1. May 20091 Capital Improvement Program HRSA-09-244 Electronic Health Record Projects and Readiness May 7, 2009

2. May 20092 CIP Funding $850M one-time, 2-year project/budget period FY 2009 grants to support Construction Renovation and equipment Acquisition of health information technology Grantees must Demonstrate improvements in access to health services for the underserved populations Create health center and construction-related jobs 2-Year project/budget period (July 1, 2009 – June 30, 2011) Maximum funding based on CY 2008 UDS Data Formula All section 330 grantees eligible for $250K base amount Plus $35 per patient served based on 2008 UDS as of 04/24/2009 New Start grantees without 2008 UDS data will have $250K maximum

3. May 20093 CIP Funding, part 2 CIP guidance available: May 1, 2009 One-time award for 2-year budget/project period No on-going funding anticipated Grantees will only be submitting one CIP application Grantees may propose more than 1 project Grantees will submit applications/requests through EHB Applications due no later than: June 2, 2009 8:00PM ET EHB-generated email Eligibility code Maximum eligible budget amount Sent to all eligible Health Center Program grantees on May 2, 2009 Electronic application available: May 4, 2009

4. May 20094 Types of CIP Projects The eligible project types are: 1.Alteration/repair/renovation, with or without IT/equipment 2.Construction (new site or expansion of existing site), with or without IT/equipment 3.IT/equipment-only purchase 4.HIT-only purchase (non-EHR equipment) 5.Certified EHR-related purchase

5. May 20095 Ineligible CIP Costs Operating costs (e.g., funding direct services, clinical full-time equivalents, rent, mortgage payments, refinanced credit facilities). Purchase of EHR systems that are not certified by an organization recognized by the Secretary of HHS. None of the funds appropriated or otherwise made available under the Recovery Act may be used by any State or local government, or any private entity, for any casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool. Non-certified EHR systems can not be listed as other equipment. Costs incurred prior to February 17, 2009.

6. May 20096 Certified Electronic Health Record (EHR) Computer software that providers use to track all aspects of patient care Health Information Technology (HIT) Includes hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packages solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information. ! For CIP, allowable costs include pre-implementation and readiness, software, infrastructure/clinical facility, data center infrastructure, and implementation staffing. EHR and HIT

7. May 20097 Allowable use of funds Certified Electronic Health Record (EHR) Certified EHR software costs: EHR application costs, maintenance, computer-based training Infrastructure clinical facility costs: wireless LAN infrastructure, LAN switches, tablets, desktop PCs, cameras, printers Data infrastructure costs: servers, routers, switches, back-up software, fire suppression, cooling/HVAC, physical security, power upgrades Implementation staff: core team training, vendor project management, data migration, paper chart conversion, CIO, network administration Health Information Technology (HIT) Telehealth-related equipment Registries Electronic prescribing Enhancements necessary to interface between HIT/EHR and other electronic systems Dental and oral health ! HIT–only (non-EHR equipment) and certified EHR-related purchases can be proposed either as site-specific, multi-site, or organization-wide (inclusive of all sites).

8. May 20098 EHR Considerations Grantees are encouraged to work with others who have successfully procured, adopted, and used certified EHRs and other HIT systems, and to use up to 2% of the CIP project budget for HIT and certified EHR implementation technical assistance. In regards to EHR-related purchases, health center grantees within the scope of a current HRSA-funded health center controlled network are encouraged to work with their network to enhance their existing system. If EHR-related equipment will require significant installation, the grantee should propose an a/r/r or construction project to account for the installation of any fixed equipment. The grantee should also propose a separate EHR project to account for the purchase of all related EHR components.

9. May 20099 Electronic Health Records All EHRs must: Be certified by an organization recognized by the Secretary of HHS –Certification Commission for Healthcare Information Technology (CCHIT) http://www.cchit.org –Any EHR certified by CCHIT is eligible All health centers must: Demonstrate readiness –Complete the EHR Readiness Checklist in Appendix 5 (pg 33) of the guidance Certify immediate readiness for certified EHR purchase, OR Certify purchase of the certified EHR system will occur once readiness is achieved within the 2-year project period

