Rural America is different from urban and suburban America. Health care providers who serve the approximately 50 million Americans who reside in rural communities face special challenges in their effort to deliver quality care. In the past two weeks, I have had the opportunity to meet with rural health care leaders at two important national meetings: with the National Rural Health Association Policy Institute at its annual conference in Washington, D.C.; and at the annual rural health care conference hosted by the American Hospital Association’s Health Forum, in Phoenix.
Both of these opportunities enabled me to learn more detail about the prospects for adoption and meaningful use of health IT in rural communities. Both of them provided some promising new ideas for HHS to pursue. And both of them reinforced my view that we must make special efforts to ensure that rural Americans have equal opportunity with their urban and suburban cousins to benefit from health IT.
It is ironical that some of the very features that create barriers to health IT adoption in rural areas are the same features that would make health IT of special benefit in rural settings. The realities of distance, isolation, and constricted resources can make health care delivery difficult, and health IT can help ameliorate some of those very problems. But first, we need to overcome the barriers to adoption itself and get health IT into our rural care facilities.
Of course, none of this is new news, and HHS has already put a strong focus on the role it should play in helping rural providers overcome difficult challenges. Our interest starts at the top: As former Governor of Kansas, HHS Secretary Sebelius has a strong personal interest. She has made rural health a high priority, and last year she convened a new HHS Rural Health IT Task Force to ensure that Federal resources are used effectively to help rural providers qualify for meaningful use incentive payments and to help enable rural America to benefit from health IT.
The Task Force is developing action recommendations. In the meantime, ONC has increased its funding support for providing technical assistance to rural facilities, in particular for Critical Access Hospitals (CAH). Technical support for adopting EHRs and achieving meaningful use is provided through a nationwide network of Regional Extension Centers (RECs). Last September, we increased support to those RECs that serve rural areas by about $20 million, with special targeting to assistance for CAHs. Today, we have released another $12 million in added support to help RECs in assisting CAHs and other rural facilities.
The biggest barriers faced by rural providers in adopting and using EHRs include:
A lack of financial capital to cover the costs of the transition to EHR systems.
Shortage of skilled personnel to help enable rural providers to integrate EHRs into the day-to-day process of providing patient care
Access to affordablebroadband connectivitysufficient to transmit relevant patient data in a reliable way
At the 2010 ONC Update meeting in December, ONC had the opportunity to host a session on the federally funded programs offered by HHS and its Federal partners to assist rural providers in overcoming these and other barriers. Below are some of the Federal resources available now for rural providers interested in achieving meaningful use of health IT. We will build on this base to provide rural facilities full opportunity to achieve the benefits of health IT.
FEDERAL RESOURCES TO HELP RURAL PROVIDERS ACHIEVE MEANINGFUL USE
The Office of the National Coordinator for Health Information Technology (ONC)
ONCprovided nearly $20 million in additional funding to 46 of the 62 Regional Extension Centers (RECs) to help critical access and rural hospitals convert from paper-based records to certified EHR systems. An additional $12 million supplemental funding was released this month, for RECs to assist critical access and rural hospitals to adopt EHRs.
ONC’s Health IT Workforce Development Program is also in place to train skilled professionals in the field of health IT to enable them to help providers adopt and meaningfully use EHRs. This includes training for health workers now employed in rural practices and facilities, with broad opportunities for distance learning. For example, the Community College Consortia to Educate Health Information Technology Professionals , which is made up of five regional groups of more than 70 community colleges in all 50 states, has implemented non-degree health IT training programs for skilled professionals that can be completed in six months or less.
Health Resources and Services Administration (HRSA)
The HRSA Office of Rural Health Policy (ORHP) is charged with coordinating activities related to rural health care within HHS. ORHP has tools and resources to help rural providers adopt and meaningfully use health IT:
The Rural Assistance Center (RAC) , a product of HHS’ Rural Initiative, was established in December 2002 as a rural health and human services information portal. RAC helps rural communities and other rural stakeholders access the full range of available programs, funding, and research. RAC offers many services to help inform decisions affecting rural health, and all services are provided free of charge. Visit www.raconline.org to help spread the word about resources from RAC.
Other ORHP tools and resources include:
Rural Health IT Adoption Tool Box —a resource targeted toward rural providers seeking to implement health IT to improve the overall effectiveness of their practices.
The HRSA Office of Health Information Technology and Quality (OHITQ) also hosts technical assistance webinars to help HRSA grantees and safety net providers who are either using or planning to use health IT as a tool to improve quality in their delivery of patient care.
The Centers for Medicare & Medicaid Services (CMS)
CMS engages in frequent outreach activities to educate the states on the Medicaid EHR Incentive Program , and to gather feedback from the states about the program. CMS hosts “All-States Calls” and has a number of educational materials available for download on its website .
Agency for Health Care Research & Quality (AHRQ)
The AHRQ National Resource Center (NRC) is a public resource for sharing research findings, best practices, lessons learned, and funding opportunities with health IT researchers, implementers, and policy makers. More than 10,000 documents, presentations, articles, and tools are freely available on the NRC .
Indian Health Service
The Indian Health Service (IHS) supports the national Telehealth Technology Assistance Center (T-TAC) by tracking changes in telehealth technologies, assessing these technologies, and providing technical assistance to grantees in the selection of strategies to optimally deliver telehealth clinical services.
Federal Communications Commission (FCC)
The FCC helps rural providers access affordable telecommunication services necessary for the adoption and meaningful use of health IT.
The Rural Health Care program provides funding to eligible health care providers for telecommunications services, including broadband necessary for the provision of health care. The program is designed to ensure that rural providers pay no more than their urban counterparts for their telecommunications and Internet access needs in providing health care.
The FCC has also initiated a Rural Health Care Pilot Program to facilitate the creation of a nationwide broadband network dedicated to health care, connecting public and private nonprofit health care providers in rural and urban locations.
U.S. Department of Agriculture (USDA)
The USDA Rural Development Office has programs in place to help rural providers establish the infrastructure they need to adopt health IT and engage in the secure sharing of information—the cornerstone of meaningful use.
The Community Programs provide grants to assist in the development of essential community facilities in rural areas; funds can be used to construct, enlarge, or improve community facilities for health care, public safety, and community and public services.
Need help finding grant opportunities or preparing grant applications?
ONC has prepared a getting started Grants Primer , which highlights the key steps needed to find and apply for grants.