ehr pathways to successful adoption...3 ehr pathways to successful adoption: agenda july 8 –...

EHR Pathways to Successful Adoption:

ARRA/HITECH Opportunities and Network Service Offerings

Clinic Webcast June 23 and 30, 2009

For discussion purposes only – not for distribution2

Agenda

• EHR Pathways to Successful Adoption Overview

• ARRA/HITECH: What does it mean to you?

• Network Service Offerings: What they are and why they matter

• EHR Demonstrations: Clinical Scenarios review

• Discussion, Q&A


EHR Pathways to Successful Adoption: Agenda

July 8 – Sacramento ORJuly 9 – Anaheim

8:00 am Registration and Breakfast

9:00 am Opening PlenaryJonah Frohlich, Deputy Secretary, Health Information Technology, California Health and Human Services Agency and Cheryl Austein-Casnoff, Director, Office of Health Information Technology, Federal Health Resources and Services Administration

10:30 am Panel Discussion: No Need to Go it Alone

11:30 am Clinic Experiences in Adopting E.H.R.sTopics: How to Implement: Big Bang or Incremental Rollouts, Practice Re-Design and Quality Reporting and Population Management

1-5 pm Afternoon EventsE.H.R. Demonstrations and One-Hour Panel Discussion on “The Network Experience”


• Significant opportunity for funding for health care

• Extremely favorable federal match rates in many programs

• Strong focus on safety net providers and programs

• Some funds already released, others coming soon

• Many programs still developing rules and proposal processes

ARRA Overview


Key Drivers of Change

http://news.yahoo.com/fc/US/Race_2008___Barack_Obama;_ylt=Ao7r1pxA.YIKNVyze6aKWfFpu6cv


First Key Mechanism of Change

Yesterday Today Tomorrow

Images courtesy of Microsoft Health Vision Presentation, 2008 and Google Image


Medical Records Medical Records in 1935in 1935


Medical Records Medical Records in 2009in 2009


ARRA Overview Multiple Funding Sources/Purposes

Appropriations for Health IT New Incentives for Adoption$2 billion for loans, grants & technical assistance for:

• National Resource Center and Regional Extension Centers

• EHR State Loan Fund

• Workforce Training

• Research and Demonstrations

New Medicare and Medicaid payment incentives for HIT adoption

• $20 billion in expected payments through Medicare to hospitals & physicians

• $14 billion in expected payments through Medicaid

• ~$34 billion expected outlays, 2011-2016

At least $300 million of the total at HHS Secretary’s discretion for HIE development

• Funneled largely through States or qualified State-designated entities

• For planning and/or implementation

Appropriations for HIE

$4.3 billion for broadband & $2.5 billion for distance learning/ telehealth grants

Broadband and Telehealth

$1.5 billion in grants through HRSA for construction, renovation and equipment, including acquisition of HIT systems

Community Health Centers


ARRA Overview Funding Sources, Recipients

Entit

lem

ent F

unds

~$34

-36B

Medicare Payment

Incentives~$20B

Medicaid Payment

Incentives~$14B

Medicare Carriers and Contractors

State Medicaid Agencies

Requires 30% share of Medicaid (except Children’s Hospitals)

CMS

CMS

ProgramFundingSource

DistributionAgency Funding Use Fund Recipients / Beneficiaries

App

ropr

iate

d Fu

nds

$2B

-$3

B

Workforce Training Grants

New Technology R&D Grants

Medical Health Informatics

EHR in Med School Curricula

Health Care Information Enterprise Integration Research

Centers

HHS, NSF

NST, NSF

Health IT Extension Program

Health IT Research Center

Regional Extension Centers

HHSAgency

TBD

HIE Planning and Development

(at least $300M)