10. May 200910 EHR Planning and Readiness Process Identify goals for the EHR project Create a strategic plan that guides the certified EHR procurement and identifies key milestones to achieving “meaningful use” Include a completed feasibility analysis Include a completed comprehensive organizational readiness assessment Include a completed comprehensive staff skills assessment Assess and inventory current resources (staff, hardware, software, etc.) Outline an implementation strategy for the EHR project that will achieve “meaningful use” Inventory all additional hardware, software, and staff expertise needed to implement the EHR project Identify a multidisciplinary committee to oversee the readiness, due diligence, selection, and implementation of the certified EHR project Identify a plan to address the decrease in productivity during training and implementation Develop a plan to protect patient’s health information ! EHR Planning and Readiness information can be found at http://www.hrsa.gov/healthit/ http://www.hrsa.gov/healthit/

11. May 200911 Electronic Health Records Caveats CIP funds cannot supplant HRSA funds that have been allocated for certified EHR-related activities (i.e., other HRSA grants that have been awarded to health center controlled networks for certified EHR adoption). Purchase of EHR systems that are not certified by an organization recognized by the Secretary of HHS are not allowed. At this time, CCHIT is the only recognized certifying organization. Grantees may not add a new site as part of certified EHR-only projects, although they may propose that these types of projects occur at a site added previously as part of an alteration/repair/renovation or construction project in the same application. Grantees must demonstrate readiness to purchase a certified EHR system prior to expanding CIP funds. If readiness gaps exist, grantees will need to certify that a certified EHR purchase will occur once readiness is achieved within the two-year period. For, applicants that cannot certify readiness to purchase a certified EHR system within the project period, EHR system costs are not eligible uses of CIP funds.

12. May 200912 EHB Specifics—EHR Readiness Checklist 1. Why are you purchasing a certified EHR or enhancing your current system? (Please check one) [_] Move from paper system to electronic [_] Reimbursement purposes, e.g., Medicare and Medicaid incentive payments [_] Clinical technology to achieve workflow efficiencies [_] Primarily as a technology to enable quality care improvement goals 2. Do you have organizational wide commitment from: (Check all that apply) [_] Leadership (CEO, COO, CMO, CFO) [_] Board Members [_] All Providers [_] IT Staff [_] Support Staff [_] Other; please identify:_________________________ 3. Has your center identified business and clinical goals for adopting a certified EHR system? [_] Yes [_] No 4. Has your center identified a clinical champion and other staff to oversee the readiness process? [_] Yes [_] No 5. Have you used the EHR Selection Guidelines for Health Centers developed by HRSA to select the functionality for your EHR? [_] Yes [_] No 6. Have you considered the ongoing expenses required for a certified EHR system? [_] Yes [_] No 7. Are all key staff members willing to use computers in their daily work? [_] Yes [_] No 8. Do you have IT staff or access to a Health Center Controlled Network or IT consultant to provide support for troubleshooting your current and proposed IT/HIT infrastructure? [_] Yes [_] No 9. Do the exam rooms in your center have networked computers? [_] Yes [_] No 10. Does your center have a broadband/high speed internet connection? [_] Yes [_] No

13. May 200913 Electronic Health Records Caveats— cont. For any contract, grantees will need to make sure they follow the standard procurement principles that apply to all HHS grants. If the project budget obligates money beyond 25% of the combined budget for all projects or $250,000, the change of scope will need to be reviewed and possibly changed. All procurement must comply with HHS 45 CFR Parts 74.34 and 92.32. –“In order to ensure objective contractor performance and eliminate unfair competitive advantage, contractors that develop or draft grant applications, or contract specifications, requirements, statements of work, invitations for bids and/or requests for proposals shall be excluded from competing for such procurements.” (http://www.access.gpo.gov/nara/cfr/waisidx_07/45cfr74_07.html.)http://www.access.gpo.gov/nara/cfr/waisidx_07/45cfr74_07.html

14. May 200914 Environmental Information and Documentation (EID) Checklist Must be completed and submitted with EACH project (applies to all project types) as part of the CIP application.

15. May 200915 EHR/HIT Specific Form 424C Line Items Costs in Line 1 (Administrative) –Personnel costs should be explained by listing each staff member who will be supported from funds, name, position title, percent full time equivalency and annual salary –Travel of staff for trainings on EHR/HIT system –Subcontracts and justifications, provide an explanation as to the purpose of each contract and how the costs were estimated –Pre-implementation/Readiness costs—including but not limited to workflow assessment, change management, planning for loss of staff productivity, communication and training for patient involvement. –EHR/HIT support, maintenance –Consultation and technical assistance costs

16. May 200916 EHR Specific Form 424C Line Items Costs in Line 10—EHR acquisition/implementation costs: –Software Costs: EHR/HIT Software costs, operating systems, Help desk application, computer based training, EHR/HIT web portal, and other software –Infrastructure Clinical Facility costs may include: Wireless LAN infrastructure, LAN switches (closets), routers, tablets, table docking stations, tablet batteries (spare), tablet keyboards, docking racks, desktop PCs, scanners, patient ID card systems, patient ID card readers, cameras, network printers, cabling- access points, network transport link to data center –Data Center Infrastructure Costs may include: servers, applications, database, reporting, routers, core switches, desktop switches, data replication, AN-applications, database, reporting, SAN-document management, backup library, backup software, firewall anti malware, server racks, space acquisition, power upgrades, UPS, fire suppression, cooling/HVAC, management consoles, back up media, fax server, etc.

