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Rural Health Briefing, November 1, 2006
National News
1. Expanded Funding for Rural Health Delivery
2. New HIPAA Recommendations
3. Aligning Quality and HIT Efforts
4. Safety and Quality from Patients’ Viewpoint
5. Rural HIT Workforce Training
6. HIT, Quality Lagging in US
7. Rural Mental Health: Policy and Practice
8. Online Maps of HRSA Information
9. Measuring Outcomes in Community Health
10. Leading Patient Safety Efforts
11. Rural Hospitals Using Web Marketing
Across Arizona
1. HIPAA Seminar for Arizona CAHs and Rural Health Providers
2. Emergency Preparedness Training
Grants and Opportunities
1. The William B. Graham Prize for Health Services Research
2. CDC Conference Grants for Public Health
3. Global Health and Human Rights Award
4. Cultural Competence Leadership Fellowships
Calendar
- November 3, Tipping Point: Achieving Health Insurance Coverage for ALL Arizonans, Scottsdale, 11:30 a.m.-1:30 p.m., St. Luke’s Health Initiatives
- November 4-8, Public Health and Human Rights, 134th Annual Meeting of the American Public Health Association, Boston
- November 8, The Coming Death and Transformation of the American Hospital, Phoenix, 7:30.-11:45 a.m., St. Luke's Health Initiates
- November 8-10, 15th Annual National Native American EMS Conference, Las Vegas, Nevada
- November 9, Electronic Health Records: Show Me the Money, webcast, 10:00-11:00 a.m.
- November 14-16, 2nd Annual National Rural Hospital Performance Improvement Conference, San Antonio
- November 15, HIPAA Seminar for Arizona CAHs, Phoenix and live videostream
- December 10-13, 18th Annual National Forum on Quality Improvement in Health Care, Orlando, Florida
- December 12, Electronic Medical Records Roadshow, Phoenix
- January 21-24, 2007, 20th Annual Rural Health Care Leadership Conference, Phoenix
- February 5-6, 2007, Engaging Physicians in a Shared Quality Agenda, Cambridge, Massachusetts
- February 12-14, 2007, The Clock is Ticking for Rural America: A Behavioral Health and Safety Conference, Sioux Falls, South Dakota
Mark Your Calendar
National News
Expanded Funding for Rural Health Delivery
The Federal Communications Commission (FCC) has issued an Order (the term used by the FCC for a new ruling) that establishes a pilot program to examine how the rural health care (RHC) funding mechanism can be used to enhance public and non-profit health care providers’ access to advanced telecommunications and information services. It is estimated that between $60 million and $100 million will be allocated to pilot projects.
All public and non-profit health care providers may apply for funds to construct a dedicated broadband network that connects health care providers in a state or region. Applicants in the pilot program must include in their proposed networks public and non-profit health care providers that serve rural areas. The program provides up to 85 percent of the applicant’s costs of deploying a dedicated broadband network.
Eligibility is limited to entities that are currently eligible under the Rural Health Discount Program, although according to FCC staff, it does not preclude an eligible entity not now receiving the discount from applying.
At a recent meeting of the national Rural Telecommunications Congress in Little Rock, Arkansas, the FCC staff in attendance acknowledged that it is not yet known just how the funding will flow, or if the funds can be used for hardware and software as well as installation of telecommunications infrastructure.
There is no grant guidance for this project. Potential applicants around the country are already holding strategy meetings to design applications based on the scant details of the FCC Order. There are 11 points in the order that applicants must address in their applications. The Order was released on Friday, September 29.
Application deadline will be 30 days after clearance date from OMB of the application form.
Click here for the Order.
The OMB form has not been released yet, and as of November 1 it was unknown when to expect its publication. However, preliminary work on applications should not wait until that release.
New HIPAA Recommendations
A draft report of HHS’ National Committee on Vital and Health Statistics is likely to recommend that the reach of the privacy protections in the Health Insurance Portability and Accountability Act (HIPAA) be extended to all personal health records.
