Enabling Health IT National Broadband Plan’s Recommendations for Health Care HIMSS10 Annual Conference March 2, 2010

The National Broadband Plan National Broadband Plan Deployment (Supply) Adoption and Usage (Demand) National Purposes Increasing the availability of broadband Serving the un-served Understanding the cost to do so Increasing adoption of broadband for those who are served Improving the utilization of broadband Consumer and business research Understanding international lessons How can broadband advance our policy goals in health care, energy, civic engagement, education, public safety, and more? Policy Team

Plan will accelerate innovation and investment across the broadband ecosystem Adoption & Utilization Network Services Devices Applications & Content Fixed and mobile Consumers, business, government

The National Purposes mandate “a plan for use of broadband infrastructure and services in: -advancing consumer welfare -civic participation -public safety and homeland security -community development -health care delivery -energy independence and efficiency -education -worker training -private sector investment -entrepreneurial activity -job creation and economic growth -and other national purposes.” Healthcare Energy and the environment Government performance and civic engagement Public safety and homeland security Economic opportunity Education American Recovery and Reinvestment Act, §6001(k)(2)(D):

As a platform for innovation and information exchange, broadband helps improve health outcomes Source: AirStrip Technologies, Intel, Medtronic, CardioNet, Corventis, ScanDocs

Health IT could result in significant cost savings Possible savings from EHRs over 15 years $Billions Source: Health Affairs; Robert Litan TotalSkin diseasePulmonary disease DiabetesHeart disease Possible savings from remote monitoring over 25 years $Billions Total 513 Physician practices Hospitals $700B in potential net savings over years

Practices with Advanced Electronic Health Information Capacity * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. Practices with Advanced Electronic Health Information Capacity Percent reporting at least 9 of 14 clinical IT functions*

Four primary barriers to health IT Lack of data and information access Outdated regulations Broadband is missing or too expensive Misaligned economic incentives

Broadband is missing or too expensive Data UtilizationRegulatory ConnectivityReimbursement Federally Funded Providers Estimated Locations Without Mass Market Broadband Connections Percent of locations for each delivery setting Total Number of Locations 346,0007, ,3003,700 Without Mass Market Broadband (Estimated %) With Mass Market Broadband (Estimated%) Urban Price Benchmarks Across the U.S. Monthly service cost ($) 4.2 X VermontNew YorkMississippiWyomingChicago, IL $ Source: AMA, HRSA, IHS, Telegeography, USAC

Program ComponentsWhat’s FundedMechanism2009 Spending Telecommunications Services Rural only Funds urban/rural price differential $59.0 Mn. Internet Access Rural only 25% of invoice 50% of invoice for states that are entirely rural $1.7 Mn. One time capital costs for network deployment Recurring costs for five years Urban and Rural 85% support $11.6 Mn. Total$72.3 Mn. Telecommunications Fund Internet Access Fund Pilot Program Rural Health Care Program Breakdown of program components

Working recommendations to ensure all providers have access to affordable broadband Data UtilizationRegulatory ConnectivityReimbursement Transform the Rural Healthcare Program 1.Re-tool broadband access support mechanism 2.Create permanent Broadband Infrastructure Fund 3.Expand the definition of eligible providers 4.Require new performance measures such as “Meaningful Use” 5.Upgrade Indian Health Service broadband service

Misaligned economic incentives Data UtilizationRegulatory ConnectivityReimbursement Providers bear the implementation and training costs but do not receive proportionate benefits PROVIDERS Health IT Implementation & Training PATIENTS PAYORS $ $ $ $ $ $ Better Health & Care $ $ $

Working recommendations to create incentives for adoption of e-care technologies Provide Congress with a plan to realize the value of e- care Increase e-care pilots that evaluate cost savings & clinical outcomes Expand reimbursement for e-care under current fee- for-service model where outcomes are proven Data UtilizationRegulatory ConnectivityReimbursement

Outdated regulations Data UtilizationRegulatory ConnectivityReimbursement Source: Lee Dobin’s “Doctor Office”, Cardionet Traditional MedicineToday’s Health Care Regulations were created to support 20 th -century health care, and must be updated to meet the needs of the 21 st century

Working recommendations to modernize health IT regulations Revise credentialing, privileging and state licensing requirements to enable e-care Clarify regulatory requirements and the approval process for converged communications and healthcare devices Data UtilizationRegulatory ConnectivityReimbursement

Lack of data and information access Data UtilizationRegulatory ConnectivityReimbursement CLINICAL DATARESEARCH DATAADMIN DATA Data is siloed and not interoperable Data is not sufficiently shared with consumers

Working recommendations to improve the utilization of health data Create next-generation interoperability across clinical, research and administrative data Ensure patients have access to and control over their health data Data UtilizationRegulatory ConnectivityReimbursement