Health IT Adoption by Rural Safety-Net Providers Speranza Avram, M.P.A. NSRHN Executive Director

NSRHN Geographic Area 435,900 residents 30,000 square miles 80% of residents live in rural or frontier communities

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 NSRHN Mission Statement To promote the health and well-being of residents in rural Northeastern California through: –comprehensive health care planning –integrated health care delivery systems –programs and services that expand access to care for all residents regardless of ability to pay

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 NSRHN Structure Non-profit corporation organized in 1995 Total membership currently 40 health care providers consisting of 100% of primary care clinics in region, 100% of rural hospitals, half of the public health departments, some private sector providers and the two regional tertiary hospitals Nine employees in two offices with current budget of $2.1 million

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Technology Projects - Overview Support Regional Telemedicine Network. Use video conferenencing for distance learning, peer support, and regional communication. Bridge the “digital divide” by operating private T-1 line network.

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Technology Projects – Overview (con’t) Coordinate telemedicine services to special populations. Provide technology tools to providers such as PDAs, on-site computer training, and upgraded IT hardware Operate regional Technology Help Desk Promote regional IT strategic planning

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Rural Challenges Lack of broadband connectivity for Internet access and video conferencing Lack of technology support infrastructure: repair facilities, computer stores, technicians, colleges Lack of economy of scale hinders technology investment options

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Rural Challenges – con’t Small facilities and rural communities are not attractive to vendors Most safety-net facilities cannot afford even temporary loss of productivity caused by new technology installation Dependence on public payors limits access to innovation and investment

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Network Strategies Aggregate need, design regional solutions, and provide vehicle for funding Develop expertise to provide centralized technical support to members Develop and manage shared telecommunications infrastructure Develop “value-added” services difficult for individual members to develop, usually on the leading edge

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Impact of Network Strategies Telemedicine links rural patients with needed specialty care (over 3,000 clinical consults conducted to date by 30 rural health telemedicine sites) Video conferencing expands educational opportunities for isolated providers, helps with retention (over 400 continuing medical education events completed) Shared T-1 line network using federal Universal Services subsidies expands connectivity at reduced cost

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Investments of over $3.5 million in private, state, and federal support for rural health providers – much of it for IT equipment, warranty support, IT training, etc) Regional rural voice to impact policy agendas (changed state regulation to expand access to telecommunications subsidies) Impact - (con’t)

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Impact - (con’t) Helped members achieve HIPAA compliance IT Help Desk fielding average of 100 calls per month (30% telemedicine-related)

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Lessons Learned Be clear on vision and mission and re-visit them through regular strategic planning Do real things to keep people interested and engaged – and do them well Be nimble and respond to the needs of your members and changes in the environment

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Lessons Learned (con’t) Approach non-traditional partners to develop “win-win” propositions Think strategically and for the long-term – while being responsive to today’s needs Diversity is our greatest asset…..and our greatest challenge

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 What’s next? Completing installation of VPN Working with providers to develop shared clinical data applications Conducting extensive education and readiness assessment for installation of HER Developing business service projects to help with sustainability Emerging as a leader in development of RHIO for northeastern California

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Virtual Private Network PDAs Shared Clinical Applications Electronic Health Records Clinician Technology Training Centralized Technology Help Desk and Support Services Patient Control of PHI Northern Sierra Rural Health Network = Regional Health Information Organization = RHIO Telemedicine Pathway graphic courtesy of The Tides Foundation Community Clinic Initiative

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Future Challenges Supporting EHR adoption at the facility level while promoting regional dialogue Engaging public sector payors in RHIO discussions (CMS, Medi-Cal, PERS) Attracting and maintaining clinician interest and attention Finding funding for both facility and RHIO investments outside of traditional Return on Investment models (need new ROI paradigms)

Health IT Adoption for Rural Safety-Net Providers November 8, 2005 Northern Sierra Rural Health Network 138 New Mohawk Rd. Suite 100 Nevada City, CA FAX: