U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services

Health Resources and Services AdministrationHealth Resources and Services Administration

HRSA’s Office of HRSA’s Office of Health Information TechnologyHealth Information Technology

Project Project HITChHITCh June Meeting:June Meeting:Health Information Technology and the Safety NetHealth Information Technology and the Safety Net

June 20, 2007June 20, 2007

Cheryl Austein CasnoffCheryl Austein CasnoffAssociate Administrator

US Department of Health and Human ServicesHealth Resources and Services Administration

Office of Health Information Technology

OutlineOutline

•• State ActivitiesState Activities

•• About the Office of Health Information Technology (OHIT)About the Office of Health Information Technology (OHIT)

•• HIT: What is happening at the Federal levelHIT: What is happening at the Federal level

•• Advancing HIT through NetworksAdvancing HIT through Networks

•• Using Telehealth to Improve Access and QualityUsing Telehealth to Improve Access and Quality

•• OHIT ActivitiesOHIT Activities

•• Areas to Watch Areas to Watch

•• Additional ResourcesAdditional Resources

State ActivitiesState Activities•• According to the NCSL, state roles in HIT planning According to the NCSL, state roles in HIT planning

include:include:•• StartStart--up Fundingup Funding

•• At least 17 state governments are funding At least 17 state governments are funding programs to examine how HIT may be used or programs to examine how HIT may be used or implementedimplemented

•• Building infrastructureBuilding infrastructure•• At least 10 states are facilitating RHIO At least 10 states are facilitating RHIO

developmentdevelopment•• StudiesStudies

•• At least 6 states have initiated planning At least 6 states have initiated planning projects but have not taken legislative actionprojects but have not taken legislative action

State ActivitiesState Activities

•• According to eHealth Initiative*, a majority of According to eHealth Initiative*, a majority of states have introduced HIT related legislationstates have introduced HIT related legislation•• 20% of nation’s governors have issued 20% of nation’s governors have issued

executive orders for state action to improve executive orders for state action to improve health care through HIThealth care through HIT

•• In 2005 and 2006, 36 bills were passed in 24 In 2005 and 2006, 36 bills were passed in 24 state legislatures and signed into law, and 121 state legislatures and signed into law, and 121 bills that specifically focus on health IT were bills that specifically focus on health IT were introduced in 30 states. introduced in 30 states.

*eHealth Initiative, 3rd Annual Survey of Health Information Exc*eHealth Initiative, 3rd Annual Survey of Health Information Exchange Activities at the State, Regional, hange Activities at the State, Regional, and Local levelsand Local levels

Health Resources and Services Health Resources and Services Administration (HRSA)Administration (HRSA)

•• Budget of approximately $6.6 billion (FY 2006)Budget of approximately $6.6 billion (FY 2006)

•• Programs reach into every corner of America, providing Programs reach into every corner of America, providing a safety net of direct health care services to 20 million a safety net of direct health care services to 20 million people each year (about 1 in every 15 Americans) people each year (about 1 in every 15 Americans)

•• Health center grantees each year deliver preventive and Health center grantees each year deliver preventive and primary health care to about 14.1 million mostly lowprimary health care to about 14.1 million mostly low--income and uninsured peopleincome and uninsured people•• Calendar year 2005Calendar year 2005

•• 954 grantees954 grantees•• 3,745 service sites3,745 service sites

•• Ryan White CARE Act grantees give more than 530,000 Ryan White CARE Act grantees give more than 530,000 people with HIV/AIDS the medication and care they need people with HIV/AIDS the medication and care they need to get better or stay wellto get better or stay well

HIT Goals for the HIT Goals for the Safety Net ProvidersSafety Net Providers

Bring HIT to America’s safety net providers which will: Bring HIT to America’s safety net providers which will:

•• Improve quality of careImprove quality of care

•• Reduce health disparities Reduce health disparities

•• Increase efficiency in care delivery systemsIncrease efficiency in care delivery systems

