Transcript Document

Health IT and Rural Healthcare:
Embracing Opportunities and
Overcoming Challenges
Leila Samy, MPH
Rural Health IT Coordinator
Office of the National Coordinator for Health IT
Conflict of Interest Disclosure
Speakers have no real or apparent conflicts of interest
to report.
Leila Samy
HHS Office of the
National Coordinator
for Health IT
Bill Menner
USDA
Rural
Development
Stephen Stewart
CAH in
Henry County
Iowa
Office of the National Coordinator for
Health IT
Thomas Klobucar
VA
Office of Rural
Health
Leila Samy, Rural Health IT Coordinator
Office of the National Coordinator for Health IT
ONC INITIATIVES AND PARTNERSHIPS
TO SUPPORT RURAL HEALTH IT
Office of the National Coordinator for
Health IT
Learning Objectives
• Overall learning objectives
– Describe unique challenges and opportunities related to financing,
implementing and sustaining the use of health IT in rural communities
– Summarize existing federal, state and private-sector programs, tools
and best practices for rural providers
– Evaluate experiences in participation and use of programs, tools and
best practices for rural healthcare providers
– Assess gaps in current programs and identify future needs in health IT
programs and research for rural healthcare organizations
• Session specific learning objectives
– Describe ONC Programs for Health IT and their objectives, including
collaborations with USDA and VA
– Identify ONC resources and tools for rural health IT
– Assess experiences with use of ONC programs and resources
Office of the National Coordinator for
Health IT
Rural Rates Compared to Overall Rates
for Providers and Hospitals Paid
by Medicare or Medicaid
Professionals
Hospitals
100%
90%
80%
94%
82%
70%
64%
64%
60%
50%
Rural professionals
are participating in
the EHR Incentive
Programs at roughly
the same rate as
the national trend.
40%
However, rural
hospitals are
lagging behind the
overall trend.
30%
20%
10%
0%
Rural
Overall
Rural
Overall
Source: EHR Dashboard on HealthIT.gov as of 11/30/2013
Percent of Small Rural and Critical Access Hospitals Paid
By State as of November 2013
Office of the National Coordinator for
Health IT
Percent of Rural Physicians, Physician’s Assistants and Nurse Practitioners Paid
By State as of November 2013
Office of the National Coordinator for
Health IT
Percent of Rural Physicians, Physician’s Assistants, and Nurse Practitioners Paid
By State as of November 2013
July 2013
November 2013
Office of the National Coordinator for
Health IT
Hospital Progress Overtime Attesting to Meaningful Use
Through November 2013, By Type and Size
100%
90%
80%
60%
50%
40%
30%
20%
10%
0%
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Percent of hospitals
70%
Note: Large = 400+ staffed beds; Medium = 100-399 staffed beds; Small = <100 staffed beds. Rural = non-metropolitan; Urban = metropolitan.
Office of the National Coordinator for
Health IT
Location of Small Rural and Critical Access Hospitals By Attestation Status
Attested
Office of the National Coordinator for
Health IT
Not Attested
Hospitals Attested By 2014 Edition Certification Status of Primary Vendor
100%
89%
(17 vendors)
Percent of hospitals attested to Stage 1
90%
80%
86%
(10 vendors)
70%
60%
50%
40%
30%
20%
10%
0%
Dec-12 Jan-13
Feb-13 Mar-13 Apr-13 May-13 Jun-13
Vendor has any 2014 edition product(s)
Jul-13
89% of EHs
that have
attested to
Stage 1 used a
primary
vendor that
had any 2014
Edition
product as of
12/31/13
Aug-13 Sep-13 Oct-13 Nov-13 Dec-13
Vendor has 2014 edition product(s) meeting Base EHR definition
Note: Primary EHR vendors are those whose products are certified to the most 2011 Edition certification criteria in the EHR system (in cases where a provider
used certified products from multiple vendors to attest). Source: ONC Certified Health IT Product List (CHPL) 12/31/2013, CMS attestation data 11/30/2013.
Office of the National Coordinator for
Health IT
Hospitals Attested By 2014 Edition Certification Status of Primary Vendor
Healthland, Inc.
