Transcript HRSA and Health Information Technology

U.S. Department of Health and Human Services
Health Resources and Services Administration
HRSA’s Office of
Health Information Technology
WorldVistA 15th VistA Community Meeting
June16, 2007
Johanna Barraza Cannon
Director, Division of HIT Policy
US Department of Health and Human Services
Health Resources and Services Administration
Office of Health Information Technology
Objectives
• Provide information about the Office of Health
Information Technology (OHIT)
• OHIT Programs
• Funding for HIT Adoption
• HIT Technical Assistance
• Other OHIT Activities
Health Resources and
Services Administration (HRSA)
• Budget of approximately $6.6 billion (FY 2006)
• 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)
• Health center grantees each year deliver preventive and
primary health care to about 14.1 million mostly lowincome and uninsured people
• 2005 Health Center Data
• 954 Health Center grantees
• 3,745 service sites in the U.S
• Ryan White CARE Act grantees give more than 530,000
people with HIV/AIDS the medication and care they need
to get better or stay well
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.
Office of Health
Information Technology
HRSA
Administrator
Dr. Betty Duke
Associate
Administrator
Cheryl
Austein Casnoff
Division of
HIT Policy
Johanna
Barraza-Cannon
Office for the
Advancement of
Telehealth
Dena Puskin
Division of HIT
State and
Community
Assistance
Susan Lumsden
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
Safety Net Challenges
• According to National Association of Community Health
Centers (NACHC) 2006 survey:
• Health Centers frequently lack the capital dollars to invest in
health IT to help them provide more improved and efficient
care.
• Only 8% of health centers currently report using a full
Electronic Medical Record (EMR).
• 60% of health centers report plans for installing a new EMR
system or replacing the current system within the next 3
years.
Safety Net Challenges
• According to a Commonwealth Fund 2006 survey:
• 23.9% of physicians providing care to non-hospitalized
patients use electronic health records in some form
• Reimbursement issues must be addressed in order to
promote health IT adoption
• There is no evidence yet of a “digital divide.” However
doctors who treat large numbers of Medicaid patients are
half as likely to have electronic health records
• Doctors in cities are more likely to have EHRs than those
in rural areas, as are doctors in larger practices and in
larger health care facilities
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:
Quality
Measures
HIT
Performance
Measures
Data
Reporting
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
Performance Quality
Measures
Measures
HRSA Health Center
Controlled Networks (HCCN)
HCCN is a HRSA grant program, led by
HRSA-funded health centers, that
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.
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
Networks and HIT
• FY 2003 – HRSA funded 6 Health Center Controlled
Networks to focus on Clinical Data, Care Model, and
Electronic Health Records (EHR) though the Integrated
Information and Communication (ICT) Initiative.
• Statewide efforts: Maine, West Virginia
• Multi-state efforts: Oregon
• Marketplace efforts: Florida, North Carolina, Illinois
Telehealth Network Grant Program (TNGP)
• Primary Program Objective: to demonstrate how
telehealth networks improve access to quality health care
services in underserved communities.
• FY 2006 Awards:
 13, 3-yr awards for broad-based telehealth networks
that collectively will offer over 28 clinical services in a
variety of rural settings, as well as provide distance
education services.
 3, 3-yr awards focus on evaluating the costs and
impact of telehealth networks on improving health care
through the provision of remote clinical and patient
monitoring services.
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
Telehealth Resource Center Grant Program
 Centers of excellence that assist health care organizations to develop
cost-effective, sustainable telehealth programs to serve medically
underserved communities.
 5, 3-yr awards to consortia of telehealth programs to provide
technical assistance in various regions of the nation.
Centers assist communities and providers to address a wide
range of challenges, from day-to-day operational issues to
understanding the business imperatives for creating financially
sustainable programs.
All centers have a strong record in providing telehealth
services or in providing TA to telehealth providers.
Consistent with Congressional intent, priority on the needs of
rural States with populations of <1.5 million.
Telehealth Resource Center
Grant Program
National Telehealth Resource Center Award:
to support the regional centers, individual
grantees, and HRSA in tracking and understanding
legislative and regulatory initiatives affecting
telehealth programs.
