HRSA and Health Information Technology

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HRSAs 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
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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

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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

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HIT Goals for the Safety Net Providers

• Bring HIT to Americas 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

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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.

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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

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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
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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.

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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

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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
  Departments efforts to meet the Presidents 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

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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
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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

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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

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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.

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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.

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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

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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.

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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

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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

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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.

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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.

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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

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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

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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

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Telehealth Resource Centers Contact Information

• NATIONAL TELEHEALTH RESOURCE CENTER
• Center for Telehealth and e-Health Law
• Phone [phone] Web www.ctel.org
• REGIONAL RESOURCE CENTERS
• California Telemedicine and eHealth Center
• Phone [phone] Web www.cteconline.org
• Great Plains Telehealth Resource and Assistance
  Center
• Phone [phone] Web www.gptrac.org
• Midwest Alliance for Telehealth and Technology
  Resources
• Phone [phone] Web www.midwesttrc.org
• Northeast Telehealth Resource Center
• Phone [phone] Web www.northeasttrc.org

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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. Drivers 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.

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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.

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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
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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.

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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.

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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_at_hrsa.gov to 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!

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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_at_hrsa.gov
  letting us know.

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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   

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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.

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OHIT Strategic Plan

• A strategic plan that will define
• OHITs role in promoting HIT adoption across HRSA
• OHITs relationships with HRSA offices and
  bureaus
• OHITs 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

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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/

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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.

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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.

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Quote

• Remember, this isnt about technology, its
  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.
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Contact Information

• Cheryl Austein Casnoff, MPH
• Associate Administrator
• DHHS/HRSA/OHIT
• 5600 Fishers Lane, 7C-22
• Rockville, MD 20857
• Phone [phone]
• Fax [phone]
• caustein-casnoff_at_hrsa.gov