5%
Indian Health Service
1%
Prognosis Health Information Systems
1%
QuadraMed Corporation
1%
Other (43 vendors, <1% each)
4%
MEDHOST
1%
Health Care Systems, Inc.
1%
Other (5 vendors, <1% each)
1%
MEDITECH
21%
Cerner Corporation
14%
Epic Systems Corporation
14%
CPSI (Computer Programs and Systems), Inc.
11%
McKesson
10%
Healthcare Management Systems, Inc.
6%
Allscripts
4%
Siemens Medical Solutions USA Inc
5%
NextGen Healthcare
1%
GE Healthcare
<1%
3%
11%
86%
Note: Primary EHR vendors are the vendors whose products are certified to the most 2011 Edition certification criteria in the provider’s EHR system
Office of the National Coordinator for
(in cases where a provider used certified products from multiple vendors to attest).
Health
IT(11/30/2013).
Sources: ONC Certified HIT Products List (CHPL) (12/31/2013), CMS Attestation
Data
Hospitals Attested By Size, Type, Location and 2014 Edition Certification
Status of Primary Vendor
-4%2%
94%
Large
-4% 3%
92%
Medium
-12% 3%
-15% 3%
-80%
-60%
-40%
-20%
0%
Small Rural
82%
-22% 2%
-100%
Small Urban
86%
Critical Access
76%
20%
40%
60%
80%
100%
Vendor has 2011 edition product(s) only
Vendor has 2014 edition product(s) not meeting Base EHR definition
Vendor has 2014 edition product(s) meeting Base EHR definition
Note: Primary EHR vendors are the vendors whose products are certified to the most 2011 Edition certification criteria in the provider’s EHR system
Office of the National Coordinator for
(in cases where a provider used certified products from multiple vendors to attest).
Health
IT(11/30/2013).
Sources: ONC Certified HIT Products List (CHPL) (12/31/2013), CMS Attestation
Data
Rural Health IT Tools and Resources
www.HealthIT.gov/RuralHealth
Office of the National Coordinator for
Health IT
ONC Data Brief of Critical Access Hospital Survey
Challenges and Opportunities
Fully Electronic
27%
Partially Electronic and
Partially Paper
62%
No EHR
11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percent of Critical Access Hospitals
No Plans to Upgrade/Install a New EHR or Do Not Know
Yes, Plans to Upgrade/Install a New EHR
Office of the National Coordinator for
Health IT
ONC Data Brief of Critical Access Hospital Survey
Challenges and Opportunities
Percent Reporting Severe Challenges:
Funding, Broadband, Workforce, Technical
EHR Implementation Costs
50%
Availability of Grants/Loans to Support EHR
Broadband Implementation Costs
23%
Workflow changes
30%
Lack of IT Personnel
27%
Clinical Staff Cooperation
Inadequate EHR training for Employees
Leadership/Executive Cooperation
Security and/or Privacy Risks
Workforce and Staffing
Challenges
22%
17%
7%
20%
Lack of Technical Support from EHR Vendor
16%
Vendor Selection/EHR Usability
15%
Broadband Unavailable or Insufficient
Cost-Related
Challenges
35%
Technical and Other Challenges
11%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Office of the National Coordinator for
Health IT
Collaborating with and Leveraging Partners
• White House Rural Council
• Streamline programs serving rural America
1. Technical assistance
2. Funding , Broadband & Workforce
3. Serving Rural veterans
Office of the National Coordinator for
Health IT
Expand Funding for Rural Health IT
ONC and USDA Rural Development launched an initiative to expand
funding for CAHs and rural hospitals.
FY 2013 Pilots: Over $38 Million in funding to CAHs and rural hospitals
across 4 states.
FY 2014: ONC and Rural Development are taking this initiative to scale in
additional states.
Office of the National Coordinator for
Health IT
ONC/VA Leveraging Health IT to Improve
Care Coordination and Quality for Rural Veterans
Project “VICTORhie”
The Veteran Initiated Coordination & Transformation of Rural Health
Information Exchange
• ONC and VA’s Office of Rural Health launched an initiative to leverage
Blue Button technology and health information exchange to improve
care coordination and quality for rural veterans and highly rural veterans
that wish to seek care both within the VHA system as well as at their
local rural clinic or hospital.
