1. HIT Project Management: Managing HIT Projects in Rural Settings June 9, 2005 Washington, D.C. Michael P. Rodriguez HIT Projects Director Agency for Healthcare Research & Quality’s 2005 Patient Safety & HIT Grantee Conference

2. Page 2 Outline what ‘rural’ means Discuss approaches to rural HIT projects Answer questions Goals for Today’s Discussion

3. Page 3 Limited healthcare access options Healthcare is ‘old fashioned’ Information is inconsistent Public transportation not the norm Chronic healthcare conditions abound What’s Rural?

4. Page 4 500,000 people living in 97,818 sq. miles More than 90% of land is considered “frontier” 48 th among the 50 states in physicians per 100,000 population Nearly half its 23 counties qualify as Health Professional Shortage Areas No passenger trains in state, no point-to-point air links; limited taxis and buses in smaller towns The Case of Wyoming

5. Page 5 Interoperability Framework Full Integration Networked Systems Stand Alone Electronic Systems Paper Medical Records

6. Page 6 Cultural Barriers Financial Constraints Systemic Barriers Technological Considerations HIT Solutions Cascading Method of Evaluation

7. Page 7 Fiercely independent Desire for local control Limited history of collaboration Fear of unknown – technology Resistance to change in workflows Cultural Barriers

8. Page 8 Cost –Hardware/software –Implementation time and effort/productivity –Sustainability/maintenance/upgrades Limited capital sources Uncertain return on investment for most constituencies Financial Constraints

9. Page 9 Majority of physician practices are small (1-2 providers) and single specialty Majority of hospitals under 100 beds Relative physician shortage High out-migration for care Market considerations for HIT vendors HIT training and education gap Systemic Barriers

10. Page 10 Low penetration of HIT in physician practices Limited electronic capture of health information Broadband more limited/expensive Provider education around HIT is a key Technological Considerations

11. Page 11 Start with ‘healthcare issues’ not HIT approaches Moving toward collaboration will facilitate HIT options -- focus on building trust Be willing to change directions when new ideas come along Don’t forget about the patients Take Away Messages