17. May 200917 Project Impact and Reporting Application projections –Projected number of providers using the certified EHR or enhanced HIT system as a result of this project –Projected number of patients with an electronic health record as a result of this project Impact of CIP funding –Number of new/improved sites –Number of health center jobs created and retained –Number of construction-related jobs created –Completion status (% complete) –Actual versus projected budget information—uses of CIP grant funds Other ARRA reporting required by Act

18. May 200918 Resources for Planning and Implementing Certified EHR Projects

19. May 200919 HRSA’s HIT Goals Bring HIT to America’s safety net providers which will –Improve quality of care –Reduce health disparities –Increase efficiency in care delivery systems –Increase patient safety –Decrease medical errors –Eliminate the digital divide

20. May 200920 HIT is….. Health Information Technology is the use of information and communication technology in health care. Health Information Technology can include: –Electronic health or medical records –Personal health records –E-mail communication –Clinical alerts and reminders –Computerized decision support systems –Hand-held devices –Other technologies that store, protect, retrieve and transfer clinical, administrative, and financial information electronically within health care settings. HHS/HRSA/Health Information Technology

21. May 200921 The Cycle of Health IT Implementation

22. May 200922 How to start? Planning Phase –Needs assessments and technology selection –Stakeholder buy-in –Funding and sustainability strategy –RFP process Implementation Phase –Vendor selection process –Implementation team organization –Sites for go-live –Cost issues Evaluation –Measure outcomes –Change strategies

23. May 200923 Needs Assessments –Document processes that are inefficient Do not automate a manual process that does not work—change the process –Understand how technology solutions can solve these inefficiencies: Need for data integration from many sources Need to deliver data to many locations Tools –HRSA Readiness Assessment Tool http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_2 27915_0_0_18/ehrguidelines.dochttp://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_2 27915_0_0_18/ehrguidelines.doc –CHCF Needs Assessment Tool http://www.communityclinics.org/section/library/?topic=2

24. May 200924 HIT Planning Considerations Data & Technical Standards Interoperability Certification by certification body that is recognized by the Secretary of HHS –Certification body for electronic health records and their networks, and an independent, voluntary, private-sector initiative

25. May 200925 What EHR should I choose? Do not start in “product selection mode” Begin by identifying the practice processes that you wish to improve first; understand your work flow. Then search for the functions you need: –Problem List –Medications –Clinical Encounters –Lab/X-ray/Pathology –Telephone Calls –Referrals –Preventive Care –Managed care

26. May 200926 Advancing HIT through Networks Why Networks? –Collaboration of health centers and other safety net providers –Economies of scale/cost efficiencies/volume –Enhanced efficiencies in business and clinical core areas –Higher performance and value –Sharing of expertise and staff among collaborators

27. May 200927 Which EHR should I choose? Anticipate primary and secondary users –Primary Clinical decision making Documentation Support for billing Quality improvement –Secondary Provider profiling and service utilization Quality report cards and outcomes analysis Regulatory reporting and justification for studies

28. May 200928 Lessons Learned Involve clinicians Identify organization’s need and how HIT adoption will address this need Integration takes time; move forward but deliberately Identify roles and responsibilities, expectations, goals, and resources such as technical assistance Learn from early adopters such as Health Center Controlled Networks or other Health Centers (most are willing to share) and consider partnering with them

29. May 200929 Lessons Learned (cont’d) Conduct due diligence with all purchases Look for small, incremental successes Set and maintain realistic expectations and goals Communication must be open, consistent, and include all partners and staff. Establish feedback loops throughout the process.

