March 8, 2005
Washington, D.C.
It's my pleasure to participate in this panel discussion on health information technology with my colleagues – John Ruiz from NACHC, Lisa Dolan from the Agency for Healthcare Research and Quality, and Lammot du Pont from the Office of the National Coordinator for Health Information Technology.
Technology is the engine that drives our world today, and it is vitally important that we in the health arena stay on the cutting edge. At HRSA, we are making every effort to mainstream health information technology applications throughout all HRSA programs.
There is a growing national focus on the critical importance of using technology to make the Nation’s health care system more effective and more efficient. And, for all of us, this is good news. President Bush is committed to this idea and so is HHS Secretary Mike Leavitt.
President Bush often uses his bully pulpit to trumpet the importance of health information technology.
He has said that we all must look for more innovative ways to strengthen the entire health care system.
And, of course, the use of health information technology can bring about many innovations in the way we do business.
Secretary Leavitt said at his confirmation hearings that 21
st century health care must include modern medical technology, modern information technology, and modern, consumer-focused delivery systems.
Think about it.
Today, all of us are just a click away from the latest health information at various reputable websites. Some patients can now even receive second opinions by going online.
Studies also tell us that more and more doctors are turning to technology to reduce medical errors and better track the care of their patients.
When President Bush appointed Dr. David Brailer to advise the federal government on health information technology, we entered a new phase of activity. Last November, HRSA and the Agency for Healthcare Quality convened an all-day expert panel with about 15 community health center directors and Mr. du Pont representing Dr. Brailer’s Office.
It was a good meeting where we were able to share ideas and discuss the challenges of planning, deploying, maintaining, and sustaining electronic medical record systems. Everyone agreed that sustainability of the systems is a major issue.
Now we are working to incorporate the ideas and recommendations that resulted from this meeting into HRSA’s overall health information technology strategy.
In 2004, HRSA awarded millions of dollars to help our community health centers improve their use of technology in order to work better and smarter for the people they serve.
For example, our Healthy Communities Access Program grants help “safety-net” health care providers in a community reorganize their health care delivery systems to provide better coordinated, more efficient care for uninsured residents. Sometimes participants pull together to create networks to share uncompensated care more fairly among local health care providers.
Or some grantees decide to link hospital and local clinic services through data systems that share information on uninsured patients.
We also award grants that are designed to promote the integration of activities and operations systems among community health centers.
Many of these grants, logically, focus on integrating information systems to reduce IT costs and allow more health center funds to be invested in direct patient care.
For example, in the mid-1990s four health centers in
South Florida formed the Florida Health Choice Network to pool resources and stretch scarce dollars by building common systems in IT, accounting and billing.
They are also implementing a software package called
Medical Manager that helps doctors track patients who suffer from chronic diseases. The software provides online clinical research protocols on these diseases that help physicians decide on the proper treatment.
News of the Network’s success began is spreading and today that network extends beyond
Florida to include 23 clinics in states as far away as
New Mexico and
Utah.
In fact, some of the
New Mexico health centers are now on solid financial footing for the first time in years thanks to improved billing processes and the ability to share resources across the network.
CIO magazine was so impressed by Health Choice Network’s achievements that they made it the runner-up in the magazine’s “Enterprise Value Award” in 2004.
Health Choice Network is clearly at the forefront of e-government efforts, and in some of our nation’s most difficult settings.
These health centers, after all, serve low-income patients, about 40 percent of whom have no health insurance. Currently, there are approximately 56 such networks in the
United States.
Another example is the Institute for Urban Family Health in
New York City -- a health center with six sites. They are now 100 percent paper free both for practice management and medical records as well as for electronic prescriptions.
And there’s the Oregon Community Health Information Network that is an independent non-profit consortium of safety net providers that includes many Federally Qualified Health Centers, as well as additional partners in
California and
Washington state. This network has acquired a high-end suite of applications called EPIC--the same system adopted by the Kaiser system. And Kaiser Permanente is generously providing support and technical assistance for this network.