Office of the National Coordinator for
Health IT
Data driven approach to pilot site selection
Office of the National Coordinator for
Health IT
19
Office of the National Coordinator for
Health IT
Bill Menner, Iowa State Director, Rural Development
US Department of Agriculture
USDA PROGRAMS AND
PARTNERSHIP WITH HHS/ONC
Office of the National Coordinator for
Health IT
Value Steps Benefits
• USDA Rural Development programs provide critical resources to rural
hospitals and clinics
• USDA Rural Development loans, grants and loan guarantees can assist in
the purchase of equipment, network infrastructure, hardware and
software for Health IT purposes
• USDA Rural Development investments lead to improved health data
reporting and quality measures reporting
• USDA Rural Development involvement may allow hospitals to use their
own resources in alternate ways thanks to resources and savings realized
Office of the National Coordinator for
Health IT
USDA’s Role in Rural Health IT
Office of the National Coordinator for
Health IT
Why is USDA Funding Rural Health IT?
• USDA Rural Development is a small mission-area focused on helping
create rural communities that are vibrant, self-sustaining and wealthcreating
• The Agency has 40 programs that assist in all aspects of rural quality-oflife, from housing to small business to clean water to health care
• Strong rural communities help to support American agriculture. Ag
producers need small towns for public safety, education, businesses that
provide off-farm income, retail and health care, among other things.
• Rural residents deserve access to quality health care that does not require
a sometimes lengthy trip to an urban center.
Office of the National Coordinator for
Health IT
What Are the Challenges in Rural America?
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Lower incomes/wages
Less educational attainment
Larger numbers of elderly
Declining populations
Job loss 11/2012-11/2013 as urban areas gain
Access to capital
Access to high-speed broadband
Greater risk of losing primary care physicians to retirement
Office of the National Coordinator for
Health IT
What Are the Opportunities in Rural America?
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Productive US agriculture
Bioeconomy favors rural
Clean water
Work ethic
Service ethic
Quality of life
Excellent schools
High-performing hospitals and clinics
Office of the National Coordinator for
Health IT
Shining the Light on Rural Health IT
• President creates White House Rural Council
• USDA and HHS secretaries sign MOU
• Departments join forces to coordinate and collaborate
Office of the National Coordinator for
Health IT
Iowa Jumps at the Chance!
Partners come together to identify new opportunities
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Iowa State Office of Rural Health
USDA Rural Development
Iowa FLEX Program – FLEX funding and education
Iowa HIT Regional Extension Center – technical assistance
State Health Information Network - data exchange
Iowa Hospital Association – hospital relationships and support
Iowa Medicaid Enterprise – state incentive and resources
Office of the National Coordinator for
Health IT
Consortium Targets and Educates
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ID rural hospitals not progressing toward MU
ID rural hospitals citing financial difficulty for lack of progress
Determine capacity of leadership to move forward
ID local/regional partners
Connect REC, USDA local staff with hospital leadership
Find opportunities to leverage
Promote partnership to key stakeholders
Office of the National Coordinator for
Health IT
Immediate Results
• Three hospitals began or expanded work toward Meaningful Use
• Conversations with hospitals about funding/loans for equipment were
initiated
• Rural Health Clinics began stepping forward to EHR/MU
• Hospitals & providers were informed and directed to attain incentives
• Other discussions commence with USDA for non-Health IT discussions
(ambulance, MRI, bricks-and-mortar)
Office of the National Coordinator for
Health IT
USDA Programs to Consider
• Community Facilities Loan/Grant (CF)
– USDA is the lender. Term may be dictated by Useful Life of equipment.
Loan dollars can be 100% of project Grant dollars extremely limited.
Population
limit 20,000 non-metro.
• Rural Economic Development Loan/Grant (REDLG)
– 0% 10-year loan via local partner (rural electric coop, rural telephone coop,
eligible municipal utility. Up to $2 million per project. Population limit 50,000
non-metro.