EHR Adoption Loan Program

Planning Grants

Implementation Grants

Loan Funds for States

Loan Funds for Indian Tribes

ONC

ONC

Physicians

• Acute care hospital • Children’s hospitals

• Nurse Practitioner• Midwife

Federally Qualified Health Centers

Req

uire

s “M

eani

ngfu

l”us

e of

EH

R

• Higher Education• Medical School• Graduate schools

• Federal Gov’t Labs

Least Advantaged Providers

• Non-profit• Consulting• Vendors

Services

Designated State Entity

State Gov’t

Indian TribesProvider

Organizations

Loans

• Non-profit• Consulting• Vendors


ARRA Overview Funding and Policy Timing


ARRA Overview Medicaid Incentives

Providers must demonstrate “Meaningful Use of Certified EHR Technology” to receive payments

Providers must demonstrate “Meaningful Use of Certified EHR Technology” to receive payments

Eligible Provider Percent Match/ Limit Medicaid Patient Volumes

Maximum Net Allowable Costs

Independent physician

85% net average allowable costs

>30% $25,000 for purchase, $10,000 for operations/maintenance

Pediatrician 85% net average allowable costs


Dentist 85% net average allowable costs


Nurse mid-wife 85% net average allowable costs


Nurse practitioner 85% net average allowable costs


Acute care hospital >10% Limited to amount calculated under Medicare, by Medicaid share

Children’s hospital N/A Limited to amount calculated under Medicare, by Medicaid share

FQHC-based practicing physician

85% net average allowable costs

> 30% of patient population are “needy individuals” – including but not limited to Medi- Cal patients

$25,000 for purchase, $10,000 for operations/maintenance

•It remains unclear whether providers who have purchased EHRs prior to the onset of HITECH funding can apply “purchase” funds toward “implementation” if they can demonstrate meaningful use, although they will receive incentives for use based upon initial year of participation and reporting.


Although initial set of recommendations was released on June 16, (see http://healthit.hhs.gov) state has the ability to weigh in on

Medicaid use and make requirements more stringent.

Incentives Tied to “Meaningful Use” of Certified EHRsInitial Requirements for Meaningful Use

Health Outcomes and Policy Priorities and Care Goals Released June 16

Objectives and Measures

• Electronic prescribing as determined to be appropriate by the Secretary of HHS,

• Health information exchange to improve the quality of health care, such as promoting care coordination, and

• Reporting on clinical quality measures and such other measures as selected by the Secretary of HHS.

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families• Improve Care coordination• Improve population and public health

• Ensure adequate privacy and security protections for health information

2011

2013

2015

http://healthit.hhs.gov/


Additional ARRA/HITECH Funding for Clinics

ARRA Program Funding Amount and Purpose

Distribution Process and Recipients

Award Dates

EHR Planning/Implementation

$2 B for EHR planning,implementation, regionalextension centers, workforce training, EHR loan fund, research and development. REC awards will average $1M to $2 M with a maximum award per REC of $10 M.

ONC distributesplanning/implementationgrants to states and statedesignated entities todistribute to health careproviders.

Beginning 2010

Regional ExtensionCentersEHR Adoption LoanFunding

Indian Health ServiceFunding

$85 M for telehealth, related infrastructure and EHR Infrastructure

ONC to regional HISoffices for hardware andHosting

TBD

Telehealth andBroadband Funding

$4.7 B through BTOP forservice expansion, $2.7 Bthrough DLTB forinfrastructure and technicalassistance.

NTIA/FCC (BTOP) andUSDA (DLTB) tocommunity organizations including providers and entities facilitating access to care.

December 2009


15

Health Center Controlled Networks well positioned in ARRA

Network deployment models

HITECH Act

• Statutory language provides that Medicaid incentives...“may also be paid to an entity promoting the adoption of certified EHR technology, as designated by the state, if participation in such a payment arrangement is voluntary for the eligible professional involved and if such entity does not retain more than 5 percent of such payments for costs not related to certified EHR technology (and support services including maintenance and training) that is for, or is necessary for the operation of, such technology.”

• Establishes Health IT Regional Extension Centers to provide technical assistance and disseminate best practices. Regional Extension Centers are charged with providing technical and change management assistance to health care providers struggling with implementing and adopting EHR technology.

