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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
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
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
nsrhn structure
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
technology projects overview
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.
technology projects overview con t
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
rural challenges
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
rural challenges con t
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
network strategies
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
impact of network strategies
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
impact con t
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)
impact con t12
Impact - (con’t)
  • Helped members achieve HIPAA compliance
  • IT Help Desk fielding average of 100 calls per month (30% telemedicine-related)
lessons learned
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
lessons learned con t
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
what s next
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

Northern Sierra Rural Health Network = Regional Health Information Organization =


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



future challenges
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)
northern sierra rural health network
Northern Sierra Rural Health Network

138 New Mohawk Rd. Suite 100

Nevada City, CA 95959

530-470-9091 FAX: 530-470-9094