• Distance Learning-Telemedicine (DLT)
– Very competitive program with grants $50,000-500,000. 15% required
matching contribution. 20,000 non-metro population limit. Can fund
hardware, software and network equipment.
• Business & Industry Loan Guarantees (B&I)
– An option for for-profit hospitals.
Office of the National Coordinator for
Health IT
Iowa Case Studies
Office of the National Coordinator for
Health IT
Henry County Health Center, Mount Pleasant, IA
Office of the National Coordinator for
Health IT
Partnership with Rural Electric Coop
• Community Size: 8,741
• Total Project: $998,134 including surgical suite
• $195,791 will be used for servers, routers, switches, wireless
controllers, docking stations and access points.
• USDA provides $798,000 to the local rural electric coop, which
passes funds to hospital via ten-year, 0% loan.
• Financing allows hospital to use its own reserves for additional
health IT investments totaling $165,000
Office of the National Coordinator for
Health IT
Iowa Specialty Hospital, Belmond, IA
Office of the National Coordinator for
Health IT
USDA Grant Drives Completion
• Community Size: 2,348
• Total Project: $440,540
• USDA provides $100,000 Community Facilities grant for purchase and
integration of software modules.
• Unanticipated Phase Two: Additional hardware needs arise that were not
anticipated when the project began. When the project was completed,
hospital had spent $190,000 more than they originally planned. Rural
Development grant was crucial to project completion.
• A very successful project. The hospital has achieved Meaningful Use
Office of the National Coordinator for
Health IT
Pocahontas Community Hospital, Pocahontas, IA
Office of the National Coordinator for
Health IT
Hospital and Municipal Utility Unite
• Community Size: 1,744
• Total Project Cost: $1 million
• USDA provides $300,000 to Municipal Utility, which passes funds (plus
20% match) to hospital at 0% over ten years.
• Project: Implementing a full electronic medical record. This required some
additional hardware components also along with a few new servers. Fully
electronic by next fall.
• From the hospital administrator: “This would not have been possible
without the financial support offered by USDA!”
Office of the National Coordinator for
Health IT
Value Steps Benefits
• USDA Rural Development programs provide critical resources to rural
hospitals and clinics
• USDA Rural Development loans, grants and loan guarantees can assist in
the purchase of equipment, network infrastructure, hardware and
software for Health IT purposes
• USDA Rural Development investments lead to improved health data
reporting and quality measures reporting
• USDA Rural Development involvement may allow hospitals to use their
own resources in alternate ways thanks to resources and savings realized
Office of the National Coordinator for
Health IT
The Big Challenge
Office of the National Coordinator for
Health IT
Stephen M. Stewart CHCIO, FCHIME, FHIMSS, FACHE
Chief Information Officer, Henry County Health Center
SUCCESS STORY: IOWA CAH GETS
USDA FINANCING FOR HEALTH IT
Office of the National Coordinator for
Health IT
Learning Objectives
• Explain what Henry County Health Center (HCHC) did to
participate in this project
• Partnership with Alliant Energy and USDA
• Share the results we gained out of this project
Office of the National Coordinator for
Health IT
The Benefits
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HCHC received ~$800,000 interest free loans for “equipment”
We were constructing new surgery center
Have fully implemented EHR
We are a CAH for HITECH reimbursement is on a cost basis
– For HCHC 55.23% Medicare Cost share
– Plus 20% CAH
– 77.23% total reimbursement for CAH for qualifying EHR
equipment
• Surgery Center required infrastructure to attach to EHR
Office of the National Coordinator for
Health IT
The USDA Grant and Loan
Programs and Health IT
About Henry County Health Center
– Critical Access Hospital-25 Acute beds
• 50 LTC beds on Campus
• 140 LTC Beds managed under contract
• 5 Dialysis Centers
• 5 Employed Physicians
• 5 Contract ER Physicians
Office of the National Coordinator for
Health IT
The USDA Grant and Loan
Program and Health IT
Demographics
– Iowa Approximately 3 Million People
– Henry County Approximately 20,000
– Mt. Pleasant Approximately 9,000
– Located SE corner of state
• 25 Miles to Illinois Border
• 50 Miles to Missouri Border
• 50 Miles from VA Medical Center Iowa City
• 60 Miles from VA Medical Center Knoxville
Office of the National Coordinator for
Health IT
The USDA Grant and Loan Program and Health IT
• HCHC sought in conjunction with Alliant Energy funding under:
– REDL (Rural Economic Development Loan) Program
– REDG (Rural Economic Development Grant) Program
– RDL (Rural Development Loan) Program
• Partnering with Alliant Energy and the USDA advanced HCHC
HIT
Office of the National Coordinator for
Health IT
The USDA Grant and Loan Program
and Health IT
• The results
– $855,000 interest free funding for 10 years
– HIT expenditures $261,205
– Qualified stimulus reimbursement- $201,728
– Net HIT Investment $59,477
– Gross amount funded interest free for 10 years
Office of the National Coordinator for
Health IT
The USDA Grant and Loan Program
and Health IT
•
What did we acquired
– Personal Computers
– Printers
– Network Fiber Switches
– EHR Software Modules
– EHR Integrated Central Monitoring System
– EHR Integrated Nurse Call System
– Wireless Voice communications integrated to EHR
Office of the National Coordinator for
Health IT
The Benefits of this Health IT Project
• Clearly in the Technology Step
– Electronic Information/Data
• Added tools we did not previously enjoy in our Surgery Center
• At the end of the day the project enables
– Better Care
– Better Outcomes
– Reduced costs
http://www.himss.org/ValueSuite
Office of the National Coordinator for
Health IT
Thomas Klobucar
Deputy Director, Office of Rural Health, Veterans Administration
HHS/VA PARTNERSHIP:
LEVERAGING HEALTH IT TO SERVE
RURAL VETERANS
Office of the National Coordinator for
Health IT
HHS/VA Partnership
• Veterans Health System (VHA)
Office of Rural Health (ORH)
• Health and Human Services (HHS)
Office of the National
Coordinator for Health
Information Technology (ONC)
• Department of Veterans Affairs
(VA) My HealtheVet Program
Office
Office of the National Coordinator for
Health IT
Need for Interagency Efforts for Health Information Exchange and
Health Care Coordination
• 90.5% of VA enrolled rural Veterans say they get at least some
healthcare outside of the VA system—with no systematic way for their
providers to exchange information to coordinate care
• 38% of Medicare-eligible Veterans who get meds from community
pharmacies say they never discussed those medications with their VA
providers
• Community providers feel the need for HIE with the VA
– “With VA, we get nothing…. [W]e need something we have to call the VA or
have the patient acquire it…[N]othing is ever sent automatically from
VA….And most of the time I don’t even know that they see the VA… I don’t
know they’re a VA patient.”
– “What would be really ideal, is if there were an interface, between, the
community, and the VA system, where if a patient gets lab work done, at
the VA, or, diagnostic studies done at the VA, or a colonoscopy done at the
VA, right? Then, that stuff would come in, and integrate, with my system.”
