Rural Health Resource Center

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HIT and its Role in Performance Improvement
Terry Hill, Executive DirectorRural Health
Resource Center Duluth, Minnesota
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Technical Assistance Services Center (TASC)

• Federally designated resource center
• Funded by HRSAs ORHP
• Supports Flex Program/CAH implementation in 45
  states
• Located in Duluth, Minnesota

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Current Federal Contracts

• Technical Assistance Services Center (TASC)
• Medicare Flex Program Evaluation
• Small Hospital Improvement Program (SHIP)
• Delta Rural Hospital Performance Improvement
  (RHPI)
• Rural HIT Project
• Rural Health Networking Technical Assistance
  Program

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Locations of Critical Access Hospitals
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Flex Program Focus on Performance Improvement

• Medicare Flex Program emphasis on Quality
  Performance Improvement
• QIOs are emerging as a major resource
• Performance improvement/BSC initiatives underway
  in most states
• HIT is a major focus

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National HIT Imperatives

• Quality Imperative
• Pandemic Imperative
• Cost Imperative
• Disaster Preparedness

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Quality Crisis
The stunning high rates of medical errors,
resulting in deaths (44,000 to 98,000 annually),
permanent disability, and unnecessary suffering,
are simply unacceptable in a medical system that
promises first to do no harm. - William
Richardson, IOM Committee Chair
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Quality Crisis
Its simple, paper medical records kill people
every day. Instead of saving lives, our current
paper-based health system is killing
them. - Newt Gingrich, March 15,
2006, on Capitol Hill
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Consumer Revolution

• Diminishing consumer confidence
• Consumers better educated
• Boomers will change the industry
• Rise of new consumer-centric services

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Consumer-Driven Health Care

• Bringing profound change
• Driven by
• High costs
• Growing quality and patient safety concerns
• More informed/demanding consumers

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The New Medicare Consumer
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Internet-based Health

• 30,000 health sites
• Increasing demand for web-based services
• The World is Flat
• Health providers slow to respond

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Consumer-Driven Health Care Initiatives

• Health Savings Accounts (HSAs)
• Pay for Performance (P4P)
• Public Reporting

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Rural Health in the Digital Age

• The IOM Quality Series The Rural Report
• HIT is a key focus area

• Establish a Rural Quality Initiative to
  coordinate and accelerate efforts to measure and
  improve quality of personal and population health
  care programs in rural areas.
• Expand experientially based workforce training
  programs in rural areas to ensure that all health
  care professionals master the core
  competenciesincluding informatics
• Congress should provide appropriate direction
  and financial resources to assist rural providers
  in converting to electronic health records over
  the next five years.

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Utilizing Information and Communications
Technology IOM Recommendations

• Office of the National Coordinator for Health
  Information Technology should include a rural
  focus with programmatic and financial resources
• Congress should ensure that rural communities are
  able to use the Internet for health-related
  applications
• Congress should provide appropriate direction and
  financial resources to assist rural providers in
  converting to EHRs

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Utilizing Information and Communications
Technology IOM Recommendations cont

• Agency for Healthcare Research and Qualitys
  (AHRQ) Health Information Technology Program
  should be expanded
• The National Library of Medicine should establish
  regional information and communications
  technology/telehealth resource centers

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Rural Health in the Digital Age

• Important Health information technologies (HIT)
  issues remain
• Lack of HIT connectivity in some rural health
  settings
• Lack of support for HIT systems, programs,
  software, etc is also an issue
• Because of isolation, small rural hospitals
  probably cannot design and implement HIT
  strategies alone
• It is difficult for rural providers to make an
  informed decision about vendors
• New national interoptability requirements for
  HIT implementation might disadvantage rural.