30. May 200930 HIT Technical Assistance Center (HITTAC) Overview—Provide consistent HIT TA to HRSA grantees and staff –One-to-many TA –One-on-one TA

31. May 200931 HITTAC: One-to-Many TA HRSA Health IT Community HIT Toolboxes HIT Webinars HIT Workshops

32. May 200932 HRSA Health IT Community Portal HRSA Health HIT Community Portal –Developed in collaboration with the AHRQ National Resource Center for Health IT (NRC) –Designed to provide news, tools, and access to research for HRSA's safety net providers interested in health IT. –Includes a searchable internet database that contains literature articles about the costs and/or benefits of health information technology –Request log on password: healthit@hrsa.govhealthit@hrsa.gov –Log in to the Portal: http://healthit.ahrq.gov/loginhttp://healthit.ahrq.gov/login

33. May 200933 Developed by Health Resources and Services Administration Compilation of planning, implementation and evaluation resources Helps community health centers, other safety net and ambulatory providers implement health IT applications Organized to support needs of stakeholders ranging from senior management to the staff implementing health information systems Provides information regarding implementing applications such as disease registries, electronic health records, etc. Various stakeholders in the health IT arena have reviewed and contributed to the toolbox to ensure accurate, relevant, and effective in supporting health IT in health centers Toolbox made publicly available in November 2008 and can be accessed at: –http://healthit.ahrq.gov/toolboxhttp://healthit.ahrq.gov/toolbox Introduction to the Health IT Adoption Toolbox

34. May 200934 HIT TA Toolboxes/Modules Overview on why we create toolboxes –Current Toolbox Health IT Adoption Toolbox –Upcoming Toolboxes Rural Health Telehealth Children’s Health IT Toolbox –Upcoming Modules Network Development Personal Health Records e-prescribing Quality through HIT

35. May 200935 Toolbox Topic-Specific Modules The toolbox is organized into the following eleven modules: –Introduction to Health IT –Getting Started –Opportunities for Collaboration –Project Management and Oversight –Planning for Technology Implementation –Organizational Change Management and Training –System Implementation –Evaluating, Optimizing, and Sustaining –Advanced Topics –Open Source and Public Domain Software –Privacy and Security

36. May 200936 HITTAC One-to-Many TA Webinars –HRSA holds monthly webinars on various HIT- specific topics –Webinars are all archived: http://healthit.ahrq.gov/login http://healthit.ahrq.gov/login –A password and log in is required to access the portal. To obtain this, email the request to healthit@hrsa.gov. healthit@hrsa.gov

37. May 200937 HITTAC One-to-Many TA Webinars Over 3,000 HRSA grantees and staff have participated in a wide range of webinars including: –HIT 101 –Important Factors to Consider When Selecting an EHR System –Collaboration (How do I collaborate with networks, state entities, etc.) –Telehealth 101 –Financing HIT –Readiness Assessments for HIT –HIE 101 –HIT for Special Populations –Using EHRs to Drive Quality Improvement –Personal Health Records

38. May 200938 HITTAC One-to-Many TA Webinars cont. Upcoming Webinars: – May 2009 – HIT and Sustainability for Rural Settings – June 2009 – Due Diligence – What is it? Why should I do it? – July 2009 – Disaster Recover Plans for HIT – August 2009 – Public Health Informatics

39. May 200939 HITTAC One-to-One TA Consultation with OHIT Staff OHIT encourages HRSA grantees and staff to call or email with any HIT questions –Can you help me identify other grantees using the same software that I am using or looking to implement? –My grantee has a question on HIT I cannot answer—can you assist us? You may contact us a healthit@hrsa.govhealthit@hrsa.gov

40. May 200940 Overview of the CIP Application in the EHB

41. May 200941 CIP Application Program Specific Information This diagram shows the structure of a Capital Improvement Program application, using the left side menus from the EHBs. The application has one Program Specific Information section that includes one or more projects. Project forms need to be completed for each proposed project. Multiple projects can be proposed within a single application. Program Specific Information Project #1 Project #2 Project #3

42. May 200942 Program Specific Information Proposal Cover Page 4 Sections: 1.Purpose 2.Sustainability Plan 3.Green/Sustainable Design Principles 4.Service Impacts Projected # additional Provider FTEs # additional patients served # of additional visits Service Impacts

43. May 200943 Program Specific Information Projects Add Project button Update or Delete a Project Application Budget Summary Information

44. May 200944 Program Specific Information Adding a Project  Choose a project type from the list  If you select and confirm the wrong project type, you will not be able to change it. You will have to delete the project from the application and start over.  Enter a project title.

45. May 200945 Program Specific Information Add Project Confirmation Certified EHR-related purchase EHR Project

46. May 200946 Program Specific Information Projects—Status Page Each project consists of numerous sections. Each project has its own Status page. Click the “Update” link in the Project Status table to open a section for editing.