HIPAA primarily applies to doctors, hospitals and health plans. Equivalent requirements do not exist where there may be exchanges of health information among noncovered entities or their business associates.
The report recommends that HHS provide those protections through enhancements and extensions to HIPAA or through other appropriate mechanisms. It also recommends that HHS develop policies for identifying individuals and the locations of their health information, such as doctors’ offices or hospitals, to ensure that medical professionals accurately match people to their health records.
In addition, the draft calls for HHS to support standards that would allow a patient’s or doctor’s preferences concerning specific data to travel across the network in health information exchanges. A patient could request, for example, to keep mental health issues confidential, no matter who had a copy of the record. (See also November 15 HIPAA Seminar below in Across Arizona section)
Adapted from Government Health IT, October 27, 2006
Aligning Quality and HIT Efforts
e-Health Initiative’s 3rd Annual Survey of Health Information Exchange Activities at the State, Regional and Local Levels was published on September 25, 2006. The summary section of key insights contains the following:
As pressures on the system for quality and efficiency improvement continue to grow, policy makers at the national, state and local levels should look to align policies for quality and HIT, enabling the infrastructure currently being built in communities across America to support the mobilization of data for care delivery, to also support the infrastructure being contemplated to improve quality and efficiency.
Both efforts require trust, the engagement of multiple stakeholders, special attention to information sharing policies related to privacy and confidentiality, and an electronic data infrastructure – and can benefit from being addressed in a complementary fashion.
Click here for the 53-page report on this survey.
Safety and Quality from Patients’ Viewpoint
A new survey, Consumers’ View of Patient Safety and Quality Information, reveals how patients are taking steps to improve quality of their care. Since the IOM issued its landmark study 7 years ago on medical errors in hospitals, there have been efforts to improve the quality of health care. Findings include:
- About one in three people (36 percent) say they have seen information comparing the quality of care provided by health plans, hospitals and doctors. About one in five (20 percent) say they have seen and used such data to make decisions about their care.
- More than half (55 percent) of Americans say they understand the term "medical error," up from 43 percent in 2004 and 31 percent in 2002. After being given a common definition of medical errors, more than four in 10 (43 percent) say preventable medical errors occur "very often" or "somewhat often" when people seek care from a health professional.
- One in three Americans (34 percent) say they have or a family member has created a set of their medical records to ensure that their health-care providers have all their medical information.
- Substantial numbers of Americans report taking certain actions aimed at improving the coordination of care and reducing the likelihood of a medical error. These include: checking the medication given by their pharmacist against the doctor's prescription (70 percent); bringing a list of all their medications to a doctor's appointment (54 percent); and bringing a friend or relative to a doctor's appointment to help ask questions (45 percent).
The Kaiser Family Foundation and AHRQ released this survey.
Click here for details.
Rural HIT Workforce Training
An important piece of the rural HIT puzzle that’s sometimes overlooked is a skilled workforce. Existing computer science programs at community colleges and universities could address this need by adding internships or, in some cases, new courses that combine the technical aspects of both informatics and healthcare. The goal is to have graduates with sufficient familiarity in both domains. As HIT reaches more advanced stages at more hospitals and clinics, there will be more opportunities coupled with more need for these positions and programs.
Upgrading the skills of existing staff is another way to meet this need. This approach has the added benefit of avoiding the other common problem rural healthcare faces with many professionals: retention. With their community roots already established, these folks are less likely to “follow the money” that their higher performance can demand.
The National Center for Health Care Informatics in Butte, Montana, has developed an on-campus curriculum that combines health care, information technology and communications. They plan on offering learning modules online in the future.
Click here for their site.
Other training opportunities in applied clinical informatics are offered by the American Medical Informatics Association (AMIA). Using distance learning, the AMIA 10 x 10 program has the goal of training 10,000 health professionals by 2010 in clinical or health care including personal health management; electronic and personal health records; health information exchange; standards and terminology; and health care quality and error prevention.