• Physicians must be “meaningful” users of certified EHR products that connect to local or regional HIEs.


Network Offerings to Clinics

• Discussion Objectives:– Define the value proposition of an EHR network

and how an EHR network differs from a standard vendor offering

– Identify considerations that community clinics and health centers (CCHCs) are likely to use in selecting an EHR network

– Review field case studies who have adopted EHRs through an EHR network model


What is an EHR Network?

An EHR Network is a health information

technology (IT) partnership focused on CCHCs that provides

services to support the adoption of EHRs and

other applications.

Health Center Controlled Networks (HCCNs) support 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.-Health Resources and

-Services Administration (HRSA)


CCHC Barriers to EHR AdoptionBarriers RationaleFinancial barriers

• Inflexible reimbursement environment leaving a lack of financial resources to meet upfront and ongoing costs of implementing and maintaining EHRs

Technical barriers

• Lack of basic hardware and software infrastructure • Difficulty in securing reliable access to the Internet, particularly

for rural areasStaffing resources

• Challenges in recruitment and retention of staff • Few in-house clinical, quality improvement and technical

expertise• Many CCHCs lack the financial resources to hire objective third

party expertise, such as consults to assist with the adoption process

CCHC customizations

• Support unique billing and reporting requirements (UDS and performance data, Medicaid billing requirements)

• Population health management functions• Multiple patient education tools


Common Approaches to EHR Adoption

Standard Vendor Partnership with local healthcare organization EHR Network

• Hundreds of EHR vendors• Commonly used CCHC

EHR vendors include:o NextGeno GE Centricityo Epic o Sageo eCW

• Direct partnerships with:o Local hospitals o Public health

departments• Children’s Clinic in LA is

partnering with Long Beach Memorial hospital to adopts its existing EHR

• ~ 34 EHR networks*• Health Resources and

Services Administration (HRSA) refers to EHR networks as “Health Center Controlled Networks (HCCN)”

* http://www.hrsa.gov/healthit/hccn2007/t6table1networkchar.htm

CCHC

CCHC

CCHC CCHC

CCHC

Vendor

CCHC


EHR Network Value Proposition

Typical vendor offering

Com

pone

nts

for

succ

essf

ul E

HR

ad

optio

n


Why a Centrally Hosted/Network Approach to EHRs?

• Access more sophisticated resources necessary• Improve profile with vendors • Reduce cost • Leverage accumulated knowledge and experience• Develop CCHC sector resources to reduce

dependency on commercial vendors• Provide opportunities for clinical collaboration and

data sharing• Address gaps in commercial products and services


Comparison of Vendor & EHR Network Products and Services

Necessary Services for EHR Adoption Vendor EHRNetwork

Executive Commitment

Collaborative environment to facilitate peer learning ○ ●

Change management resources ○

Care Process Change

Readiness and needs assessments ○ ●

Customized workflow training ●

Workflow re-engineering ●

Workforce development ○ ●

Ongoing staff training ●

Operational support ●

●

: Service typically provided in a basic offering ○

: Service typically not provided in a basic offering: Service may be provided and may require additional cost


Comparison of Vendor and EHR Network Products and Services

Necessary Services for EHR Adoption Vendor EHR Network

Quality Improvement

Educational resources ○ ●

QI Expertise ●

Population-based services ○ ●

Hardware and Technology Operations

Data center ○ ●

Software configuration ●

Vendor management ○ ●

Help-desk support ●

Disaster/recovery ●

●

: Service typically provided in a basic offering ○

: Service typically not provided in a basic offering: Service may be provided and may require additional cost


Is an EHR Network the Right Approach?