•• Increase patient safetyIncrease patient safety

•• Decrease medical errorsDecrease medical errors

•• Prevent a digital dividePrevent a digital divide

HRSA HIT Quality StrategyHRSA HIT Quality Strategy

•• In May 2006, HRSA reconfirmed its goal to improve the In May 2006, HRSA reconfirmed its goal to improve the quality of health service and outcomes for all patients quality of health service and outcomes for all patients served by HRSA grantees:served by HRSA grantees:

HITHIT

Data Data ReportingReporting

PerformancePerformanceMeasuresMeasures

Quality Quality MeasuresMeasures

HRSA HIT Quality StrategyHRSA HIT Quality Strategy

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

HITHIT

Data Data ReportingReporting

PerformancePerformanceMeasuresMeasures

Quality Quality MeasuresMeasures

Office of Health InformationOffice of Health Information TechnologyTechnology

•• Formed in December 2005, as the principal advisor to the Formed in December 2005, as the principal advisor to the HRSA Administrator in developing an agency wide HIT HRSA Administrator in developing an agency wide HIT strategystrategy

Mission:Mission:The Office of Health Information Technology (OHIT) The Office of Health Information Technology (OHIT) promotes the adoption and effective use of health promotes the adoption and effective use of health information technology (HIT) in the safety net communityinformation technology (HIT) in the safety net community

Office of Health Office of Health Information Technology Information Technology -- GoalsGoals

•• Develop a strategy and supportive policy that leverages the poweDevelop a strategy and supportive policy that leverages the power of r of health information technology and telehealth to meet the needs ohealth information technology and telehealth to meet the needs of f people who are uninsured, underserved and/or have special needs.people who are uninsured, underserved and/or have special needs.

•• Identify, disseminate and provide technical assistance to healthIdentify, disseminate and provide technical assistance to healthcenters and other HRSA grantees in adopting model practices and centers and other HRSA grantees in adopting model practices and technologies.technologies.

•• Disseminate appropriate information technology advances, such asDisseminate appropriate information technology advances, such aselectronic medical records systems or provider networks. electronic medical records systems or provider networks.

•• Promote grantee health information technology advances and Promote grantee health information technology advances and innovations as models. innovations as models.

•• Work collaboratively with foundations, national organizations, tWork collaboratively with foundations, national organizations, the he private sector, and other Government agencies to help HRSA private sector, and other Government agencies to help HRSA grantees adopt health information technology. grantees adopt health information technology.

•• Ensure that HRSA health information technology policy and Ensure that HRSA health information technology policy and programs are coordinated with those of other U.S. Department of programs are coordinated with those of other U.S. Department of Health and Human Services components. Health and Human Services components.

Office of Health Information TechnologyOffice of Health Information Technology

Associate Associate AdministratorAdministrator

Cheryl Cheryl Austein CasnoffAustein Casnoff

Division of Division of HIT PolicyHIT PolicyJohanna Johanna

BarrazaBarraza--CannonCannon

Office for the Office for the Advancement ofAdvancement of

Telehealth Telehealth Dena PuskinDena Puskin

Health Center Health Center Controlled Controlled NetworksNetworks

Susan LumsdenSusan Lumsden

HRSA HRSA AdministratorAdministrator

Safety Net ChallengesSafety Net Challenges

•• According to National Association of Community According to National Association of Community Health Centers (NACHC) 2006 survey:Health Centers (NACHC) 2006 survey:

•• Health Centers frequently lack the capital dollars Health Centers frequently lack the capital dollars to invest in health IT to help them provide more to invest in health IT to help them provide more improved and efficient care.improved and efficient care.

•• Only 8% of health centers currently report using a Only 8% of health centers currently report using a full EHR.full EHR.

•• 60% of health centers report plans for installing a 60% of health centers report plans for installing a new EHR system or replacing the current system new EHR system or replacing the current system within the next 3 years.within the next 3 years.

