Mark Schoenbaum, Office of Rural Health & Primary Care The Minnesota e-Health Initiative e-Health Initiative Smart Health for Rural communities July 19, 2005

Health & Health Care System Challenges Error rates are too high Quality is inconsistent Costs are escalating Research results are not rapidly used Demographics of baby boomers increasing demand Capacity for early detection & response to threats is minimal

Health Information Technology: What is it? Electronic Health Records (EHR), but also: Computerized provider order entry (CPOE), Including applications like: –E-Pharmacy (Formulary, History and Prescribing) –Diagnostic applications for Laboratory, Radiology Secure communication Telehealth & Imaging Technology Public Health monitoring and disease surveillance, and prevention –Communicable Disease Reporting –Immunization Registries Computerized decision support systems Personal health records

Minnesota e-Health Initiative What is it? Based on: National Framework for Strategic Action 2004 State legislation 2004, 2005

Minnesota e-Health Initiative What is it? Public - Private collaboration 2004,2005 Advisory Committees Designed to accelerate the use of Health Information Technology in all areas of the state Purpose is to: -Improve health and health care quality, -Increase patient safety, -Reduce health care costs, and -Improve public health

Minnesota Roadmap

Minnesota Challenges and Gaps* Type of Facility/ Provider NumberEstimated use of HIT Gap/ Comment Clinics / Primary Care~ 700Est. 5%-15%Small & rural clinics Long Term care-Nursing Homes ~ 402~ 2% - 4%Clinical support, Inter- connectivity Hospital Emergency Departments ~ 129~ 10% - 12%Rural & smaller, Connect across systems Local Public Health Departments ~ 91VariesLimited access to community data No Interoperability * Preliminary data – Based limited surveys

Vision: A Minnesota Health Information Exchange MN-HIE will interconnect clinicians and be the connection point for: National Health Information Network (NHIN) Community-Based Initiatives

Framework for HIT Financing in Minnesota MN & National Goals Goal 1 Inform Clinical Practice Goal 2 Interconnect Physicians Goal 3 Personalize Care Goal 4 Improve Population and Public Health System Technology (Initial Focus) Electronic Health Record RHIO Infrastructure/Hub Personal Health Record (PHR) Disease Surveillance MN-PHIN Startup Phase Ongoing Operations Phase

Nat’l Critical Access Hospital HIT Survey (May 05, n = 361) Conducted by Rural Health Resource Center, Duluth Biggest Barriers to Initiating HIT: – Capital Needs – 81% of respondents noted – Staff Time - 50% Biggest Barriers to Continuing HIT: –Acquiring hardware/software – 50% –Staff time – 50% Most Helpful Resources? –Grants/loans – 92% –Access to best practices – 46%

Financing Needs & Sources Finance Needs - Who,What, Where: Locations and Institutions: Clinics, Clinic Systems, Nursing Homes, Hospitals, Pharmacies, Home Health Care Systems, Local Health Departments, etc. Persons: Physicians, Nurses, other providers What: Infrastructure, hardware, software, education, conversion initiatives Potential Funding Sources: Employers, Purchasers/Insurers, Private Financing, Self- funded, State Loans/Grants, Federal Grants, Non-profit Grants

Financing Principles Financially “able” entities are expected to make investments as part of their regular budget and IT planning State financing will complement, not displace, private or federal investments Public financing will: –Support small, rural, or underserved communities –Require resource commitments from recipients –Require interoperable system investment

Financing Principles Investments need to: –Advance interoperability –Improve quality –Be consistent with national standards & certifications Align the cost of HIT investment with benefits received

Doctor’s Office Quality Information Technology (DOQ-IT) Stratis - Medicare QIO Will help small/med clinics implement EHR systems –readiness assessment – vendor selection –practice redesign –implementation and change management

Grants/Loans for HIT MN Rural Hospital Capital Improvement Grant Program MN Rural Hospital Planning/Transition Grants MN Community Clinics Grant Program Healthier MN Community Clinic Fund USDA RUS Telemedicine Grant Program US Office for Advancement of Telehealth US Agency for Healthcare Research & Quality Loans – various sources Iron Range Resources

Opportunities for Action/Support Conduct readiness assessment for HIT Participate in community/regional collaboration Increase health informatics knowledge & education Educate your elected representatives on your needs on this issues Help shape Minnesota directions

Summary Critical need & readiness for change leadership & innovation Rural issues on the radar, we need to keep them there! Call us! –Mark Schoenbaum – us Thanks! “…Doctors deserve to focus on the quality of their care, not the quantity of their paperwork. And both patients and doctors deserve systems that will prevent medical errors before they become medical and legal problems.” Secretary Thompson – July 2004

For More Information