An EHR network is more suitable for CCHCs with one or more of the following characteristics:• Seeks products and services tailored to safety-net without need

for extensive customization• Small or mid-sized organizations without an existing, robust

technical or quality improvement infrastructure• Inability to dedicate substantial time to the EHR implementation,

training customization, workflow redesign and optimal adoption • Interest in leveraging requirements of other CCHCs that have

already adopted an EHR • Interest in implementing disease management (DM) and QI

programs that leverage and EHR


National Network Examples

CCHC EHR Network Value Proposition

Community Health Alliance of Pasadena

(CHAP)

OCHIN Oregon

• Robust technical and operational support• Services and offerings have been developed and

customized for clinics• Mission-driven organization• Focus on quality improvement, including integration

of guidelines and clinical expertise• Responsiveness to clinic concerns• Well developed, detailed implementation plan

including role-based descriptions customized to safety-net providers and training process

• CCHC leverage with EHR network versus a vendor• Sustainability and dependability• ASP model

West Hawaii Community Health Center (WHCHC)

Health Choice Network (HCN)

Florida

St. Anthony’s Free Clinic

Alliance of Chicago (AOC)

Illinois


Afternoon Session Agenda

Time E.H.R. Demonstrations

StructuredDemonstrations ofClinical Scenarios

The Network Experience Panel

1 – 1:301:30 - 2 Scenario 1 – Wel l

Child and Dental2 – 2:302:30 - 33 – 3:303:30 - 4 Scenario 2 -Population

Health Management4 – 4:304:30 - 5


Vendor Demonstration of Clinical Scenarios: Scenario #1 - Well Child and DentalSummary: Pediatric patient with complicated well child visit and subsequent hospitalization

Physician’s office is contacted by the mother of a five year-old patient for the scheduling of a child health and disability prevention visit. The child has a history of poor weight gain, asthma, and urinary tract infection, all of which are addressed during the visit. Appropriate immunizations and screenings are performed during the visit, as well as acute care for an asthma exacerbation. A referral is made for dental care and testing is ordered with regard to UTI. Follow- up visits for review of tests are scheduled. After the visit, the patient’s asthma worsens, requiring admission to the hospital.


Key EHR-Related Events: Scenario #1

• Scheduling and update of contact information• Review of coverage and benefits eligibility• Entry of patient history and physical data into EHR• Notice to physician/staff of arrival and in office location of patient• Review of immunization status, prompting, entry into database• Scanning of information into EHR• Notification of drug allergy• Generation of patient education sheets for specific conditions• Access of clinic EHR by ER physician• Generation of patient history summary for use by admitting physicians;

access to clinic EHR by admitting physicians through HIE• Notice upon admission of scheduled diagnostic testing, rescheduling

based on severity of asthma exacerbation• Entry of discharge summary into hospital EHR accessible through HIE• Delivery of follow-up test results and notifications to physician


Care Goals for Meaningful Use: Scenario #1

• Provide access to comprehensive patient health data for patient’s health care team

• Use evidence-based order sets and CPOE• Apply clinical decision support at the point of care• Provide patients and families with access to data,

knowledge, and tools to make informed decisions and to manage their health

• Exchange meaningful clinical information among professional health care team

• Provide transparency of data sharing to patient


Vendor Demonstration of Clinical Scenarios : Scenario #2 - Population Health Management

Summary: Use of E.H.R. to facilitate population-based interventions by identifying at-risk patients

Clinic searches E.H.R. data for all hypertensive patients in the clinic E.H.R. system. Criteria are set to identify patients who have not had a primary care visit in the last year, patients whose last blood pressure reading was over a threshold number regardless of time of last visit and those who have ongoing hypertension, but have not had a renal work-up completed, and to identify the next scheduled visit (if any) for all such patients. Once identified, patients are categorized as needing (a) automated follow-up (telephone or otherwise) as a reminder to schedule visit, (b)targeted follow-up by nurse for patients with blood pressure over the threshold number, or (c) renal evaluation, in which case the chart is flagged to remind the physician of the need for evaluation.