 FY 2006 Award: Center for Telehealth and EHealth Law (3-yr grant)
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, HI, ID, MT, OR, UT, WA, WY
• Great Plains Telehealth Resource and Assistance Center (Avera
Rural Health Institute): ND, SD, NE, MN
Potential Funding Opportunities
HIT PLANNING GRANTS
LEGISLATIVE INFORMATION: PHS Act, Title III, Section 330(c)1D
PURPOSE: To support health centers in structured planning
activities that will prepare them to adopt E H R or other HIT
innovations including: readiness assessment, workflow analysis,
due diligence in selecting vendor, business planning, determining
specific network HIT functions, marketplace assessment, initial
stages of collaboration with partners, and business planning.
ELIGIBILITY: Health centers acting on behalf of the member health
centers and the network.
ESTIMATED OR AVERAGE SIZE OF EACH AWARD: $125,000
ESTIMATED PROJECT PERIOD: 1 year
Potential Funding Opportunities
EHR IMPLEMENTATION INITIATIVE
LEGISLATIVE INFORMATION: PHS Act, Section 330(e)(1)(C)
PURPOSE: Funding for implementation of an electronic health
record (EHR) in support of the President's goal of universal
adoption of electronic health records by 2014.
ELIGIBILITY:
-A health center applying on behalf of a managed care network; or
-A health center applying on behalf of a practice management
network; or
-Operational networks, controlled by and acting on behalf of the
health center(s).
ESTIMATED OR AVERAGE SIZE OF EACH AWARD: $550,000
ESTIMATED PROJECT PERIOD: 3 years
•
Potential Funding Opportunities
HIT INNOVATION INITIATIVE
LEGISLATIVE INFORMATION: PHS Act, Title III, Section
330(e)(1)(C)
PURPOSE: To implement HIT other than EHRs including, but not
limited to: e-prescribing, physician order entry, personal health
records, community health records, health information exchanges,
smart cards, using telehealth to advance previous investments
(e.g., using e-prescribing to build a telepharmacy), and creating
interoperability with outside partners such as health departments
and other HRSA grantees.
ELIGIBILITY:
-a health center applying on behalf of a managed care network or
plan; or
-a health center applying on behalf of a practice management
network; or
-operational networks, controlled by and acting on behalf of the
health center(s).
ESTIMATED PROJECT PERIOD: 3 years
Tier One vs. Tier Two projects
Potential Funding Opportunities
HIGH IMPACT EHR INITIATIVE
LEGISLATIVE INFORMATION: PHS Act, Title III, Section
330(e)(1)(C)
PURPOSE: Funding for implementation of an EHR in support of
the President's goal of universal adoption of EHRs by 2014. Funds
must be used for implementation of new EHRs in at least 15 sites.
Goals include the adoption and effective use of EHRs; the creation
of sustainable business models for deploying HIT in HCCNs and
large multi-site health centers; as well as improving quality and
health outcomes in the health center program.
ELIGIBILITY:
-a health center applying on behalf of a managed care network or
plan; or
-a health center applying on behalf of a practice management
network; or
-operational networks, controlled by and acting on behalf of the
health center(s).
*Large multi-site health centers must have 30 or more sites.
ESTIMATED OR AVERAGE SIZE OF EACH AWARD: $1,400,000
ESTIMATED PROJECT PERIOD: 1 year
Federal HIT Funding
• $169 million for HIT in the 2007 President’s Budget.
• The 2008 Federal budget proposes spending over $4.5 billion for
health IT, including $4.3 billion for bioterrorism and emergency
preparedness, $127 million for state and local health IT projects, and
$118 million for the Office of the National Coordinator.
• Agencies funding HIT initiatives:
• AHRQ
• CMS
• NIH
• HRSA
• Agencies implementing HIT into operations:
• FDA
• IHS
• CDC
• DoD
• VA
Stark and Anti-Kickback Laws
• Stark Law
• a law that prevents physician self referral
• Physician self-referral is the practice of a physician referring a
Medicare / Medicaid patient to a medical facility in which she/he
has a financial interest, be it ownership, investment, or a
structured compensation arrangement
• Enforced by CMS
• “Exceptions”
• Anti-Kickback Statute
• Broader – penalties for entities that get money for referral of
business reimbursable under any Federal health care program
• Enforced by OIG
• “Safe-Harbors”
Companion 2007 IRS Ruling
• The IRS ruled that not-for-profit hospitals can
help subsidize the cost of providing electronic
health record systems and other IT services to
affiliated physicians without losing their taxexempt status.