Safety Net ChallengesSafety Net Challenges

•• According to a Commonwealth Fund 2006 survey:According to a Commonwealth Fund 2006 survey:

•• 23.9% of physicians providing care to non23.9% of physicians providing care to non--hospitalized hospitalized patients use electronic health records in some form.patients use electronic health records in some form.

•• Reimbursement issues must be addressed in order to Reimbursement issues must be addressed in order to promote health IT adoption.promote health IT adoption.

•• Doctors who treat large numbers of Medicaid patients are Doctors who treat large numbers of Medicaid patients are half as likely to have electronic health records.half as likely to have electronic health records.

•• Doctors in cities are more likely to have EHRs than those Doctors in cities are more likely to have EHRs than those in rural areas, as are doctors in larger practices and in in rural areas, as are doctors in larger practices and in larger health care facilities.larger health care facilities.

•• Is there a digital divide in EHR use?Is there a digital divide in EHR use?

Federal HIT FundingFederal HIT Funding

•• $169 million for HIT in the 2007 President’s Budget.$169 million for HIT in the 2007 President’s Budget.

•• The 2008 Federal budget proposes spending over $4.5 billion for The 2008 Federal budget proposes spending over $4.5 billion for health IT, health IT, including $4.3 billion for bioterrorism and emergency preparedneincluding $4.3 billion for bioterrorism and emergency preparedness, $127 ss, $127 million for state and local health IT projects, and $118 millionmillion for state and local health IT projects, and $118 million for the Office for the Office of the National Coordinator.of the National Coordinator.

•• Agencies funding HIT initiatives:Agencies funding HIT initiatives:•• HRSAHRSA•• CMSCMS•• NIHNIH•• AHRQAHRQ

•• Agencies implementing HIT into operations:Agencies implementing HIT into operations:•• FDAFDA•• IHSIHS•• CDCCDC•• DoDDoD•• VAVA

Office of the National Coordinator for Office of the National Coordinator for Health Information TechnologyHealth Information Technology

•• The ONC advises the Secretary of HHS on health IT The ONC advises the Secretary of HHS on health IT policies and initiatives, and coordinates the policies and initiatives, and coordinates the Department’s efforts to meet the President’s goal of Department’s efforts to meet the President’s goal of making an electronic medical record available for most making an electronic medical record available for most Americans by 2014. Americans by 2014.

•• Initiatives include:Initiatives include:•• American Health Information Community (AHIC) American Health Information Community (AHIC) •• Product CertificationProduct Certification•• StandardsStandards•• Nationwide Health Information NetworkNationwide Health Information Network•• Activities with the National Governors Association Center Activities with the National Governors Association Center

for Best Practicesfor Best Practices

HRSA Health Center HRSA Health Center Controlled Networks (HCCN)Controlled Networks (HCCN)

HCCN is a HRSA grant program, led by HCCN is a HRSA grant program, led by HRSAHRSA--funded health centers, that funded health centers, that supports the creation, development, and supports the creation, development, and operation of networks of safety net operation of networks of safety net providers to ensure access to health care providers to ensure access to health care for the medically underserved populations for the medically underserved populations through the enhancement of health center through the enhancement of health center operations, including health information operations, including health information technology.technology.

Advancing HIT through HCCNsAdvancing HIT through HCCNs

•• Why Health Center ControlledWhy Health Center Controlled Networks?Networks?

•• Collaboration of health centers and other safety net Collaboration of health centers and other safety net providersproviders

•• Economies of scale/cost efficiencies/volumeEconomies of scale/cost efficiencies/volume

•• Enhanced efficiencies in business and clinical core Enhanced efficiencies in business and clinical core areasareas

•• Higher performance and valueHigher performance and value

•• Sharing of expertise and staff among collaboratorsSharing of expertise and staff among collaborators

HRSA FY 2007 HRSA FY 2007 Network Grant OpportunitiesNetwork Grant Opportunities

•• Planning GrantsPlanning Grants•• Small amounts (less than $100,000 per year) to plan and start Small amounts (less than $100,000 per year) to plan and start

implementing HIT initiatives such as EHRs and eimplementing HIT initiatives such as EHRs and e--prescribing.prescribing.