• Access and search EHR database of all patients using user-specified criteria

• Flag EHR of each patient selected for follow-up and integration of follow-up plan into EHR

• Automatic notification of providers for each follow-up step

• Update of EHR based on follow-up status• Update searches to gauge follow-up and efficacy of

intervention



• Generate lists of patients who need care and use them to reach out to patients (e.g., reminders, care instructions, etc)

• Report to patient registries for quality improvement, public reporting, etc

• Communicate with public health agencies • Ensure privacy and security protections for

confidential information through operating policies, procedures, and technologies and compliance with applicable law


Summary: Adult male with complex medical and mental health issues requiring in-office intervention, home health follow-up and on-going management of therapy

Adult male arrives and is seen for scheduled appointment. The patient has a history of obesity, diabetes, back injury, depression and anxiety. Prior to the visit, a confirmation notice is automatically generated by the E.H.R., and contactand coverage information are updated when the patient calls or logs in to the clinic website to confirm the appointment. History and physical records are entered into the E.H.R. during the visit, based on guide templates for management of diabetes and depression. During the office visit, the patient is treated for mild opiate withdrawal, seen by a clinical social worker and has stat lab work done. Discharge instructions include scheduling of a home health visit, referral to Addiction Medicine and Diabetic Clinic, and changes to medications for which new prescriptions are transmittedelectronically to the patient’s pharmacy. Follow-up actions including checking on thepatient’s status, reviewing notes from referred clinics, denying requests for certain additional medications and prescribing alternatives–in response to requests through electronic prescribing system–and based on clinical guidelines for use of opiates and behavioral health available in the E.H.R.

Vendor Demonstration of Clinical Scenarios : Scenario #3 - Behavioral Health (OPTIONAL)



• Automatic reminder of visit• Website access to update coverage information • Review of coverage and benefits eligibility• Entry of patient history and physical data into EHR• Notice to physician/staff of arrival and in office location of patient• Generation of problem list in EHR (clinic patient summary)• EHR based calculation of BMI• Automatic behavioral health note template with appropriate confidentiality

safeguards• Referral scheduling with special notation• Follow-up alerts to appropriate staff• Guidance on withdrawal treatment• Automatic updates to bill and coding for encounter• Electronic signature of note and bill• Delivery of e-script service with handling for controlled substances • Receipt of refill notice from pharmacy via EHR, e-script service or fax • Incorporation of home health note into EHR• Delivery of lab results to EHR with alert to physician



• Provide access to comprehensive patient health data for patient’s health care team

• Apply clinical decision support at the point of care• Provide patients and families with access to data,

knowledge, and tools to make informed decisions and to manage their health

• Exchange meaningful clinical information among professional health care team

• Provide transparency of data sharing to patient• Ensure privacy and security protections for confidential

information through operating policies, procedures, and technologies and compliance with applicable law


Discussion

• Q&A


HITECH and ARRA Incentive Reference Information


ARRA and Privacy & Security

• Extends HIPAA directly to Business Associates

• Establishes first national data security breach notification law

• Creates new restrictions on use & disclosure of PHI

• Expands individuals’ rights over flow of information

• Grants State AGs authority to bring civil actions

• Toughens HIPAA’s civil penalties

- No knowledge of violation: max penalty $100 per violation up to $25,000 per year - “Reasonable cause”: $1,000/$100,000

-“Willful neglect”: $500,000/$1.5 million


HIE Planning & Implementation GrantsFunding MechanismAppropriations, subject to annual review & authorization

Payment AgentONC

Timeline and Status• TBD through procurement expected in Summer 09

Payment Recipients•State or state-designated entity

Level of Funding• TBD, but majority of funds expected to go to implementation• State matching funds may be required in FY 09 & 10 (and will be required in FY 11).