Click here to go there.
HIT, Quality Lagging in US
A very low score for health information technology adoption contributed to a near-failing grade for the U.S. health system in a new score card the Commonwealth Fund’s Commission on a High Performance Health System issued. Compared with other industrialized countries and benchmarks of high-quality health care, the U.S. scores were too low in every category.
The commission grouped its ratings into four major categories: quality, access, efficiency and equity. Of these, efficiency, the category that included health IT, got the lowest score, 51.
Besides the lack of e-medical records, the low score also reflects high administrative costs and lapses in care in the U.S. system. The lapses included test results and other medical records that were missing or unavailable.
Click here for the score card.
Rural Mental Health: Policy and Practice
A report by the National Association for Rural Mental Health outlines innovative evidence-based solutions tailored specifically to rural needs. While acknowledging misunderstanding of rural realities by state and national policy makers, the report finds that key progress is being made in the areas of effective programs, model policies and telehealth.
Important roles of advocacy and quality assurance by State Offices of Rural Health are also discussed.
Click here for the 13–page report, Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices.
Online Maps of HRSA Information
HRSA’s Geospatial Data Warehouse allows users to create customized maps online of HRSA-related information by quickly entering an address or zip code. It includes:
- HRSA awarded grant data, including grantee names, contacts, awarded amounts by fiscal year;
- HRSA supported health care service delivery sites, including Health Centers, Ryan White CARE Act Ambulatory/Outpatient Medical care sites, National Health Service Corps clinician sites, and Nursing Education Loan Repayment sites;
- Health Professional Shortage Areas;
- Medically Underserved Areas and Populations; and,
- Hospitals, skilled nursing facilities and other Medicare-approved providers
Click here to go there.
Measuring Outcomes in Community Health
Inside Stories is a new publication series that uses narrative to create conversation around challenging issues facing health philanthropy. Its purpose is to build an effective learning community to help participants improve their work. Grantmakers In Health plans to publish these stories quarterly and welcomes comments. The first story, "What to Expect When You're Expecting to Improve Community Health," recounts what the Sierra Health Foundation in California and its partners learned about measuring health outcomes in communities over a ten-year period.
Click here for the 8-page report.
Leading Patient Safety Efforts
The Leadership Guide to Patient Safety is a white paper that shares the experience of senior leaders who have decided to address patient safety and quality as a strategic imperative within their organizations. It presents what can be done to make the dramatic changes that are necessary to ensure that patients are not harmed by the very care systems they trust will heal them.
Although the focus of this paper is on the acute care setting, most of the concepts apply to other settings of care as well. It is understood that organizations will be at different stages of development, and thus will move at different paces through the improvement process. An organization with significant experience in improvement methodology and a successful portfolio of previous safety work will be able to make progress at a faster pace than an organization that has yet to build the infrastructure and commitment to safety at all levels.
Click here for the report, published by the Institute for Healthcare Improvement.
Rural Hospitals Using Web Marketing
Can the Web offer surprising marketing advantages to rural hospitals? Several reasons point positively in that direction.
- Farther reach. Almost anyone can reach your website and sites are often less expensive to maintain than other advertising.
- Consumer tracking. You can track what people are searching for and what they download.
- Creates an experience. It can build a good image even before people walk in the door. It can add to work of mouth buzz, too.
- Multiply your public relations. Your standard press materials can be on your site and give ready access to reporters and local media.
Read more at Health Leaders Media, September 2006.
Across Arizona
HIPAA Seminar for Arizona CAHs and Other Rural Hospitals
The Arizona Flex program will offer the seminar, HIPAA for Arizona critical access and other rural health care providers on November 15. The event will be at the new UA College of Medicine in Phoenix from 9:00 a.m.-3:30 p.m. As a special feature, the first two hours of the seminar will be videostreamed live through the Arizona Telemedicine Program.
