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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
For discussion purposes only – not for distribution3
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”
For discussion purposes only – not for distribution4
• 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
For discussion purposes only – not for distribution5
Key Drivers of Change
For discussion purposes only – not for distribution6
First Key Mechanism of Change
Yesterday Today Tomorrow
Images courtesy of Microsoft Health Vision Presentation, 2008 and Google Image
For discussion purposes only – not for distribution7
Medical Records Medical Records in 1935in 1935
For discussion purposes only – not for distribution8
Medical Records Medical Records in 2009in 2009
For discussion purposes only – not for distribution9
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
For discussion purposes only – not for distribution10
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
For discussion purposes only – not for distribution11
ARRA Overview Funding and Policy Timing
For discussion purposes only – not for distribution12
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
>20% $16,667 for purchase, $6,667 for operations/maintenance
Dentist 85% net average allowable costs
>30% $25,000 for purchase, $10,000 for operations/maintenance
Nurse mid-wife 85% net average allowable costs
>30% $25,000 for purchase, $10,000 for operations/maintenance
Nurse practitioner 85% net average allowable costs
>30% $25,000 for purchase, $10,000 for operations/maintenance
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.
For discussion purposes only – not for distribution13
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
For discussion purposes only – not for distribution14
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
For discussion purposes only – not for distribution15
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.
For discussion purposes only – not for distribution16
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
For discussion purposes only – not for distribution17
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)
For discussion purposes only – not for distribution18
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
For discussion purposes only – not for distribution19
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
For discussion purposes only – not for distribution20
EHR Network Value Proposition
Typical vendor offering
Com
pone
nts
for
succ
essf
ul E
HR
ad
optio
n
For discussion purposes only – not for distribution21
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
For discussion purposes only – not for distribution22
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
For discussion purposes only – not for distribution23
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
For discussion purposes only – not for distribution24
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
For discussion purposes only – not for distribution25
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
For discussion purposes only – not for distribution26
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
For discussion purposes only – not for distribution27
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.
For discussion purposes only – not for distribution28
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
For discussion purposes only – not for distribution29
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
For discussion purposes only – not for distribution30
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.
For discussion purposes only – not for distribution31
Key EHR-Related Events: Scenario #2
• 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
For discussion purposes only – not for distribution32
Care Goals for Meaningful Use: Scenario #2
• 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
For discussion purposes only – not for distribution33
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)
For discussion purposes only – not for distribution34
Key EHR-Related Events: Scenario #3
• 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
For discussion purposes only – not for distribution35
Care Goals for Meaningful Use: Scenario #3
• 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
For discussion purposes only – not for distribution36
Discussion
• Q&A
For discussion purposes only – not for distribution37
HITECH and ARRA Incentive Reference Information
For discussion purposes only – not for distribution38
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
For discussion purposes only – not for distribution39
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
For discussion purposes only – not for distribution40
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” non- profit 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
For discussion purposes only – not for distribution41
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
For discussion purposes only – not for distribution42
Funding MechanismAppropriations, subject to annual review & authorization
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
For discussion purposes only – not for distribution43
Funding MechanismAppropriations, subject to annual review & authorization
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
For discussion purposes only – not for distribution44
Funding MechanismAppropriations, subject to annual review & authorization
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
For discussion purposes only – not for distribution45
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
For discussion purposes only – not for distribution46
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