Requirements for Funding• Submission of a plan, approved by HHS, that describes the activities to facilitate and expand the electronic

movement and use of HIE according to nationally recognized standards and implementation specifications

Use of Funds• Enhancing broad and varied participation in nationwide HIE• Identifying State or local resources available towards a nationwide effort to promote health IT• Complementing other federal programs and efforts towards the promotion of health IT• Providing technical assistance to develop & disseminate solutions to advance HIE• Promoting effective strategies to adopt and utilize health IT in medically underserved communities• Assisting patients in utilizing health IT• Encouraging clinicians to work with Health IT Regional Extension Centers• Supporting public health agencies’ access to electronic health information • Promoting the use of EHRs for quality improvement


Funding MechanismAppropriations, subject to annual review & authorization

Payment AgentONC

Timeline and Status• ONC to publish notice of program description and

availability of funds by May 18

Payment Recipients•Centers should be “affiliated with” nonprofit institutions

Level of Funding• Up to 50 percent of capital and annual operating budget for two years, Secretary has discretion to

waive matching requirement if economic conditions warrant • Continuing support possible• Funds available upon enactment

Requirements for Funding• Centers must prioritize assistance to public or not-for-profit and critical access hospitals, FQHCs,

rural or other providers that serve uninsured, underinsured or medically underserved patients, and individual or small group practices

Use of Funds• Centers are designed to promote provider adoption of HIT through

– Assistance with implementation, effective use, upgrading, and ongoing maintenance of HIT, including EHRs– Dissemination of best practices and research on HIT implementation– Participation in HIE– Integration of HIT into the training of health professional– Other

Health IT Regional Extension Centers


State EHR Loan ProgramFunding MechanismAppropriations, subject to annual review & authorization

Payment AgentONC

Timeline and Status• Funds available as of Jan 1, 2010

Payment Recipients•States•Indian Tribes

Level of Funding• TBD, at the discretion of HHS/ONC• States may accept contributions from private sector• States are on the hook for $1 in matching funds for every $5 in federal funding

Requirements for Funding• States and Indian tribes must submit strategic plans that include

–A list of the projects to be assisted through the loan fund–A description of the criteria and methods established for the distributions of funds –A description of the financial status o f the loan fund–Short and long-term goals for the fund

Use of Funds• States may grant loans to providers for

–Purchases of certified EHRs–EHR upgrades–Personnel training–Improvements in HIE



Payment AgentHHS & NSF

Timeline and StatusTBD

Payment Recipient/Applicants•Institutions of higher education may qualify for funding under this program, though the stimulus package does not reference specific types

Level of Funding/Timing• Matching grants may fund up to 50 percent of a recipient institution’s total costs• Grantees may request a higher federal proportion of funding on the grounds that national economic

conditions are such that they “would render the cost-share requirement detrimental to the program.”

Requirements for Funding• TBD• HHS to give priority to existing education and training programs and to programs designed to be

completed in less than six months

Use of Funds• Certification, undergraduate, or master’s degree programs for both health care and information

technology students may be developed with funding under this program• Grant funding may be used to develop and revise curricula in medical health informatics and related

disciplines; recruit and retain students; acquire equipment necessary for student instruction in these programs; and establish or enhance bridge programs in the health informatics fields between community colleges and universities

Grants to Expand Medical Health Informatics Programs



Payment AgentNIST, NSF, Others TBD

Timeline and StatusTBD

Payment Recipients/Potential Applicants•Institutions of higher education (or consortia thereof which may include nonprofit entities and Federal Government laboratories).

Level of Funding/Timing• The stimulus package sets aside $20 million to NIST for continued work on advancing health care information enterprise

integration through activities such as technical standards analysis and establishment of conformance testing infrastructure• No mention of a match requirement• Timing TBD

Requirements for Funding• Applicants must submit an application to NIST detailing the following:

–The research projects that will be undertaken by the Center and the respective contributions of the participating entities;–How the Center will promote active collaboration among scientists and engineers from different disciplines, such as information technology, biologic sciences, management, social sciences, and other appropriate disciplines;–Technology transfer activities to demonstrate and distribute the research results, technologies, and knowledge; and–How the Center will contribute to the education and training of researchers and other professionals in fields relevant to health information enterprise integration.

Use of Funds• Establishment of Centers for Health Care Information Enterprise Integration, which are tasked with generating innovative

approaches to health care information enterprise integration by conducting “cutting-edge” research on the systems challenges to health care delivery and with developing health information technologies.

