HRSA’s Office of Health Information Technology ORHP All Programs Meeting August 28, 2007

1. HRSA’s Office of Health Information TechnologyORHP All Programs MeetingAugust 28, 2007 Cheryl Austein Casnoff, MPH Associate Administrator US Department of Health and Human Services Health Resources and Services Administration Office of Health Information Technology

2. Outline • About the Office of Health Information Technology (OHIT) • HIT: What is Happening at the Federal & State Levels • Advancing HIT through Networks • Using Telehealth to Improve Access and Quality • OHIT Activities • Additional Resources

3. Health Resources and Services Administration (HRSA) • Programs reach into every corner of America, providing a safety net of direct health care services to 20 million people each year (about 1 in every 15 Americans). • HRSA has made significant progress in meeting the needs of the uninsured and underserved individuals, special needs populations, and many others through its’ efforts to: • Improve health care • Improve health outcomes • Improve quality of care • Eliminate health disparities • Improve public health and health care systems • Improve ability of the health care system to respond to public health emergencies

4. 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

5. Office of Health Information Technology • Formed in December 2005, as the principal advisor to the HRSA Administrator in developing an agency wide HIT strategy. Mission: The Office of Health Information Technology (OHIT) promotes the adoption and effective use of health information technology (HIT) in the safety net community.

6. Data Reporting HIT Performance Measures Quality Measures HRSA HIT Quality Strategy • In May 2006, HRSA reconfirmed its goal to improve the quality of health service and outcomes for all patients served by HRSA grantees:

7. HRSA HIT Quality Strategy • HRSA's goal is not simply to collect data; it is also important that the data be used to track individual and population health outcomes and improve patient care. The long-term vision of HRSA and OHIT is to transform systems of care for safety-net populations through the effective use of HIT. Data Reporting HIT Quality Measures Performance Measures

8. Office of Health Information Technology - Goals • Develop a strategy and supportive policy that leverages the power of health information technology and telehealth to meet the needs of people who are uninsured, underserved and/or have special needs. • Identify, disseminate and provide technical assistance to health centers and other HRSA grantees in adopting model practices and technologies. • Disseminate appropriate information technology advances, such as electronic medical records systems or provider networks. • Promote grantee health information technology advances and innovations as models. • Work collaboratively with foundations, national organizations, the private sector, and other Government agencies to help HRSA grantees adopt health information technology. • Ensure that HRSA health information technology policy and programs are coordinated with those of other U.S. Department of Health and Human Services components.

9. HHS HIT Funding • FY 2008 Federal budget proposes $165 million for HIT in the Department of Health and Human Services. • $118 million ONC • $ 45 million AHRQ • $ 2 million ASPE • Agencies funding and implementing HIT initiatives: • HRSA • CMS • NIH • AHRQ • FDA • IHS • CDC

10. Office of the National Coordinator for Health Information Technology • The ONC advises the Secretary of HHS on health IT policies and initiatives, and coordinates the Department’s efforts to meet the President’s goal of making an electronic medical record available for most Americans by 2014. • Initiatives include: • American Health Information Community (AHIC) • Product Certification • Standards • Nationwide Health Information Network • Activities with the National Governors Association Center for Best Practices

11. Centers for Medicare & Medicaid Services • MEDICAID • Section 1115 Waiver (DRA) • States may apply for waiver to increase their flexibility to develop Medicaid plans that may extend coverage to additional populations, increase covered services and control costs • Deficit Reduction Act of 2005 (DRA) • Grants states flexibility to design different coverage options for different populations without applying for a Section 1115 Waiver • Opportunity to incorporate HIT initiatives into state Medicaid reform plans • Medicaid Transformation Grants • DRA authorizes new grant funds to States for the adoption of innovative methods to improve effectiveness and efficiency in providing medical assistance under Medicaid. • $103 million in awards announced on January 25, 2007 Source: 2006 Medicaid Congress Conference Summary

12. State Support for HIT • Over 240 health information technology bills were introduced in 2007 at the State level.  • A total of 45 bills passed in 28 states and the District of Columbia with funding for HIT

13. State HIT Topics • Electronic Medical Records • June 27, 2007 - Louisiana has allocated $30 million to Phase 1 of their statewide electronic medical records system for state public hospitals and medical centers • Health Data Exchange • 4/24/07 – Maryland will devote $30 million over the next 3 years to establish a regional data exchange • Grant Opportunities • 3/27/07 – Idaho will offer $2.5 million in in competitive grants to Community Health Centers for equipment, including HIT equipment • School HIT • 1/16/07 – District of Columbia will use $200,000 HIT in public and charter school nurse suites

14. HRSA Health Center Controlled Networks (HCCN) • Led by HRSA-funded health centers. • Supports the creation, development, and operation of networks of safety net providers to ensure access to health care for the medically underserved populations through the enhancement of health center operations, including health information technology.

15. Advancing HIT through Networks • Why Networks? • Collaboration of health centers and other safety net providers. • Economies of scale/cost efficiencies/volume. • Enhanced efficiencies in business and clinical core areas. • Higher performance and value. • Sharing of expertise and staff among collaborators.

