1. Steering Committee on Telehealth and Healthcare Informatics Since 1993 Honorary Co-Chairs Senator Kent Conrad ● Senator Mike Crapo Senator John Thune ● Senator Sheldon Whitehouse Rep. Rick Boucher ● Rep. Eric Cantor Rep. Phil English ● Rep. Bart Gordon ● Rep. Allyson Schwartz Rep. David Wu In Coordination With The “House 21 st Century Healthcare Caucus” Reps. Patrick Kennedy & Tim Murphy Co-Chairs In Collaboration with The Healthcare Leadership Council “Protecting Electronic Healthcare Information” November 18th, 2008 Reserve Officers Association

2. Some Policy Considerations The More Things Change – The More They Stay the Same  Reimbursement & Capital Costs –Aligning Financial Incentives –Driving Cost-Effectiveness (i.e. Chronic Care & Disease Mgmt) –Start-up Costs Capital Investment  Standards (Clinical & Communications) –Quality & Safety  Infrastructure Issues –Network Infrastructure / Broadband Access / Interoperability  Human Dimension Issues - Arrangements to Practice in an e-enabled Environment - Practitioner and Patient Acceptance - Licensure, Accreditation, Certification - Legal (Stark Law, Liability, FDA, HIPAA) - Training an HIT Workforce

3. Capitol Hill HIT Series  “If we run out of lunch…...know that we’ll still quench your thirst for knowledge, and provide significant food for thought” –Neal Neuberger

4. 2008 Proposed Budget HIT Related $118 M. - ONCHIT ($90 M. Infrastructure Grants) ($28 M. HIT Network Development) $ 45 M - AHRQ HIT $ 5 M - Federal Health Architecture $ 2 M. - Department Management (HIT) $ 4.3B - Bio-Preparedness, DHHS ($1.1 B) states, locals, hospitals for Emg. response $ 322 M - Pandemic Flu, CDC, NIH, FDA, OS $ 7 M - OAT, HRSA (Same as 2007 CR). $ 25 M - RUS, DoA, DLT Grants, (Same as 2007 CR) Army TATRC ~$280 M in 07 versus ~$400 M in 06 Under CR & DoD Regular Approps. (2008 Request Not Clear Yet) © 2007 Health Tech Strategies, LLC All Rights Reserved

5. Numerous Players  Federal Government –Congress –Agencies (DHHS, DoC, Ag, DoD, VA, IHS, NASA)  States –Statewide Initiatives, Regional Networks  Private Sector –Coalitions / Consortia (ATA, HIMSS, eHI, AHIMA) –Standards Groups –Foundations (Markle, RWJ, Commonwealth, eHI Fndt)

6. What Everyone is Going Thru: Some Planning Considerations  Governance  Principles & Key Objectives  Stakeholder Perspectives  Establishing a Business Case  Needs Assessment  Legal & Regulatory Challenges  Defining Interoperable Architectures  Evaluation Methodologies

7. Some Additional Rural & Practice Challenges  Small Rurals may have no IT support let alone an IT Department  Hard to find M.D. or Adm leaders / change agents  Other business priorities i.e. “surviving”  No business case for connectivity / linkages to other institutions (stand-alone EHRs ?)  No aggregate buying power (hence pooled vendor selection processes)  Need to address critical referral pattern issues, disruptions, patient flows etc.

8. Some Additional Rural & Practice Challenges  Patients are isolated, must travel long distances  Rural residents older, often with chronic conditions  Low patient volume  Lower income, and less private insurance  Bottom Line - Rural Healthcare Organizations will need special legislative consideration

9. Rural HIT Coalition RHRC & HTS  Linking groups thru Web Portal & list serve  Network to highlight issues and opportunities  Review and disseminate literature  Identify funding and resources  Models and case studies useful to others  Create fellowship and educational exchanges

10. Rural Underserved HIT Coalition  Rural Health Coalition –Clinics –HIT Networks / Infrastructure –State Offices  Minority Health Coalition  Behavioral Health Coalition  Health Education / Workforce Training Coalition

11. Policy Considerations  Reimbursement & Capital Costs –Aligning Financial Incentives –Driving Cost-Effectiveness (i.e. Chronic Care & Disease Mgmt) –Start-up Costs Capital Investment  Standards (Clinical & Communications) –Quality & Safety  Infrastructure Issues –Network Infrastructure / Access / Interoperability  Human Dimension Issues - Practitioner and Patient Acceptance - Licensure, Accreditation, Certification - Legal (Stark Law, Liability, FDA, HIPAA)

12. Put Positively  “ There are no problems….. just insurmountable opportunities ”