Office of the National Coordinator for
Health IT
The Program
• HHS/ONC brings in the community providers through their grantees
• VHA provides the training and information to Veteran patients on
how to get the information to their community provider
• Site Teams
• VA Health Care Facility
• HHS grantees
• Rural healthcare providers and organizations
• Critical Access Hospitals (CAHs)
• Rural health clinics
• Federally Qualified Health Care Centers (FQHCs)
• Mental health clinics
Office of the National Coordinator for
Health IT
Participating Locations
Office of the National Coordinator for
Health IT
Stephen M. Stewart CHCIO, FCHIME, FHIMSS, FACHE
Chief Information Officer, Henry County Health Center
SUCCESS STORY:
IOWA CAH PARTICIPATES IN HHS/VA
PILOT TO SERVE RURAL VETERANS
Office of the National Coordinator for
Health IT
Learning Objectives
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Create an awareness of the projects intentions and the need
Describe what the project means to our Veterans
Detail the process steps we took
Describe the outcomes
Look to the next steps for the project
Office of the National Coordinator for
Health IT
The Benefits
• Our Veterans deserve this. It is the right work
• Veteran’s Satisfaction with non VA services is enhanced
• Veterans are better able to communicate with their community based
providers
• Community base providers satisfaction grows as they have better information
than normal from the VA
• Veteran Safety is enhanced with better information
• Community based outcomes appear to be improving
• The more veterans who get involved the stronger the program becomes
• Gives great opportunity for a CAH to reach out in a proactive positive way to
their community
Office of the National Coordinator for
Health IT
The ONC/VA Rural Veteran Project:
“VICTORhie”
About Henry County Health Center
– Critical Access Hospital-25 Acute beds
• 50 LTC beds on Campus
• 140 LTC Beds managed under contract
• 5 Dialysis Centers
• 5 Employed Physicians
• 5 Contract ER Physicians
Office of the National Coordinator for
Health IT
The ONC/VA Rural Veteran Project:
“VICTORhie”
Demographics
– Iowa Approximately 3 Million People
– Henry County Approximately 20,000
– Mt. Pleasant Approximately 9,000
– Located SE corner of state
• 25 Miles to Illinois Border
• 50 Miles to Missouri Border
• 50 Miles from VA Medical Center Iowa City
• 60 Miles from VA Medical Center Knoxville
Office of the National Coordinator for
Health IT
The ONC/VA Rural Veteran Project:
“VICTORhie”
• The Project
– Co-Ordinate with VA In Iowa City
– Plan and Execute Internal Process Flows
– Set area for Vets to use Computers
– Plan and Execute Vet Training Classes
– Design and execute workflow to deliver CCD’s to HIM and appropriate
Clinics
– Engage the Physicians
Office of the National Coordinator for
Health IT
The ONC/VA Blue Button Project:
“VICTORhie”
• The results
– 55 Vets in County with right My Health E Vet accounts
– Conducted two training sessions in hospital training center
– Received about 20 CCD’s to date
– Largest Primary Care Group independent but on campus
– Share CCD with the Clinics
– Today that is a manual process, with printed document
Office of the National Coordinator for
Health IT
The ONC/VA Blue Button Project:
“VICTORhie”
• The Vets
– Great Positive feedback
• The Clinicians
– Info was hard to get from VA in the past
– Great Step Forward
• The Physicians
– Love it
– Got little from VA in the past
– Positive impact on patient care
• IT-Easy to execute, VA wonderfully co-operative
Office of the National Coordinator for
Health IT
The Benefits of this Health IT Project
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Satisfaction and Treatment/Clinical
Electronic exchange to come
Vets will benefit more from electronic exchange
Exposure to Direct Secure Messaging will be huge
Physicians can provide better care
Hospitals have more information to work with and provide better care
Office of the National Coordinator for
Health IT
Recap of Learning Objectives
Office of the National Coordinator for
Health IT
Get involved
Contact:
Leila Samy, Rural Health IT Coordinator
[email protected]
Share:
Tools, resources and best practices
www.healthit.gov/ruralhealth
Review report card for 2011-2013
ONC efforts and collaborative initiatives in support of rural
health IT: www.healthit.gov/buzz-blog/rural-health/onc-orhprural-health/
Office of the National Coordinator for
Health IT
Critical Access and Rural Hospital Champion Award
2012
2012
2013
Barry Little
Bill Sonterre
Brock Slabach
Chuck Christian
Harry Wolin
Jac Davies
Joe Wivoda
Kay Gooding
Kevin Driesen
Louis Wenzlow
Lynette Dickson
Melissa Hungerford
Patricia Alafaireet
Patricia
Dombrowski
Paul Kleeberg
Phil Deering
Randy McCleese
Roger Holloway
Sally Buck
Shanti Wilson
Tammy Flick
Terry Alexander
Terry Hill
Val Schott
Kathy Whitmire
Office of the National Coordinator for
Health IT
2013
Bill Menner
David Willis
Ed Gamache
Jessica Zufolo
Kendra Siler-Marsiglio
Mark Renfro
Marty Fattig
Norma Morganti
Thank you!
Questions?