• Hospitals donating IT to physicians would be
granted exemptions from Federal anti-kickback
and Stark laws.
OHIT Activities
HIT Technical Assistance
Helping you navigate the
maze of HIT by bringing:
HIT Tools
HIT Resources
HIT Policy Council
• The HIT Policy Council meets on a monthly basis to enhance
HIT collaboration throughout HRSA.
Activities include:
• Formulation of HIT strategy for the agency
• Collaboration with the Office of the National Coordinator
(ONC) and with other agencies
• Exchange information about OHIT and HRSA-related HIT
program activities
• Learn about new HIT funding opportunities and emerging
technologies in the HIT field
HRSA Health IT Community
• In partnership with the Agency for Health Care Quality
and Research (AHQR), HRSA has established a Health
IT Community for HRSA grantees.
• The ‘Community’:
• 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.
• 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.
Health Center HIT Toolbox
• Development of an interactive Toolbox that will assist
health centers, maternal and child health, rural health,
and HIV/AIDS grantees in HIT planning, implementation,
and sustainability.
• Focus:
•
•
•
•
Collaborative solutions
Module based
Interactive
Questions and answers
HRSA HIT Grantee Meetings
• GOAL: Promote collaboration, knowledge sharing, and the
leveraging of resources among HRSA grantees to promote
HIT adoption by safety net providers.
• Will invite approximately 500 HRSA grantees
• Will identify model practices, promote new partnerships and
collaborations.
• Meeting Date: November 5 – 7, 2007
Strategic Plan
• OHIT is developing a strategic plan that will define:
• OHIT office
• Relationships with offices within HRSA
• Relationships with its grantees
• Relationships with other constituents
• How OHIT addresses its mission to promote the
adoption and effective use of HIT in the safety net
community
HIT Technical Assistance Center
• In FY 2007, OHIT is initiating a health IT technical
assistance (TA) center that will identify and organize the
HIT TA efforts across HRSA
• EHR implementation, network development, procurement,
workforce, training, disaster recovery
• Our goal is to provide consistent HIT TA to HRSA
grantees
Open Source and Public Domain EHR
Technical Assistance
• OHIT is creating technical assistance tools to
promote the adoption of open source and public
domain EHR systems
• OHIT is working closely with IHS and WorldVistA
• Open source adoption is not free
• “SOFT COSTS”
• One-on-one TA
• Toolkit module on open source adoption
• HRSA Community portal for open source
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
HIMSS HIT Dashboard
• The Health Information Management and Systems Society
(HIMSS) HIT Dashboard gives industry professionals,
policymakers, industry leaders and vendors a snapshot of
major HIT initiatives throughout the United States and its
territories.
• The extensive database provides a color-coded, easy-toread visual interface that tracks more than 500 state,
federal, and local HIT network projects, fulfilling the
demand for a complete information presented in an
interactive format.
http://www.hitdashboard.com/
Resources
• HRSA
• OHIT Website: http://www.hrsa.gov/healthit/
• Health IT Community
Contact: [email protected]
• CMS
http://www.cms.hhs.gov
• AHRQ
http://healthit.ahrq.gov
• Veterans Health Administration
https://www.myhealth.va.gov
• Indian Health Service
http://www.ihs.gov
• Department of Health and Human Services
http://www.hhs.gov/healthit
Resources
• Health Information Management and Systems Society
http://www.himss.org
• California Healthcare Foundation
http://www.chcf.org
• Markle Foundation
http://www.markle.org
• Robert Wood Johnson
http://www.rwjf.org
• National Conference of State Legislatures
http://www.ncsl.org
• eHealth Initiative
http://toolkits.ehealthinitiative.org/assets/Documents/eHI2006
HIESurveyReportFinal09.25.06.pdf
Contact Information
Johanna Barraza Cannon
DHHS/HRSA/OHIT
5600 Fishers Lane, 7C-26
Rockville, MD 20857
Phone: 301-443-4651
Fax: 301-443-1330
[email protected]