This session will reinforce the three components of the HIPAA regulation as well as provide important “notes from the field”.
New regulations or updates will be addressed including:
- Complying with the Final HIPAA Enforcement regulation
- Complying with the new National Provider Identifier
- Readiness for the new HIPAA standard transactions including the revised claim form and the claims attachment
HIPAA Privacy and Security will be addressed in detail from the perspective of maintaining an effective compliance program. This includes:
- Conducting periodic audits
- Maintaining an effective training program
- Maintaining an effective complaint resolution program
- Managing privacy alerts and accountings
- Managing security in an ever changing HIT environment especially in consideration of Electronic Health Record implementation
At the end of the seminar, participants will be able to articulate an understanding of the changes in the HIPAA regulations, and understand steps they need to take to bring their facility into compliance.
David Ginsberg, the instructor, has more than 25 years experience in the healthcare industry including HIPAA and compliance expertise, training and support.
The seminar is offered free of charge but registration is required by November 8.
Click here for a complete agenda and registration details.
Emergency Preparedness Training
The Critical Response and Emergency Systems Training (CREST) program offers a variety of training opportunities in emergency preparedness and response including modules that can be scheduled at rural locations or as part of an existing conference. Online courses and a speakers bureau are also available.
The project is a partnership of the University of Arizona, the University of New Mexico and New Mexico State University through a cooperative agreement with HRSA.
Click here for more information.
Grants and Opportunities
Note: Technical assistance is available for the development of grant proposals and other funding applications from the professional staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peters.
The William B. Graham Prize for Health Services Research
Nominations due: December 1, 2006
This prize recognizes worldwide contributions to the improved health of the public through health services research, particularly research that has a lasting impact on the healthcare system. It acknowledges national or international contributions of health services researchers who apply analytic methods to examine the organization, financing, and/or delivery of health services. A single, major research contribution or a career-long record of achievement may be recognized.
The prize consists of an individual award of $25,000. In addition, $25,000 will be awarded to a not-for-profit institution designated by the recipient to support his or her work.
Click here for details.
CDC Conference Grants for Public Health
Application deadlines: December 11, 2006 and March 7, 2007
The purpose of CDCs’ conference support funding is to provide partial support for specific non-Federal conferences in the areas of health promotion and disease prevention information and education programs, and applied research. $2.6 million in total funding is expected to be made in approximately 100 awards.
Click here for details.
Global Health and Human Rights Award
Nomination deadline: January 15, 2007
The Jonathan Mann Award for Global Health and Human Rights was established to highlight the vital link between health and human rights. Sponsored by four founding organizations, Association François-Xavier Bagnoud, Doctors of the World, John Snow, Inc. and the Global Health Council, the award is bestowed annually to a leading practitioner in health and human rights and comes with a financial reward to help recipients pursue their work.
Click here for details.
Cultural Competence Leadership Fellowships
Application deadline: January 30, 2007
The Health Research and Educational Trust and the Institute for Diversity in Health Management (IFD), in partnership with the National Center for Healthcare Leadership (NCHL), Health Forum, and the American Hospital Association (AHA), are accepting applications for the Cultural Competence Leadership Fellowship. Now in its second year, the program equips participants with critical skills to lead their organizations in providing safe, high quality care to multicultural patients and communities. Fellows explore practical approaches to assessing organizational competence, enhancing patient-provider interaction, and using systems approaches to reduce disparities. Community practitioners and teams are encouraged to apply.
Click here for details.
Contact Your Representatives
a. Arizona Congressional Delegation: Links to Arizona members of the U.S. House of Representatives are available at: U.S. Representatives. Links to Arizona members of the U.S. Senate are available at: U.S. Senate
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 or follow links at Arizona Legislature.
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the UA Zuckerman College of Public Health, and supported, in part, through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Your questions (or answers) are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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