• Areas of research may include: interfaces between human information and communications technology systems, voice- recognition systems, software that improves interoperability and connectivity among health information systems, software dependability in systems critical to care delivery, health information enterprise management, health information technology security and integrity, and measurement of the impact of information technologies on the quality and productivity of health care.

Health Care Information Enterprise Integration Research Centers



Payment AgentHHS

Payment Recipients/Potential Applicants• Eligible institutions include:

–Schools of medicine, osteopathic medicine, dentistry, or pharmacy, a graduate program in behavioral or mental health, or any other graduate health professions school;–Graduate schools of nursing or physician assistant studies;–A consortium of two or more schools; or –Institutions with a graduate medical education program in medicine, osteopathic medicine, dentistry, pharmacy, nursing, or physician assistance studies

Level of Funding/Timing• Matching grants may fund up to 50

percent of a recipient institution’s total costs

• Grantees may request a higher federal proportion of funding on the grounds that national economic conditions are such that they “would render the cost-share requirement detrimental to the program”

• Timing TBD

Requirements for Funding• Applicants must submit a strategic plan for integrating certified EHR technology in clinical education

as a means by which to reduce medical errors and enhance health care quality• Applicants must also have the capacity to collect data on the effectiveness of the demonstration

project in improving patient safety, increasing the efficiency of care delivery, and in increasing the likelihood that graduates will adopt and incorporate EHRs in their clinical practice

Use of Funds• Integration of EHRs into the recipient’s clinical education program(s). Grant funds may not be used to

purchase hardware, software, or technology services

Grants to Integrate EHRs into Medical School Curricula


Broadband Technology Opportunities Program (BTOP)Funding MechanismFederal appropriations

Payment AgentNational Telecommunications and Information Administration

Payment Recipients/Potential Applicants• Eligible recipients include:

– State and local governments– Foundations and nonprofit corporations, institutions, and

associations– Any entity, including broadband service or infrastructure

providers, is eligible if the NTIA’s assistant secretary determines that the funds will promote public interest

• The assistant secretary shall consider if applicants are socially and economically disadvantages small business concerns

Level of Funding/Timing• $4.7 billion• Funds available starting April – June 1009

through September 30, 2010• 3 rounds of competitive grants

– Round 1: April – June 2009– Round 2: October – December 2009– Round 3: April – June 2010

Requirements for Funding• Recipients or a third party must contribute at least 20% of the total cost

– This criteria may be waived for financial hardship

Use of Funds• At least $250 million for innovative programs that encourage sustainable adoption of broadband services• At least $200 million to upgrade technology and capacity at public computing centers• $10 million to the Office of Inspector General for BTOP oversight/audits• Up to $350 million will fund development and maintenance of statewide broadband inventory maps


Distance Learning, Telemedicine, and Broadband (DLTB) Program

Funding MechanismFederal appropriations

Payment AgentRural Utilities Service (RUS)

Payment Recipients/Potential Applicants• ARRA does not specify which entities are eligible.

However, current or former borrowers under Title II of the Rural Electrification Act of 1936 and traditional telecommunications borrowers receive priority.

Level of Funding/Timing• $2.5 billion• Funds are expected to be available

around June 2009• No deadline for expenditure of funds

Requirements for Funding• 75% of a project area must be rural and have insufficient access to high-speed broadband

– The criteria for “rural” are being defined • Certain applicants receive priority, including those

– Whose projects will begin promptly after approval– Whose projects will be fully funded if they receive aid– That offer a choice of multiple service providers– With the highest proportion or rural residents who do not have broadband access

• No area of a DLTB-funded project may receive funding from BTOP for the same purpose. However applicants may apply for and receive funding from both programs

Use of Funds• Specific uses of funds are being defined, with the focus expected to be on broadband

infrastructure

ehr pathways to successful adoption...3 ehr pathways to successful adoption: agenda july 8 –...

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