Johanna Barraza Cannon Director, Division of HIT Policy US Department of Health and Human Services

1. HRSA’s Office of Health Information TechnologyWorldVistA 15thVistA Community MeetingJune16, 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

2. Objectives • Provide information about the Office of Health Information Technology (OHIT) • OHIT Programs • Funding for HIT Adoption • HIT Technical Assistance • Other OHIT Activities

3. 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 low-income 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

4. 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.

5. HRSA Administrator Dr. Betty Duke Office of Health Information Technology

6. 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

7. 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.

8. 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

9. 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:

10. 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

11. 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.

12. 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

13. 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

14. 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.

15. 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

16. 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.

17. 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 E-Health Law (3-yr grant)

18. 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

19. Potential Funding OpportunitiesHIT 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: $125,000ESTIMATED PROJECT PERIOD: 1 year

20. 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: $550,000ESTIMATED PROJECT PERIOD: 3 years

21. Potential Funding OpportunitiesHIT 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

22. Potential Funding OpportunitiesHIGH 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: $1,400,000ESTIMATED PROJECT PERIOD: 1 year

23. 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

24. 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”

25. 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 tax-exempt status. • Hospitals donating IT to physicians would be granted exemptions from Federal anti-kickback and Stark laws.

26. OHIT Activities Helping you navigate the maze of HIT by bringing:

27. 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

28. 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.

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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-to-read 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/

37. Resources • HRSA • OHIT Website: http://www.hrsa.gov/healthit/ • Health IT Community Contact: Christie.Brown@hrsa.hhs.gov • 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

38. 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/eHI2006HIESurveyReportFinal09.25.06.pdf

39. Contact Information Johanna Barraza Cannon DHHS/HRSA/OHIT 5600 Fishers Lane, 7C-26 Rockville, MD 20857 Phone: 301-443-4651 Fax: 301-443-1330 jbarraza-cannon@hrsa.gov