•• Electronic Health Record Implementation GrantsElectronic Health Record Implementation Grants•• 33--year grants to purchase and implement year grants to purchase and implement EHRsEHRs

•• HIT Innovation GrantsHIT Innovation Grants•• 33--year grants to purchase and implement other HITyear grants to purchase and implement other HIT

•• High Impact High Impact EHRsEHRs Implementation GrantsImplementation Grants•• 1 year grant for high impact implementation of an EHR; 1 year grant for high impact implementation of an EHR;

implementation of new implementation of new EHRsEHRs must be in at least 15 sites. must be in at least 15 sites.

HRSA Telehealth ActivitiesHRSA Telehealth Activities•• OAT leads, coordinates and promotes the use of OAT leads, coordinates and promotes the use of

telehealth technologies, for example:telehealth technologies, for example:

•• Fosters partnerships within HRSA and with other Federal Fosters partnerships within HRSA and with other Federal and private organizations to promote telehealth projects and private organizations to promote telehealth projects and demonstrations and create synergy among programsand demonstrations and create synergy among programs

•• Administers grant programs that “seed” the field and Administers grant programs that “seed” the field and advance the use of costadvance the use of cost--effective telehealth technologieseffective telehealth technologies

•• Provides technical assistanceProvides technical assistance

•• Promotes knowledge exchange about successful and not Promotes knowledge exchange about successful and not so successful telehealth practicesso successful telehealth practices

•• Identifies options for addressing barriers to the effective Identifies options for addressing barriers to the effective use of telehealth technologiesuse of telehealth technologies

Telehealth GrantsTelehealth Grants

•• Telehealth Resource Center Grant ProgramTelehealth Resource Center Grant Program•• National Telehealth Resource Center AwardNational Telehealth Resource Center Award: : Support the Support the regional centers, individual grantees, and HRSA in tracking and regional centers, individual grantees, and HRSA in tracking and understanding legislative and regulatory initiatives affecting understanding legislative and regulatory initiatives affecting telehealth programs.telehealth programs.•• 6 awards6 awards

•• Telehealth Network Grant Program (including home Telehealth Network Grant Program (including home health)health)• Primary Program ObjectivePrimary Program Objective: Demonstrate how telehealth networks improve access to quality health care services in underserved communities.•• 16 awards16 awards

•• Licensure Portability Grant ProgramLicensure Portability Grant Program•• 2 awards2 awards

HIT Policy CouncilHIT Policy Council

•• The HIT Policy Council meets on a monthly basis to enhance The HIT Policy Council meets on a monthly basis to enhance HIT collaboration throughout HRSA’s bureaus and offices. HIT collaboration throughout HRSA’s bureaus and offices. Activities include:Activities include:

•• Formulation of HIT strategy for the agencyFormulation of HIT strategy for the agency

•• Collaboration with the Office of the National Coordinator Collaboration with the Office of the National Coordinator (ONC) and with other agencies(ONC) and with other agencies

•• Exchange information about OHIT and HRSA related HIT Exchange information about OHIT and HRSA related HIT program activities program activities

•• Learn about new HIT funding opportunities and emerging Learn about new HIT funding opportunities and emerging technologies in the HIT fieldtechnologies in the HIT field

Technical AssistanceTechnical AssistanceHRSA Health IT CommunityHRSA Health IT Community

•• In partnership with the Agency for Health Care Research and QualIn partnership with the Agency for Health Care Research and Quality ity (AHRQ)(AHRQ) HRSA has established a Health IT Community for HRSA HRSA has established a Health IT Community for HRSA grantees.grantees.

