Health Information TechnologyMeaningful Use and the Role for
Networks
600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 800.997.6685 or 218.727.9390 I www.ruralcenter.org
Terry HillNational Rural Health Resource
Center Executive Director
May 2010
Mission
• To provide technical assistance, information,
tools and resources for the improvement of
rural health care.
• To serve as a national rural health knowledge
center and strive to build state and local
capacity.
v
• Non-Profit Located in Duluth, Minnesota
• Delta Rural Hospital Performance Improvement
• National Rural HIT Coalition
• Federally funded Technical Assistance and Services
Center (TASC)
• Regional Extension Center – MN/ND
About the Center
The HITECH Act’s Framework for Meaningful Use of Electronic Health Records (EHRs)
Broad Goals for Meaningful UseVisionEnable significant and measurable improvements inpopulation health through a transformed health care delivery system
Goals• Improve quality, safety, efficiency and reduce health disparities• Engage patients and families• Improve care coordination• Ensure adequate privacy and security protections for personalhealth information• Improve population and public health
Meaningful Use EvolutionThe proposed rule lays out three stages to be appliedto providers and hospitals seeking to receive incentive payments: • The first stage will be applied to all those seeking tomeet the requirements when the program launches in FY 2011 (hospitals) and CY 2011 (providers). • The second and third stages, which will be proposed in late 2011 and late 2013, will apply to providers and hospitals as they progress in their meaningful use ofEHRs.
Bending the Curve Towards Transformed Health; Achieving Meaningful Use of Health Data
Data capture and sharing
Advanced clinical
processes
Improved outcomes
2011 2013 2015
“Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.”
Source: Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009
National HIT Policy and Funding for Rural Health
• Is there an adoption gap?– For hospitals, yes
• AHA survey and Flex survey– For other rural providers
AHA Survey
Rural hospitals less likely to be investing
AHA Survey
Urban hospitals using IT more than
rural hospitals
TASC HIT Survey Conclusions• Medicare cost-based reimbursement has permitted many
CAHs to make initial investments in HIT infrastructure• CAHs have high use rates for administrative and financial
IT application, but much lower rates for clinical applications
• CAH HIT use rates are lower than overall rates for hospitals• Future efforts need to focus on increasing use of clinical
applications and interconnectivity of CAHs and other health care providers
Rural Health in the Digital Age• Important Health information technologies (HIT)
issues remain:
- Lack of support for HIT systems, programs, software, etc… is also an issue
- Because of isolation, small rural hospitals probably cannot design and implement HIT strategies alone
• Important Health information technologies (HIT) issues remain:
- It is difficult for rural providers to make an informed decision about vendors
- New national “interoperability” requirements for HIT implementation might disadvantage rural
Rural Health in the Digital Age
Additional Rural & Practice Challenges• Small rural hospitals may have no IT support let
alone an IT Department• Hard to find physician or administrative
leaders/change agents• Other business priorities i.e. “surviving”• No business case for connectivity/linkages to other
institutions (stand-alone EHRs?)
• No aggregate buying power (hence pooled vendor selection processes)
• Need to address critical referral pattern issues, disruptions, patient flows, etc.
• Rural health care organizations will need special legislative consideration
Additional Rural & Practice Challenges
Choices, Planning, Execution
Determines extent of Slide
Leadership and Management
Determines how long you’re in the valley of despair.
Good Choices and management determines level
of productivity and satisfaction
Little or No HIT
Implement EHR
Implemented and Supported
Pref
erre
d Fu
ture
Possible Future
Time
Prod
uctiv
ity
Valley of Despair
HIT Theme Strategy Map
Increased cost efficiency
Increased market share
Finance
Increased revenue
As financial stakeholders, how do we intend to meet the goals
and objectives in the hospital’s Mission
Statement?
Patient safety outcomes Physician satisfaction Patient satisfaction
Increased margin to fund mission
Community health outcomes
Customers & Community
Internal Processes
Learning & Growth
As customers of the hospital’s services, what
do we want, need or expect?
As members of the hospital staff, what do we
need to do to meet the needs of the patients and healthcare community?
As an organization, what type of culture, skills,
training and technology are we going to develop to
support our processes?
Clinical processes
Acquire HIT expertise
Ensure a skilled workforce
Business processesOperational processes
Establish an empowering work
culture
LeadershipInstill change management
Acquire needed HIT systems
Ongoing education
A Quick Lesson in Physics
There are six types of simple machines: • Levers• Pulleys• Wheels & axles• Ramps• Wedges• Screws
Simple MachinesA simple machine is a device that can provide
one of the two following benefits:1. It can increase the force that is applied, so
that the output (resistance) force is bigger than the input (effort) force.
OR2. It can increase the speed at which a task is
performed.
A Network as a Simple Machine
• It increases the effort that is applied to issues affecting your members, so that the benefits are larger than what individual members could reasonably accomplish on their own.
• It can increase the speed at which these benefits are accomplished.
• Best of all, you can achieve both of these things at once and so much more.
