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

thill@ruralcenter.org