•• The ‘Community’:The ‘Community’:

•• Serves as a virtual community for health centers, networks and Serves as a virtual community for health centers, networks and PCAs to collaborate around the adoption of technologies PCAs to collaborate around the adoption of technologies promoting patient safety and higher quality of care promoting patient safety and higher quality of care

•• Facilitates collaboration via discussion forums where health Facilitates collaboration via discussion forums where health centers facing similar challenges can share thoughts and lessonscenters facing similar challenges can share thoughts and lessonsfrom experiences with a variety of IT systems and scenarios..from experiences with a variety of IT systems and scenarios..

•• Creates a central hub for communication across geographically Creates a central hub for communication across geographically disparate sites, allows team members to view important disparate sites, allows team members to view important announcements, documents, tasks, events, and discussions announcements, documents, tasks, events, and discussions related to their initiative.related to their initiative.

•• Provides access documents, tools and resources on issues Provides access documents, tools and resources on issues related to planning for and implementing health IT in the related to planning for and implementing health IT in the community provider setting.community provider setting.

Health Center HIT ToolboxHealth Center HIT Toolbox

•• Development of an interactive Toolbox that will assist Development of an interactive Toolbox that will assist health centers, maternal and child health, rural health, health centers, maternal and child health, rural health, and HIV/AIDS grantees in HIT planning, implementation, and HIV/AIDS grantees in HIT planning, implementation, and sustainability. and sustainability.

•• Focus:Focus:•• Collaborative solutionsCollaborative solutions•• Module basedModule based•• InteractiveInteractive•• Questions and answersQuestions and answers

HRSA HIT Grantee MeetingsHRSA HIT Grantee Meetings

•• GOAL:GOAL: Promote collaboration, knowledge Promote collaboration, knowledge sharing, and the leveraging of resources sharing, and the leveraging of resources among HRSA grantees to promote HIT among HRSA grantees to promote HIT adoption by safety net providers.adoption by safety net providers.

•• Will invite approximately 500 HRSA Will invite approximately 500 HRSA granteesgrantees

•• Will identify model practices, promote new Will identify model practices, promote new partnerships and collaborations.partnerships and collaborations.

•• Meeting Date: November 5 Meeting Date: November 5 –– 7, 20077, 2007

HIT Technical Assistance CenterHIT Technical Assistance Center

•• In FY 2007, OHIT will initiate a health IT technical In FY 2007, OHIT will initiate a health IT technical assistance (TA) center that will identify and organize the assistance (TA) center that will identify and organize the HIT TA efforts across HRSAHIT TA efforts across HRSA

•• EHR implementation, network development, procurement, EHR implementation, network development, procurement, workforce, training, disaster recovery, HIT readinessworkforce, training, disaster recovery, HIT readiness

•• Our goal is to provide consistent HIT TA to HRSA Our goal is to provide consistent HIT TA to HRSA granteesgrantees

Areas to WatchAreas to Watch

•• Personal health recordsPersonal health records•• Continuous records of one's diagnoses, medications, treatments Continuous records of one's diagnoses, medications, treatments

and outcomesand outcomes----portable and interoperable with electronic health portable and interoperable with electronic health records, clinical decision support and clinical data repositorirecords, clinical decision support and clinical data repositorieses----will dramatically improve continuity of care by 2014. will dramatically improve continuity of care by 2014.

•• Access to health IT for disadvantaged, Access to health IT for disadvantaged, underserved and vulnerable patient populationsunderserved and vulnerable patient populations•• IT will help reduce disparities in healthcare distribution so thIT will help reduce disparities in healthcare distribution so that at

underserved populations are not left out. underserved populations are not left out.

•• Role of the states Role of the states •• States will become much more involved in health information States will become much more involved in health information

exchange initiatives and exchange initiatives and RHIOsRHIOs, setting policies and monitoring , setting policies and monitoring service delivery to improve accessibility to evidenceservice delivery to improve accessibility to evidence--based based healthcare. healthcare.