On to the Network Summit
• December 15-16, 2009, Minnesota• Sponsored by the National Rural Health
Resource Center and the National Cooperative of Health Networks
• Funding from the Health Resources and Services Administration, Office of Rural Health Policy
On to the Summit
Who Attended?• Montana Rural Health Care Performance Improvement Network• Western Healthcare Alliance• The Hospital Cooperative• National Cooperative of Health Networks• Oregon Rural Healthcare Quality Network• Montana AHEC and Office of Rural Health• Rural Healthcare Quality Network• University of Minnesota, Rural Health Research Center• Upper Peninsula Michigan Network• Federal Office of Rural Health and Policy• Texas Organization of Rural Community Hospitals• Illinois Critical Access Hospital Network• Rural Wisconsin Health Cooperative
Goal of the Summit
To tap into the collective wisdom of these experienced network leaders.
• Productive network activities• Critical success factors• Lessons learned• National knowledge center • National learning community
• Facilitated meeting of network leaders• Questions were sent in advance• While on site participants were asked to– Relate experiences– Share perspectives–Offered opinions
• Topics: Quality, HIT, finances, work force, governance & leadership and more
Goal of the summit
Why Do Networks Form?• Economies of scale and access to funds• Advocacy at the regional, state and national level• Develop new products and services• Increased manpower and technical expertise• Address common needs• Share education, information and other resources• Networking and peer support• Enable benchmarking and improvement• Meet future challenges and create opportunities
Health Information Technology
Challenges included:• Agreeing on a common system/ownership of
data• Achieving interoperability/exchange• Shortage of skilled professionals• Lack of capital funding to purchase EMR
systems
Health Information TechnologyLessons learned: • Networks must be involved in state/regional HIT
policy and activities• Networks should help formulate a vision for how HIT
improves quality, safety, efficiency and productivity• Recruit, train and share qualified HIT staff and
consultants• Seek capital funding, discount pricing and shared
services
Rural Wisconsin Health CooperativeMembers:• Thirty-five, rural acute, general medical-surgical hospitals• In 1996, RWHC created a non-voting Affiliate Membership for specialty provider based systems
RWHC:• Is the “rural advocate of choice” for its members• Develops and manages a variety of products and services• Assists members to offer high quality, cost effective healthcare• Assists Members to partner with others to make their communities
healthier• Generates additional revenue by services to non-members• Actively uses strategic alliances in pursuit of its vision
Members: 50 CAH members
ICAHN Core Network Activities include:• Ensuring appropriate funding and financial resources• Promoting efficient use of information technology services• Maintaining and further developing specific-type user groups,
activities and list serves that promote hospital operational efficiencies and connectivity
• Offering on-going educational opportunities and resources• Developing and offering projects that are self-sustaining and add
value• Developing and offering shared services that offer value
Illinois Critical Access Hospital Network
Members:• 17 members including CAHs, rural and urban hospitals
and nursing homes • Also have 4 Associate MembersPurpose:• Consortium of medical centers located throughout
greater Minnesota that work together to share information technology resources
• SISU members maintain their independence while collaboratively investing in cutting-edge technology
SISU Medical Systems
Western Colorado Health Alliance
• 27 Hospital members• Since 1989• Numerous business products and services
(e.g. collections)• Returns cash dividends to members• Shared IT staff
Upper Peninsula Health Network
• All 14 hospitals in UP of Michigan• Since 1997• Telehealth network• Also have a health insurance product• Various business products
Northern Montana Healthcare Alliance• Since 2003• 15 hospitals• Coordinated fundraising and implementation
of EHRs• Ongoing education• Administer the regional telehealth network– Clinical services– Conferencing
Nevada Rural Hospital Partners• 14 hospitals• Since 1987• Group purchasing of equipment and support• Standardize practices and processes• Negotiate discounts• Dedicated CIO and IT staff• Developing a Health Information Exchange
Other HIT Networks• Integrated Health System of Alabama (2004)• Guadalupe Valley Healthcare Network (1995)• Minnesota Rural Health Coop (1995)• Lake Okeechobee Rural Health Network (1994)• Community Health Network of West Virginia (2000)• Ohio State Health Network (2001)• Appalachian Health Information Exchange (2008)• Susquehanna Valley Rural Health Partnership (2002)• St. John’s River Rural Health Network (1994)
HIT Critical Success Factors
• Sense of urgency• Strong team/coalition• Clear vision and planning framework• Ongoing communication• Empowerment and engagement of staff• Short-term wins• Anchor change in culture
Develop a
What Hospitals Should Do Now…
• Network with other hospitals• Seek out the experience of others who have done it already• Raise awareness that HIT implementation will be difficult but
necessary• Involve employees and medical staff throughout the hospital• Begin to to clean up/document hospital processes now• Seek assistance from HIT Regional Extension Centers and
other state and national resources
• Begin with the end in mind—develop a plan
Terry HillExecutive Director
National Rural Health Resource Center600 East Superior Street, Suite 404
Duluth, MN 55808(218) 727-9390 ext. 232