There are also examples of networks, Healthnet in Boston and Community Health Access Network in New Hampshire, that have succeeded in garnering significant amounts of privately donated funds to support their purchase of systems.
HRSA is currently supporting another network project in which several health centers in
West Virginia are participating in a pilot of a new version of the VISTA Office software that can be used in ambulatory clinics.
The health centers in
West Virginia were able to get in on the ground floor with this pilot and the testing of this software making sure early-on that the software can really meet the needs of the health centers.
The Centers for Medicare and Medicaid Services also sponsors the Doctors Office Quality--Information Technology Project, called DOQ-IT. Pilot QIOs will provide assistance to physician offices to help them select available systems and implement them in the clinical setting. The aim is to promote the use of HIT in redesigning care delivery processes.
The federal government is also supporting something we call Regional Health Information organizations-- or RHIOs. They are designed as a major instrument of regional collaboration, bringing EHRs into clinical practice and interconnecting clinicians who may be seeing the same patients. RHIOs may be a possible source of assistance for small practices trying to navigate through the HIT acquisition process. RHIOs potentially can help with technical assistance and in leveraging better deals in the marketplace.
Several RHIOs are currently getting underway. For example, one of our HCAP grantees, the Primary Care Coalition of Montgomery County, MD, recently received an AHRQ planning grant to explore the potential of health information exchange between safety organizations and mainstream health providers in the
Washington, DC metro area. They will be striving to determine how information exchange can best serve the needs of organizations treating the underserved and what a sustainable business case might be.
I mention these varied examples to give you all some idea of the different ways that some health centers are making necessary technology improvements.
At HRSA, we
want to continue investing in this technology but in the current budget climate, it is unlikely that we will have the resources to deploy and operate these systems throughout the community health center community. We-- and you-- need to find the resources elsewhere. If we can demonstrate that this technology can reduce health care costs and dramatically improve efficiency, then perhaps we will be able to attract public and private partners who will be willing to share their savings with us.
The bottom line is clear. All of you need to get involved. With specific technology improvements, we know that our community health centers can refocus their efforts and resources into providing more and better care.
Clinical services increase, while costs go down.
The end result is that service and quality improve at the same time that patient access improves – a win-win for everybody involved.
We are moving in the right direction, but we still have a way to go. We still must do a better job of helping our grantees grasp the changes these technologies will provoke. What we have found is that spreading its use is not just about putting the technology in place, it’s also – and perhaps mainly – about getting people and organizations to pull together in ways that are new and often strange to them.
HRSA Administrator Betty Duke often tells a story about one grantee who insisted to her she couldn’t use HRSA funds to buy and implement telehealth equipment.
This opinion was incorrect, but since we didn’t know how many other grantees shared her view, we have made certain that future grants included language stating clearly that such purchases are okay and above board.
As technology software advances and clinicians and health center chief executives continue to recognize the potential of technology to virtually transform their organizations, I believe that we will see vast changes in our health care system that will benefit all of us.
Without a doubt, information technology has and will continue to radically change our lives.
But IT will only improve the delivery of health care to the degree that we humans are able to speak clearly and build the collaborative relationships that are needed to take advantage of its incredible potential.
In closing, I want to thank you all for being here and for being our partner in this most exciting endeavor. This meeting presents an unparalleled opportunity to share information and resources, increasing both knowledge and the potential for networking among all our partners.
In the months ahead, I can assure you that we at HRSA will continue our work to spread the good news about the many benefits of health information technology.
We want to be sure that providers in remote areas have the best and most up-to-date technologies available to them. We also will continue to look to distance learning activities to increase education and training opportunities for our public health workforce. And we will continue to share knowledge about technology advances, pool our expertise, and expand our relationships.
Remember that partnerships make it possible to serve more people, to serve them better and to control costs.
Countless individuals will benefit from the excellent health care resulting from your efforts. Working together, I know we can continue to make progress shaping and adapting all the new technologies for the benefit of our national public health.
Thank you.
