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Health IT Adoption by Rural Safety-Net Providers

Health IT Adoption by Rural Safety-Net Providers . Speranza Avram, M.P.A. NSRHN Executive Director. NSRHN Geographic Area. 435,900 residents 30,000 square miles. 80% of residents live in rural or frontier communities. NSRHN Mission Statement.

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Health IT Adoption by Rural Safety-Net Providers

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  1. Health IT Adoption by Rural Safety-Net Providers Speranza Avram, M.P.A. NSRHN Executive Director

  2. NSRHN Geographic Area • 435,900 residents • 30,000 square miles 80% of residents live in rural or frontier communities

  3. NSRHN Mission Statement • To promote the health and well-being of residents in rural Northeastern California through: • comprehensive health care planning • integrated health care delivery systems • programs and services that expand access to care for all residents regardless of ability to pay

  4. NSRHN Structure • Non-profit corporation organized in 1995 • Total membership currently 40 health care providers consisting of 100% of primary care clinics in region, 100% of rural hospitals, half of the public health departments, some private sector providers and the two regional tertiary hospitals • Nine employees in two offices with current budget of $2.1 million

  5. Technology Projects - Overview • Support Regional Telemedicine Network. • Use video conferenencing for distance learning, peer support, and regional communication. • Bridge the “digital divide” by operating private T-1 line network.

  6. Technology Projects – Overview (con’t) • Coordinate telemedicine services to special populations. • Provide technology tools to providers such as PDAs, on-site computer training, and upgraded IT hardware • Operate regional Technology Help Desk • Promote regional IT strategic planning

  7. Rural Challenges • Lack of broadband connectivity for Internet access and video conferencing • Lack of technology support infrastructure: repair facilities, computer stores, technicians, colleges • Lack of economy of scale hinders technology investment options

  8. Rural Challenges – con’t • Small facilities and rural communities are not attractive to vendors • Most safety-net facilities cannot afford even temporary loss of productivity caused by new technology installation • Dependence on public payors limits access to innovation and investment

  9. Network Strategies • Aggregate need, design regional solutions, and provide vehicle for funding • Develop expertise to provide centralized technical support to members • Develop and manage shared telecommunications infrastructure • Develop “value-added” services difficult for individual members to develop, usually on the leading edge

  10. Impact of Network Strategies • Telemedicine links rural patients with needed specialty care (over 3,000 clinical consults conducted to date by 30 rural health telemedicine sites) • Video conferencing expands educational opportunities for isolated providers, helps with retention (over 400 continuing medical education events completed) • Shared T-1 line network using federal Universal Services subsidies expands connectivity at reduced cost

  11. Impact - (con’t) • Investments of over $3.5 million in private, state, and federal support for rural health providers – much of it for IT equipment, warranty support, IT training, etc) • Regional rural voice to impact policy agendas (changed state regulation to expand access to telecommunications subsidies)

  12. Impact - (con’t) • Helped members achieve HIPAA compliance • IT Help Desk fielding average of 100 calls per month (30% telemedicine-related)

  13. Lessons Learned • Be clear on vision and mission and re-visit them through regular strategic planning • Do real things to keep people interested and engaged – and do them well • Be nimble and respond to the needs of your members and changes in the environment

  14. Lessons Learned (con’t) • Approach non-traditional partners to develop “win-win” propositions • Think strategically and for the long-term – while being responsive to today’s needs • Diversity is our greatest asset…..and our greatest challenge

  15. What’s next? • Completing installation of VPN • Working with providers to develop shared clinical data applications • Conducting extensive education and readiness assessment for installation of HER • Developing business service projects to help with sustainability • Emerging as a leader in development of RHIO for northeastern California

  16. Northern Sierra Rural Health Network = Regional Health Information Organization = RHIO Shared Clinical Applications Electronic Health Records Clinician Technology Training Patient Control of PHI Centralized Technology Help Desk and Support Services Virtual Private Network Pathway graphic courtesy of The Tides Foundation Community Clinic Initiative PDAs Telemedicine

  17. Future Challenges • Supporting EHR adoption at the facility level while promoting regional dialogue • Engaging public sector payors in RHIO discussions (CMS, Medi-Cal, PERS) • Attracting and maintaining clinician interest and attention • Finding funding for both facility and RHIO investments outside of traditional Return on Investment models (need new ROI paradigms)

  18. Northern Sierra Rural Health Network 138 New Mohawk Rd. Suite 100 Nevada City, CA 95959 530-470-9091 FAX: 530-470-9094 www.nsrhn.orgsperanza@nsrhn.org

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