1. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis The American Recovery and Reinvestment Act of 2009 Broadband Connectivity and Health Information Technology Florida League of Cities and Florida Association of Counties Economic Stimulus Summit May 15, 2009

2. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis The American Recovery and Reinvestment Act of 2009 (ARRA) Funding for Health Information Technology 2 This talk will cover a summary of the provisions under ARRA for health information technology, broadband access and an example of an HIT implementation to rural hospitals in the Florida Panhandle: 1. 1. ARRA funding for broadband 2. 2. ARRA funding for health information technology 3. 3. FCC Rural Health Care Pilot Project

3. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis HIT Strategy Model for ARRA Funding 3

4. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA – Broadband Access Under ARRA, $7.2 billion in grant and loan funding for the Broadband Technology Opportunities Program (BTOP) was provided for broadband development to: Provide access to broadband service to consumers residing in unserved areas and improved access to consumers residing in underserved areas Improve access to, and use of, broadband service by public safety agencies; and Stimulate the demand for broadband, economic growth, and job creation. 4

5. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Funding for NTIA 5 ARRA allocated $4.7 billion to the National Telecommunications and Information Administration (NTIA) in the Department of Commerce for grants. Funding covers 80% of cost, with a match of 20% $3.9 billion in grants for infrastructure development $200 million in grants to expand public computer center capacity at community colleges and libraries $250 million in grants for innovative programs to encourage sustainable adoption of broadband $350 million for broadband mapping

6. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Funding for RUS 6 ARRA allocated $2.5 billion to the Rural Utilities Service (RUS) in the Department of Agriculture for the Community Connect Grant Program and the Rural Development Broadband Loan Program. Funding includes grants and loans:   Loan programs include 4% loans   75% of service must be in a rural area without sufficient access to high-speed broadband service to facilitate rural economic development

7. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Grant Expectations Competitive grants under BTOP are intended to: Acquire equipment, networking capability, hardware and software, and broadband infrastructure Construct, deploy and ensure access to broadband services by community and anchor institutions; Facilitate access to broadband service by vulnerable populations to provide educational and employment opportunities to them Construct and deploy broadband facilities that improve public safety broadband services 7

8. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis BTOP Grant Considerations BTOP grants are expected to: Award at least one (1) grant to each State; Deploy broadband infrastructure to increase the affordability of service to the greatest population Provide the greatest broadband speed possible enhance service for health care delivery, education, or children to the greatest population 8

9. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Funding Requirements for BTOP BTOP funding has specific time and access requirements: All BTOP grants must be awarded by Sept. 30, 2010 All of the BTOP funds must be spent by grantees within two years of the grants awards All grants must adhere to the non-discrimination and network interconnection obligations contained in the FCC’s broadband policy statement (FCC 05-15): “…consumers are entitled to competition among network providers… service providers, and content providers.” 9

10. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Funding for Health Information Technology Planning and Implementation Grants to States for Health Information Exchange Loans for Electronic Health Record Systems Grants for Regional HIT Extension Centers Grants for HIT Research Centers Medicare/Medicaid Incentives to Providers for Adoption of Electronic Health Records Medicare/Medicaid Incentives to Acute Care Hospitals for HIT

11. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Funding to the Office of the National Coordinator for Health Information Technology (ONC) $2 Billion to ONC for investment in HIE $300 million immediately distributed to states or state designated entities for HIE $1.7 billion for other discretionary uses HIE – Additional funding as determined by ONC Electronic Health Record Adoption Loan Programs Technical Assistance – Regional Extension Centers HIE Research Centers

12. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Grants to States to Promote Health Information Exchange Broad range of use of ARRA Funds Enhancing broad and varied participation in HIE Technical assistance for dissemination of solutions to barriers to HIE Assisting patients in utilizing health IT Supporting public health agencies use of and access to electronic health information Promoting use of EHRs for quality improvement including reporting of quality measures 12

13. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Provides Funding for HIT Through Medicare and Medicaid Incentives $19 Billion allocated for Medicare and Medicaid incentives to physicians Medicare incentives to providers for “meaningful” use electronic health record systems and engaging in health information exchange Medicaid funding is aimed at eligible physicians, Federally Qualified Health Centers, rural health clinics, acute care and children hospitals for installing health information technology 13

14. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Medicare Incentives “Meaningful use” of an EHR in 2011 or 2012 provides incentive payments between $15,000 and $18,000 for the first payment year, and declining amounts in payment years 2013 through 2016 Payment reductions for eligible professionals who do not demonstrate "meaningful use" of an EHR will begin in 2015 14

15. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Medicare Incentives: Eligible Medicaid Provider Types Independent physicians, dentists, nurse mid- wives, and nurse practitioners with greater than 30% patient volume Federally qualified health centers with greater than 30% needy individuals Pediatricians with greater than 20% patient volume Hospitals with greater than 10% patient volume or children’s hospitals 15

16. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA Medicaid Incentives States are authorized to make payments to eligible Medicaid physicians for 85% of the allowable costs for certified EHR technology Limit of $25,000 in year one Limit of $10,000 per year five years through 2021 Hospitals are paid on a formula basis Eligibility based on level of Medicaid patient volume 16

17. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis ARRA: Other HIT Related Funding $1.5 billion for community health centers, a sum that can be used toward health IT acquisition $500 million for the Social Security Administration for processing disability and retirement workloads, of which up to $40 million may be used for health IT research and adoption $1.1 billion to the Agency for Healthcare Research and Quality, Health and Human Services, and the National Institutes of Health for research into the comparative effectiveness of health IT 17

18. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis FCC Rural Health Care Pilot Program o This contract will allow the Big Bend Health to connect rural hospitals with gigabit fiber and provide its Regional Health Information Network services to them o Providing broadband connections to rural towns and cities supports their potential for generating economic development in all business sectors - to create a healthy economy In November 2007 the Federal Communication Commission awarded $9.6 million to Big Bend Health and the Agency for Health Care Administration to build a broadband network connecting rural hospitals and surrounding clinics in the Florida Panhandle

19. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Connectivity in Rural Areas of Florida The Florida Panhandle is the largest rural area in Florida, as shown by the purple sections in the map While urban areas have high speed connections, rural areas of the state have limited broadband access

20. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis The Goal of the FCC: A Nationwide Network of Health Care Facilities

21. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Rural Health Care Pilot Construction Plan In 2009 Big Bend Health plans to run optical fiber from Florida LambdaRail interface points to a Point of Presence (POP) in each rural county. From the POP, optical fiber will be run the last mile to complete the broadband connections to the nine rural hospitals and one VA clinic in the project. In Phase 2 of the project, a wireless broadband network will be deployed to connect other providers. The project proposes to connect the rural hospitals to urban hospitals in Tallahassee, Panama City and Pensacola.

22. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Radiology TDI CRMC TMH VSA CHP CHP. NFWC TNC VPN Remote & VPN Users BBRHIO RHIN Urology Big Bend Health Private Medical Area Network The Big Bend Health pMAN is a 1 Gigabit fiber ring with high- speed connections to providers

23. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis

24. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis FCC Rural Broadband Pilot Project Connecting Nine Rural Hospitals in the Florida Panhandle

25. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Connecting Calhoun-Liberty Hospital in Calhoun County Calhoun-Liberty Hospital Point of Presence

26. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Target Rural Areas in Florida’s Panhandle Fifteen hospitals and clinics will be connected to the Florida Panhandle Health Care Network and will be eligible for health information exchange services from Big Bend Health.

27. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Hospitals Included in the FCC Pilot Project oCalhoun-Liberty Hospital, Blountstown, Calhoun County oGeorge Weems Memorial Hospital, Apalachicola, Franklin County oSacred Heart Hospital, Port St Joe, Gulf County oDoctor’s Memorial Hospital, Bonifay, Holmes County oCampbellton-Graceville Hospital, Graceville, Jackson County oJackson Hospital, Marianna, Jackson County oMarianna Veterans Clinic, Jackson County oMadison County Memorial Hospital, Madison, Madison County oDoctor’s Memorial, Perry, Taylor County oNorthwest Florida Community Hospital, Washington County oTMH Family Medicine Quincy, Quincy, Gadsden County

28. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Health Information Exchange Services Big Bend Health maintains a community repository for the storage and retrieval of: Demographic/encounter data Medication claims data and e-prescribing Document viewer including lab/radiology Secure messaging Disaster recovery Remote data backup outside service area

29. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Big Bend Health Record Locator Service Patient record locator for medical records

30. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Big Bend Health Provides Clinical Records Clinical data display can include: lab reports, radiology reports, allergies, problem list, provider encounter data, demographic data on patients

31. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Big Bend Health Supports e-Prescribing e-Prescribing and Medication History

32. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Big Bend Health Accepts Paper Records Paper records can be scanned and retrieved from the Big Bend Health record repository

33. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Benefits of ARRA for Health Care in Florida Delivering high speed broadband connections to health care providers in Florida will create many new opportunities: o Provide telemedicine services not available today o Improve access to health care services for rural Floridians and reduce drive time for appointments o Increase the quality of health care by supporting the timely and secure delivery of health care information o Connect providers in a secure, dedicated network o Improve the economic health of the rural communities by creating new business and job growth

34. Florida League of Cities and Florida Association of Counties - Economic Stimulus Summit Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Christopher B. Sullivan, Ph.D. Administrator, Office of Health IT Florida Center for Health Information and Policy Analysis Agency for Health Care Administration sullivac@ahca.myflorida.com Updates on the FCC project are available at: http://www.fhin.net/FHIN/HITinitiatives/RHCPP.shtml http://www.fhin.net/FHIN/HITinitiatives/RHCPP.shtml