Areas to WatchAreas to Watch•• BiosurveillanceBiosurveillance and Public Healthand Public Health

•• Public and private healthcare providers will make extensive use Public and private healthcare providers will make extensive use of of biosurveillancebiosurveillance when responding to natural disasters, when responding to natural disasters, epidemics and terrorist attacks, including identification and epidemics and terrorist attacks, including identification and management of the psychological response to trauma. management of the psychological response to trauma.

•• Continuity of care for military personnelContinuity of care for military personnel•• Portable electronic health records will improve access to Portable electronic health records will improve access to

physical and mental health diagnostic and treatment services forphysical and mental health diagnostic and treatment services forveterans with physical injuries, as well as postveterans with physical injuries, as well as post--traumatic stress traumatic stress disorder and traumatic brain injury. disorder and traumatic brain injury.

•• To improve continuity of care, these records should include To improve continuity of care, these records should include health information from all sources, from prehealth information from all sources, from pre--deployment deployment baselines to military hospitals to nursing homes and private baselines to military hospitals to nursing homes and private health care. health care.

QuoteQuote

““Remember, this isn’t about technology, it’s Remember, this isn’t about technology, it’s about transforming the health of the about transforming the health of the

nation. My role is to get IT out there to nation. My role is to get IT out there to improve the quality and efficiency of health improve the quality and efficiency of health

care and the ability of consumers to care and the ability of consumers to manage their own health.”*manage their own health.”*

-- Robert Robert KolodnerKolodner,,National Coordinator for Health IT National Coordinator for Health IT

* From iHealth Beat article, “Government Tapping IT To Boost Care, National Health IT Leader Says.” Issue May 18, 2007.

ResourcesResources

•• HRSA HRSA •• OHIT Website: OHIT Website: http://www.hrsa.gov/healthit/http://www.hrsa.gov/healthit/•• Health IT CommunityHealth IT Community

Contact:Contact: Christie.Brown@hrsa.hhs.govChristie.Brown@hrsa.hhs.gov•• CMSCMS

http://www.cms.hhs.govhttp://www.cms.hhs.gov•• AHRQAHRQ

http://healthit.ahrq.govhttp://healthit.ahrq.gov•• Veterans Health AdministrationVeterans Health Administration

https://www.myhealth.va.govhttps://www.myhealth.va.gov•• Indian Health ServiceIndian Health Service

http://http://www.ihs.govwww.ihs.gov•• Department of Health and Human ServicesDepartment of Health and Human Services

http://www.hhs.gov/healthithttp://www.hhs.gov/healthit

ResourcesResources

•• Health Information Management and Systems Society Health Information Management and Systems Society http://www.himss.orghttp://www.himss.org

•• California Healthcare FoundationCalifornia Healthcare Foundationhttp://www.chcf.orghttp://www.chcf.org

•• Markle FoundationMarkle Foundationhttp://www.markle.orghttp://www.markle.org

•• Robert Wood JohnsonRobert Wood Johnsonhttp://www.rwjf.orghttp://www.rwjf.org

•• National Conference of State LegislaturesNational Conference of State Legislatureshttp://www.ncsl.orghttp://www.ncsl.org

•• eHealth InitiativeeHealth Initiativehttp://toolkits.ehealthinitiative.org/assets/Documents/eHI2006http://toolkits.ehealthinitiative.org/assets/Documents/eHI2006HIESurveyReportFinal09.25.06.pdfHIESurveyReportFinal09.25.06.pdf

Contact InformationContact Information

Cheryl Austein CasnoffCheryl Austein CasnoffAssociate AdministratorAssociate Administrator

DHHS/HRSA/OHITDHHS/HRSA/OHIT5600 Fishers Lane, 7C5600 Fishers Lane, 7C--2222

Rockville, MD 20857Rockville, MD 20857Phone: 301Phone: 301--443443--0210 0210

Fax: 301Fax: 301--443443--13301330causteincaustein--casnoff@hrsa.govcasnoff@hrsa.gov