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Rural Health in the Digital Age

• HIT issue cont
• Rural workforce are older wear many hats
• Limited infrastructure
• Rural Boards often reluctant to invest in HIT
• Rural HIT standards are lacking

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Put Positively
There are no problemsjust insurmountable
opportunities
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Rural Health in the Digital Age

• Build HIT skills in rural areas
• Build a close connection to schools
• Grow your own HIT experts
• Establish a reverse mentoring program where
  students mentor hospital personnel on basic HIT
  skills
• Create state HIT infrastructure to support rural
  remote support
• Need cost sharing within communities for HIT
  technical support and training

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Rural Health in the Digital Age

• Need for an integrated strategic planning effort
  with HIT as a component and connect to annual
  budget
• Develop a tool to help hospitals/clinics make
  informed HIT decisions
• HIT needs
• Choosing a vendor
• Integration of HIT

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Rural Health in the Digital Age

• Link rural health HIT needs to bioterrorism and
  access available funding for hardware, software,
  and training
• Create a resource directory of potential vendors
• Develop HIT technical assistance centers at state
  and national level
• Need board education on HIT as part of an overall
  board leadership effort

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Rural Health in the Digital Age

• Need to stress what states and communities can do
  for themselves
• Need state and national communication efforts to
  drive learning nationwide
• Need more rural HIT research as well as a means
  of communicating the research to rural providers
• Need more grants for HIT solutions as well as
  access to HIT grant writers

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Rural Health in the Digital Age

• Create a web-based national HIT network that
  would electronically connect rural providers,
  researchers, and technical resource people and
  others. The purpose would be to
• Drive HIT learning
• Highlight models
• Recommend new policies or policy changes

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Rural Health in the Digital Age

• Access needed HIT resources from the QIOs in
  their 8th Scope of Work
• Coordinate conferences of Federal projects in HIT
• Look to university training programs for HIT help

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CAH Data CollectionStrategic Purpose
Data Collection
Data Reporting
Data Analysis
Typical Effort
Desired Effort

• Hospitals make significant investments in
  collecting data for regulatory or accreditation
  purposes, which limits the value.
• The goals are to push the Effort Curve to the
  right.

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On-Track to Performance Improvement
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Brief History of the BSC
Strategic Management
HarvardBusinessReview Articles
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Glossary of Terms
Perspective
Key Question
As financial stakeholders, how do we intend to
meet the goals objectives in our hospital
mission statement?
As customers of our hospitals services, what do
we want, need or expect?
As members of the hospital staff, what do we need
to do to meet the needs of our various customers?
What type of culture, skills, training and
technology are we going to improve in order to
support our key processes?
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Understanding the Balanced Scorecard

• A successful Balanced Scorecard program starts
  with a recognition that it is not a metrics
  project
• ITS A CHANGE PROCESS
• Robert Kaplan
• Balanced Scorecard Collaboratives
• Government Summit. Sept. 2004

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The Power of the Balanced Scorecard
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(No Transcript)
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System for Sustaining Performance and Change

• Framework
• a. BSC
• b. LEAN Sigma
• Education
• a. Traditional
• b. Online
• Culture
• a. Empowerment of workforce
• b. Change management
• c. Customer Service
• d. Collaboration

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Systems for Sustaining Performance and Change
4. Skilled Workforce a. Nurses and
technicians b. IT expertise c. Clinicians d.
Recruitment and retention 5. Ongoing Process
Improvement a. Clinical b. Business c.
Operations 6. Leadership a. Board b.
Management c. Physician
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Systems for Sustaining Performance and Change
7. Technology a. HIT b. Medical 8.
Partnerships a. Physicians b. Other
hospitals c. Other health care
organizations d. Community 9. Access to
Capital 10. Technical Expertise
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HIT Theme Strategy Map
Finance
As financial stakeholders, how do we intend to
meet the goals and objectives in the hospitals
Mission Statement?
Customers Community
As customers of the hospitals services, what do
we want, need or expect?
Internal Processes
As members of the hospital staff, what do we need
to do to meet the needs of the patients and
healthcare community?
Learning Growth
As an organization, what type of culture, skills,
training and technology are we going to develop
to support our processes?
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Concept Definition
Even if youre on the right track,youll get
run over if you just sit there.

• Will Rogers

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Terry J. Hill, MPA Executive Director, Rural
Health Resource Center 600 E. Superior St., Suite
404 Duluth, MN 55802 218-727-9390, ext.
232 thill_at_ruralcenter.org