47. May 200947 Project Information Project Cover Page 1.Site Information 2.Project Management 3.Contact Information 4.Need 5.Implementation 6.Timeline Standard Sections: EHR-specific section: 7. EHR System Readiness

48. May 200948 Project Information Project Cover Page—EHR System Readiness Download and Attach EHR Readiness Checklist Template (see next slide) EHR Readiness Certification

49. May 200949 Project Information EHR System Readiness Checklist 1.Why are you purchasing a EHR? 2.Do you have staff commitment? 3.Do you have business and clinical goals? 4.Do you have a clinical champion? 5.Did you use HRSA’s EHR Selection Guidelines?

50. May 200950 Project Information Project Impact Direct Impacts indicated in terms of: Square feet improved Square feet increased # of providers using the EHR or HIT # patients with EHR Projected FTEs

51. May 200951 Project Information Equipment List Click to Add Equipment Select Desired line first to Update or Delete

52. May 200952 Project Information Add Equipment Information Select from 3 Types of Equipment: Clinical Non-clinical HIT/EHR

53. May 200953 Project Information Project Budget Subtotals calculated by system These Totals carried over to Funding form (see next slide) Application Budget Summary Information

54. May 200954 Project Information Funding Sources These Totals carried over from Project Budget form

55. May 200955 Project Information Budget Justification Budget Justification is an attached document

56. May 200956 Project Information Form 5B: Sites Pick Sites from current Scope of Project  “Grantees may not add a new site as part of an IT/equipment-only, HIT, or certified EHR- related project, although they may propose that these types of projects occur at a site added previously as part of an alteration/repair/renovation or construction project in the same application.” (CIP Announcement HRSA-09-244 pages 3-4)  By default the completion status of the site is marked as COMPLETE for sites picked from scope. You will not be allowed to update any information for such sites in the CIP application. Add Sites proposed in CIP A/R/R or Construction Project

57. May 200957 Project Information Attempting to Add a Site for an EHR Project

58. May 200958 Project Information Form 5B: Sites, Select from Scope Site Name 1 Site Name 2 Site Name 3 Site Name 1 Address Site Name 2 Address Site Name 3 Address When picking a site from scope, simply select the site, and then click “Save and Continue.”

59. May 200959 Add Site Checklist and Other Requirements for Sites are not required for EHR Projects The Add Site Checklist page is only required for A/R/R, Construction and IT/Equipment-only Purchase projects where the applicant is proposing to add a new site.

60. May 200960 Project Information EID Checklist EID Checklist is a downloadable Template … that must be attached

61. May 200961 Help Resources ResourceTypePurpose https://grants.hrsa.gov/webexternal/home.aspWebsiteHRSA Electronic Handbooks URL. Call the HRSA Call Center at 877-Go4-HRSA/877-464-4772; 301-998-7373 (9:00 AM to 5:30 PM ET M-F) E-mail: callcenter@hrsa.govcallcenter@hrsa.gov Phone and/or E-mail System help by phone or via e-mail. Do not use this for program questions. Call the BPHC Help Desk at 1-301-443-7356 (8:30 AM to 5:30 PM ET M-F) E-mail BHCMISys@hrsa.govBHCMISys@hrsa.gov Phone and/or E-mail Program help by phone or e- mail. There will extended hours of operation for the CIP initiative beginning May 30 and ending June 2, 2009. For these dates the hours of operation will be 7:00 AM to 7:00 PM (ET)

62. May 200962 CIP Application Technical Assistance Frequently Asked Questions http://bphc.hrsa.gov/recovery/ Health IT Adoption Toolbox http://healthit.ahrq.gov/toolbox Sustainable and Green Design http://www.usgbc.org http://www.gghc.org Equipmenthttp://www.epeat.net http://www.energystar.gov

63. May 200963 CIP Contacts Type of Assistance NeededPlease Contact Business, administrative, or fiscal issues related to this announcement Health Resources and Services Administration Office of Federal Assistance Management Division of Grants Management Operations  Neal Meyerson, Telephone: 301-443-5906; Email: NMeyerson@hrsa.gov NMeyerson@hrsa.gov  LaShawna Smith, Telephone: 301-443-4241; Email: LSmith3@hrsa.gov LSmith3@hrsa.gov Program issues Health Resources and Services Administration Bureau of Primary Health Care Office of Policy and Program Development  Marie Legaspi, Telephone: 301-594-4319  Meghan Ochal, Telephone: 301-594-2096  Beth Tchinski, Telephone: 301-443-1389 Email: BPHCRecovery@hrsa.govBPHCRecovery@hrsa.gov