Enabling Health ITNational Broadband Plan’s Recommendations for Health Care
HIMSS10 Annual Conference
March 2, 2010
The National Broadband Plan
National Broadband Plan
Deployment(Supply)
Adoption and Usage(Demand)
National Purposes
• Increasing the availability of broadband
• Serving the un-served
• Understanding the cost to do so
• Increasing adoption of broadband for those who are served
• Improving the utilization of broadband
• Consumer and business research
• Understanding international lessons
• How can broadband advance our policy goals in health care, energy, civic engagement, education, public safety, and more?
Policy Team
Plan will accelerate innovation and investment across the broadband ecosystem
Adoption &Utilization
Network Services
Devices
Applications &Content
Fixed and mobile
Consumers, business,
government
The National Purposes mandate
“a plan for use of broadband infrastructure and services in:
- advancing consumer welfare- civic participation- public safety and homeland
security- community development- health care delivery- energy independence and
efficiency- education- worker training- private sector investment- entrepreneurial activity- job creation and economic
growth- and other national purposes.”
Healthcare
Energy and the environment
Government performance and civic engagement
Public safety and homeland security
Economic opportunity
Education
American Recovery and Reinvestment Act, §6001(k)(2)(D):
As a platform for innovation and information exchange, broadband helps improve health outcomes
Source: AirStrip Technologies, Intel, Medtronic, CardioNet, Corventis, ScanDocs
Health IT could result in significant cost savings
Possible savings from EHRs over 15 years $Billions
Source: Health Affairs; Robert Litan
19716
24
55102
TotalSkin disease
Pulmonary disease
DiabetesHeart disease
Possible savings from remote monitoring over 25 years$Billions
142
371
Total
513
Physician practices
Hospitals
$700B in potential
net savings over 15-25 years
Practices with Advanced Electronic Health Information Capacity
92 91 89
6654
49
3626
19 15 14
0
25
50
75
100
NZ AUS UK ITA NET SWE GER US NOR FR CAN
* Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care.
Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Practices with Advanced Electronic Health Information CapacityPercent reporting at least 9 of 14 clinical IT functions*
Four primary barriers to health IT
Lack of data and information access
Outdated regulations
Broadband is missing or too
expensive
Misaligned economic incentives
Broadband is missing or too expensiveData UtilizationRegulatory
Connectivity Reimbursement
Federally Funded Providers
99% 91%74% 71% 67%
33%29%26%9%
1%
All Locations withPhysicians
FQHCs Critical AccessHospitals
Rural Health Clinics I HS Locations
Estimated Locations Without Mass Market Broadband ConnectionsPercent of locations for each delivery setting
Total Number of Locations346,000 7,800 6701,300 3,700
Without Mass Market Broadband (Estimated %)
With Mass Market Broadband (Estimated%)
Urban Price Benchmarks Across the U.S.Monthly service cost ($)
5,0824,6203,680
2,800
1,205
0
2,000
4,000
6,000
4.2 X
VermontNew YorkMississippi
WyomingChicago, IL
$
Source: AMA, HRSA, IHS, Telegeography, USAC
Program Components What’s Funded Mechanism 2009 Spending
• Telecommunications Services
• Rural only
• Funds urban/rural price differential
$59.0 Mn.
• Internet Access
• Rural only
• 25% of invoice
• 50% of invoice for states that are entirely rural
$1.7 Mn.
• One time capital costs for network deployment
• Recurring costs for five years
• Urban and Rural
• 85% support $11.6 Mn.
Total $72.3 Mn.
Telecommunications Fund
Internet Access Fund
Pilot Program
Rural Health Care ProgramBreakdown of program components
Working recommendations to ensure all providers have access to affordable broadband Data UtilizationRegulatory
Connectivity Reimbursement
• Transform the Rural Healthcare Program1. Re-tool broadband access support mechanism2. Create permanent Broadband Infrastructure Fund3. Expand the definition of eligible providers4. Require new performance measures such as “Meaningful Use”
5. Upgrade Indian Health Service broadband service
Misaligned economic incentivesData UtilizationRegulatory
Connectivity Reimbursement
Providers bear the implementation and training costs but do not receive proportionate benefits
PROVIDERS
Health IT Implementation & Training
PATIENTS
PAYORS
$
$ $ $ $ $ $ $ $ $ $
Better Health & Care
$ $ $
Working recommendations to create incentives for adoption of e-care technologies
• Provide Congress with a plan to realize the value of e-care
• Increase e-care pilots that evaluate cost savings & clinical outcomes
• Expand reimbursement for e-care under current fee-for-service model where outcomes are proven
Data UtilizationRegulatory
Connectivity Reimbursement
Outdated regulationsData UtilizationRegulatory
Connectivity Reimbursement
Source: Lee Dobin’s “Doctor Office”, Cardionet
Traditional Medicine Today’s Health Care
Regulations were created to support 20th-century health care, and must be updated to meet the needs of the 21st century
Working recommendations to modernize health IT regulations
• Revise credentialing, privileging and state licensing requirements to enable e-care
• Clarify regulatory requirements and the approval process for converged communications and healthcare devices
Data UtilizationRegulatory
Connectivity Reimbursement
Lack of data and information accessData UtilizationRegulatory
Connectivity Reimbursement
CLINICAL DATA RESEARCH DATA ADMIN DATA
Data is siloed and not interoperable
Data is not sufficiently shared with consumers