.
• Physicians 44,000/63,750 over 5-10 years.
• Penalties starting in 2015.
• Hospitals 2M bonus plus extra DRG payments.
• Support for adoption 2 billion to Office of
  National Coordinator for Health Information
  Technology (ONC).

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Technical Assistance with Adoption

• 693 million
• 62 Regional Extension Centers covering entire
  U.S.
• Health Information Technology Research Center.
• 118 million
• Training over 40,000 new health IT support
  personnel
• First class graduated 9/10 from UT Austin.

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The Health Information Technology Research Center

• 50 million to help Regional Extension Centers
  identify and share best practices in
• EHR adoption
• Meaningful use
• Provider support

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Health Information Exchange

• Laying the Basic Foundation
• Multi-faceted approach
• Setting standards and certification criteria
• Providing local leadership
• Supporting exchange of information through the
  Nationwide Health Information Network (NHIN)

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State Health Information Exchange Program

• 564 million
• Promote HIE through State leadership

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Nationwide Health Information Network

• NHIN Exchange
• NHIN Direct

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Privacy and Security as a Foundation.
Health IT Outcomes
Privacy Security
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FEDERAL GOVERNMENTS ROLEPrivacy Security

• Banned sale of health information without
  consent.
• Federal activity in enforcement
• Expanded patient rights to access their
  information
• Improved encryption technology to prevent
  breaches
• MORE to COME

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Workforce

• ONC allocated 84 million
• Community College Consortia to Educate Health
  Information Technology Professionals, 36 million
• University-Based Health IT Training, 32 million
• Curriculum Development Centers, 10 million
• Competency Examination Program, 6 million

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Remaining challenges

• HITECH a great start, but many challenges to
  implementation.
• Getting regional centers up and running
• Assuring infrastructure for exchange
• Training necessary workforce
• Defining future stages of meaningful use
• Sustaining economic incentives for adoption and
  meaningful use

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3. Rural Initiative
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Rural providers barriers to adoption

• Broadband access
• Financing
• Personnel and expertise

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Reducing Rural Health IT Disparities

• Need to address the specific needs of rural
  healthcare providers

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Federal Resources that Benefit Rural Healthcare
Providers

• ONC programs, resources, and initiatives
• Regional Extension Centers
• Critical Access Hospital Supplement
• Communities of Practice
• State Health Information Exchange
• Workforce Training
• Beacon Community Program
• Health Resources and Services Administration
  programs
• Centers for Medicare and Medicaid programs
• Indian Health Service programs

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Coordination of Federal Resources Continued

• US Department of Agriculture
• Community Facilities Program
• Programs that support the development of
  broadband infrastructure
• Federal Communications Commission
• Rural Health Care Support Mechanism

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5. Thinking Outside the Box
Be part of this inevitable revolution in modern
medicine.
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7. QUESTION ANSWER
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