Steering Committee on Telehealth and Healthcare Informatics Since

Steering Committee on Telehealth and Healthcare Informatics Since 1993 Honorary Co-Chairs Senator Kent Conrad ● Senator Mike Crapo Senator John Thune ● Senator Sheldon Whitehouse Rep. Rick Boucher ● Rep. Eric Cantor Rep. Phil English ● Rep. Bart Gordon ● Rep. Allyson Schwartz Rep. David Wu In Coordination With The “House 21 st Century Healthcare Caucus” Reps. Patrick Kennedy & Tim Murphy Co-Chairs In Collaboration with The Healthcare Leadership Council “Protecting Electronic Healthcare Information” November 18 th, 2008 Reserve Officers Association

Some Policy Considerations The More Things Change – The More They Stay the Same § Reimbursement & Capital Costs – Aligning Financial Incentives – Driving Cost-Effectiveness (i. e. Chronic Care & Disease Mgmt) – Start-up Costs Capital Investment § Standards (Clinical & Communications) – Quality & Safety § Infrastructure Issues – Network Infrastructure / Broadband Access / Interoperability § Human Dimension Issues - Arrangements to Practice in an e-enabled Environment - Practitioner and Patient Acceptance - Licensure, Accreditation, Certification - Legal (Stark Law, Liability, FDA, HIPAA) - Training an HIT Workforce

Capitol Hill HIT Series § “If we run out of lunch…. . . know that we’ll still quench your thirst for knowledge, and provide significant food for thought” – Neal Neuberger

2008 Proposed Budget HIT Related $118 M. - ONCHIT ($90 M. Infrastructure Grants) ($28 M. HIT Network Development) $ 45 M - AHRQ HIT $ 5 M - Federal Health Architecture $ 2 M. - Department Management (HIT) $ 4. 3 B - Bio-Preparedness, DHHS ($1. 1 B) states, locals, hospitals for Emg. response $ 322 M - Pandemic Flu, CDC, NIH, FDA, OS $ 7 M - OAT, HRSA (Same as 2007 CR). $ 25 M - RUS, Do. A, DLT Grants, (Same as 2007 CR) Army TATRC ~$280 M in 07 versus ~$400 M in 06 Under CR & Do. D Regular Approps. (2008 Request Not Clear Yet) © 2007 Health Tech Strategies, LLC All Rights Reserved

Numerous Players § Federal Government – Congress – Agencies (DHHS, Do. C, Ag, Do. D, VA, IHS, NASA) § States – Statewide Initiatives, Regional Networks § Private Sector – – – Coalitions / Consortia (ATA, HIMSS, e. HI, AHIMA) Standards Groups Foundations (Markle, RWJ, Commonwealth, e. HI Fndt)

What Everyone is Going Thru: Some Planning Considerations § § § § Governance Principles & Key Objectives Stakeholder Perspectives Establishing a Business Case Needs Assessment Legal & Regulatory Challenges Defining Interoperable Architectures Evaluation Methodologies

Some Additional Rural & Practice Challenges § Small Rurals may have no IT support let alone an IT Department § Hard to find M. D. or Adm 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.

Some Additional Rural & Practice Challenges § Patients are isolated, must travel long distances § Rural residents older, often with chronic conditions § Low patient volume § Lower income, and less private insurance § Bottom Line - Rural Healthcare Organizations will need special legislative consideration

Rural HIT Coalition RHRC & HTS § Linking groups thru Web Portal & list serve § Network to highlight issues and opportunities § Review and disseminate literature § Identify funding and resources § Models and case studies useful to others § Create fellowship and educational exchanges

Rural Underserved HIT Coalition § Rural Health Coalition – Clinics – HIT Networks / Infrastructure – State Offices § § § Minority Health Coalition Behavioral Health Coalition Health Education / Workforce Training Coalition

Policy Considerations § Reimbursement & Capital Costs – Aligning Financial Incentives – Driving Cost-Effectiveness (i. e. Chronic Care & Disease Mgmt) – Start-up Costs Capital Investment § Standards (Clinical & Communications) – Quality & Safety § Infrastructure Issues – Network Infrastructure / Access / Interoperability § Human Dimension Issues - Practitioner and Patient Acceptance - Licensure, Accreditation, Certification - Legal (Stark Law, Liability, FDA, HIPAA)

Put Positively § “There are no problems…. . just insurmountable opportunities”