16. HRSA FY 2007 Network Grant Opportunities • Planning Grants • Small amounts (less than $100,000 per year) to plan and start implementing HIT initiatives such as EHRs and e-prescribing. • Electronic Health Record Implementation Grants • 3-year grants to purchase and implement EHRs. • HIT Innovation Grants • 3-year grants to purchase and implement other HIT. • High Impact EHRs Implementation Grants • 1 year grant for high impact implementation of an EHR; implementation of new EHRs must be in at least 15 sites. • Total funding: Approximately $20 million

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

18. FY 2006 Telehealth Grants • Telehealth Resource Center Grant Program • 6 awards • Telehealth Network Grant Program (including home health) • 16 awards • Licensure Portability Grant Program • 2 awards • Funding of approximately $6.8 million in FY 2007

19. OHIT Grant Applicants • Over 721 Health Centers Applied • Representing all Regions of the US and over 25 States • 14 Primary Care Associations • 52 Networks • 26 Community Health Centers

20. Telehealth Network Grants • To demonstrate how telehealth technologies can be used through telehealth networks to: • Expand access, coordinate, and improve quality of health services. • Improve and expand the training of health care providers. • Expand and improve the quality of health information available to health care providers, and to patients and their families. • Eligibility: Open to urban and rural networks, but limited funding resulted in only rural networks funded.

21. Telehealth Grants Allow Grantees to… • Purchase/lease equipment (up to 40% of grant). • Pay for organizational development and operations. • Conduct internal evaluations on cost-effectiveness of services. • Provide clinical services, develop distance education programs, mentor/precept at a distance. • Promote collaboration in the region to improve the quality of and access to health services.

22. Telehealth Network Grants • University of Arkansas for Medical Sciences, AR • Northern Sierra Rural Health Network, CA • Ware County Board of Health, GA • The Queen's Medical Center, HI • Public Hospital Cooperative SE Idaho Inc, ID • Illinois Department of Human Services, IL • University of Kansas Medical Center Research Institute, KS • Eastern Maine Healthcare Systems, ME • Tri-County Hospital, MN • Citizen's Memorial Hospital District, MO • St. Patrick Hospital & Health Foundation, MT • Duke University, NC • Children's Hospital Medical Center of Akron, OH • Home Nursing Agency & Visiting Nurse Association, PA • University of Washington, WA • Marshfield Clinic Research Foundation, WI

23. Telehealth Resource Centers • Purpose: To promote the cost-effective use of Telehealth technologies through technical assistance to grantees, potential grantees, health care providers, and communities • Technical Assistance • Dissemination • Website • Conferences • Webinars • Peer-to Peer TA • Individual TA

24. FY 2006 Telehealth Resource Center Grantees/States Covered • California Telemedicine and eHealth Center: CA • Northeast Telehealth Resource Center (Medical Center at Lubec): ME, VT, NH, MA • Midwest Alliance for Telehealth and Technologies Resources (Marquette Hospital): MI, KS • Northwest Regional Telehealth Resource Center (St. Vincent Foundation): AK, HA, ID, MT, OR, UT, WA, WY • Great Plains Telehealth Resource and Assistance Center (Avera Rural Health Institute): ND, SD, NE, MN • Center for Telehealth and E-Health Law: National Center

25. Telehealth Resource Centers Contact Information NATIONAL TELEHEALTH RESOURCE CENTER • Center for Telehealth and e-Health Law • Phone: (202) 230-5090; Web: www.ctel.org REGIONAL RESOURCE CENTERS • California Telemedicine and eHealth Center • Phone: (916) 552-7679; Web: www.cteconline.org • Great Plains Telehealth Resource and Assistance Center • Phone: (888) 239-7092; Web: www.gptrac.org • Midwest Alliance for Telehealth and Technology Resources • Phone: (866) 603-4733; Web: www.midwesttrc.org • Northeast Telehealth Resource Center • Phone: (207) 287-4060; Web: www.northeasttrc.org • Northwest Regional Telehealth Resource Center • Phone: (509) 789-4976; Web: www.nrtrc.org

26. Licensure Portability GrantsNational Council of State Boards of Nursing Grant • Aassist states in adoption of the Nurse Licensure Compact (NLC). • Mutual recognition licensure model based on the U.S. Driver’s License Compact. • Allows both RN and LP/VN nurses to hold one license to practice in their home state while being permitted to practice in other participating NLC states, both physically and electronically. • Develop strategies to overcome barriers to implementation. • Assess the costs and benefits of such strategies. • Nurse Summit to increase knowledge about the NLC among states. • Assist states in defraying costs of criminal background check (CBC) for licensees – a major barrier to adoption in some states. • Development of standardized financial impact tools to evaluate the cost of implementing the NLC and CBCs.

27. Licensure Portability GrantsFederation of State Medical Boards of the United States, Inc. • To create demonstrations of models that reduce licensure barriers to telehealth for physicians practicing across state lines. • Implements 2 proposals developed by medical boards in the northeastern (ME, MA, VT, CT, RI and NH) and western regions (ND, KS, CO, MN, IA, ID, OR, and WY) to share licensure information across jurisdictions. • Development of a centralized data management system with immediate access to credentials that confirm physicians’ qualifications to practice – reducing the burden faced by applicants seeking verification of their credentials in multiple states. • Expected Outcomes: • Reduce amount of time and paperwork required to issue licenses, thereby encouraging more physicians to participate in electronic practice across state lines. • Facilitate mobilization of physicians in disasters when the need for immediate and accurate physician information is essential.

28. A Strategy for Providing HIT Technical Assistance (TA) TA Tools developed by OHIT form a mechanism to increase health IT knowledge in the grantee community. – September 2007

29. TA – HRSA Portal • In partnership with the Agency for Health Care Research and Quality (AHRQ) HRSA has established a Health IT Community for HRSA grantees. • Serves as a virtual community for health centers, networks and PCAs to collaborate around the adoption of technologies promoting patient safety and higher quality of care. • Facilitates collaboration via discussion forums where health centers facing similar challenges can share thoughts and lessons from experiences with a variety of IT systems and scenarios.

30. TA – HRSA Portal • Will include tabs for maternal and child health, rural health, HIV/AIDS grantees, and telehealth grantees. • Creates a central hub for communication across geographically disparate sites, allows team members to view important announcements, documents, tasks, events, and discussions related to their initiative. • Private community capability • A virtual place for grantees to have a place for project plan tasks lists, upload documents, create calendars, and have discussion boards on the project. • Grantee controls who has access to the community. • Perfect for large health centers, networks, and people working with other partners.

31. TA – HRSA Portal • Includes a repository of information on IT targeted to the health center population members. • For login name and password for the HRSA Health IT Community, email HealthIT@hrsa.govto obtain logins for you and your staff. • The HRSA Health IT Community news is updated daily with articles and news releases related to HIT.  Be sure to check it!

33. TA - HIT Toolbox • An interactive Toolbox that will assist health centers, maternal and child health, rural health, and HIV/AIDS grantees in HIT planning, implementation, and sustainability. • Dissemination of the HIT Toolkit is for November 2007. • Focus: • Collaborative solutions • Module based • Interactive • Questions and answers • We will be sharing the draft toolkit for feedback among a small set of stakeholders in September/October.  If you would like to be part of this group, please email HealthIT@hrsa.govletting us know.

34. TA - HIT Toolbox • The toolbox is organized by 9 topic-specific modules: • Introduction to Health IT      • Getting Started        • Opportunities for Collaboration         • Project Management and Oversight  • Planning for Technology Implementation       • Organizational Change Management and Training • System Implementation        • Evaluating, Optimizing, and Sustaining           • Advanced Topics   

35. TA - HIT TA Center • Provide consistent HIT TA to HRSA grantees. • TA “One to Many" Calls • HIT 101 • Workflow Analysis and HIT • 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.

36. OHIT Strategic Plan • A strategic plan that will define: • OHIT’s role in promoting HIT adoption across HRSA • OHIT’s relationships with HRSA offices and bureaus • OHIT’s relationships with its grantees and other constituents • How OHIT addresses its mission to promote the adoption and effective use of HIT in the safety net community • Expected release – November 2007

37. HRSA HIT Grantee Meetings • Promote collaboration, knowledge sharing, and the leveraging of resources among HRSA grantees to promote HIT adoption by safety net providers. • Audience approximately 500 HRSA grantees • Meeting Date: November 5 – 7, 2007 • Location: Crystal City, VA • Website: http://blsmeetings.net/OHIT/

38. Areas to Watch • Personal health records • Continuous records of one's diagnoses, medications, treatments and outcomes--portable and interoperable with electronic health records, clinical decision support and clinical data repositories--will dramatically improve continuity of care by 2014. • Access to health IT for disadvantaged, underserved and vulnerable patient populations • IT will help reduce disparities in healthcare distribution so that underserved populations are not left out. • Role of the states • States will become much more involved in health information exchange initiatives and RHIOs, setting policies and monitoring service delivery to improve accessibility to evidence-based healthcare.

39. Areas to Watch • Biosurveillance and Public Health • Public and private healthcare providers will make extensive use of biosurveillance when responding to natural disasters, epidemics and terrorist attacks, including identification and management of the psychological response to trauma. • Continuity of care for military personnel • Portable electronic health records will improve access to physical and mental health diagnostic and treatment services for veterans with physical injuries, as well as post-traumatic stress disorder and traumatic brain injury. • To improve continuity of care, these records should include health information from all sources, from pre-deployment baselines to military hospitals to nursing homes and private health care.

40. Quote “Remember, this isn’t about technology, it’s about transforming the health of the nation. My role is to get IT out there to improve the quality and efficiency of health care and the ability of consumers to manage their own health.”* - Robert Kolodner, National Coordinator for Health IT * From iHealth Beat article, “Government Tapping IT To Boost Care, National Health IT Leader Says.” Issue May 18, 2007.

41. 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