[Federal Register Volume 71, Number 181 (Tuesday, September 19, 2006)]
[Notices]
[Pages 54829-54830]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-15489]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Strategy To Support Health Information Technology Among HRSA's 
Safety Net Providers

AGENCY: Health Resources and Services Administration (HRSA), HHS.

ACTION: Solicitation of comments.

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SUMMARY: HRSA is requesting comments on the future direction and 
strategy regarding investments in health information technology (HIT) 
for section 330 grantees and other HRSA safety-net providers through 
its Office of Health Information Technology (OHIT). OHIT will evaluate 
all comments received during the public comment period to inform OHIT's 
policy direction.

DATES: To be considered, comments must be received by October 10, 2006.

FOR FURTHER INFORMATION CONTACT: Anthony Achampong, Division of Health 
Information Technology State and Community Assistance, Office of Health 
Information Technology, Health Resources and Services Administration, 
5600 Fishers Lane, 7C-22, Rockville, Maryland 20857; 
[email protected].

SUPPLEMENTARY INFORMATION: In accordance with Public Health Service 
Act, Title III, section 330(e)(1)(C), and 330(c)(1)(B) and 
330(c)(1)(C).

Background

    The Health Resources and Services Administration (HRSA), an agency 
of the U.S. Department of Health and Human Services, is the primary 
Federal agency for improving access to health care services for people 
who are uninsured, isolated or medically vulnerable. Comprising five 
bureaus and 12 offices, HRSA provides leadership and financial support 
to health care providers in every State and U.S. territory. HRSA 
grantees provide health care to uninsured people, people living with 
HIV/AIDS, and pregnant women, mothers and children. They train health 
professionals and improve systems of care in rural communities. HRSA is 
the Nation's access agency--improving health and saving lives by making 
sure the right services are available in the right places at the right 
time.
    The Office of Health Information Technology (OHIT) serves as the 
HRSA Administrator's principal advisor for promoting the adoption of 
HIT in the service of the medically uninsured, underserved and other 
vulnerable populations, and ensuring that key issues affecting the 
public and private adoption of HIT are addressed. The mission of OHIT 
is to promote quality of care and improvements in patient health 
outcomes through the adoption and effective use of health information 
technology (HIT) in the safety-net community. OHIT is also responsible 
for administering the Telehealth and Health Center Controlled Network 
(HCCN) grant programs. OHIT's goal is to represent the HIT needs of the 
safety-net community providers to ensure that a digital divide does not 
separate care for patients of HRSA grantees and those receiving care in 
other sectors. OHIT's goal is also to provide leadership across the 
Federal agencies in HIT adoption in the safety-net community.
    HCCNs are the potential foundation for a HRSA strategy on HIT 
adoption and use by section 330 grantees. The HCCN grant program was 
developed in 1994 to support the creation, development, and operation 
of networks, controlled by health centers, to ensure access to health 
care for the medically underserved populations through the enhancement 
of health center operations. The HCCNs routinely perform core business 
functions across their marketplace, State, or region. The core business 
functions range from electronic health records, credentialing and 
privileging programs, utilization review and management, and clinical 
quality improvement. They provide these functions at or below 
marketplace cost to their members to increase efficiencies, reduce 
costs, and improve health care quality for underserved and uninsured 
populations. As such, the HCCNs are vital to achieving the President's 
goal of assuring that every American in the Nation will have an 
Electronic Health Record (EHR) by 2014.

HRSA'S Quality Initiative

    In May 2006, HRSA reconfirmed its goal to improve the quality of 
health service and health outcomes for all the patients served by HRSA 
grantees including the 14.5 million patients served by health centers, 
and announced a commitment to develop new reporting requirements to 
measure and document clinical outcomes. It is expected that further 
development of the HIT infrastructure used by health centers and other 
HRSA grantees will

[[Page 54830]]

take place in the context of HRSA's quality initiative. As such, HRSA's 
goal is not simply to collect data; it is also important that the data 
be used to track individual and population health outcomes and improve 
patient care. The long-term vision of HRSA and OHIT is to transform 
systems of care for safety-net populations through the effective use of 
HIT. HIT is an important tool in measuring and improving patient care. 
For example, the data available in EHRs can be used to better manage 
the treatment of chronic diseases, inform clinical and operational 
processes, and target community-oriented primary care resources. As the 
lessons of the HRSA Health Disparities Collaborative have shown, 
collecting and using data to drive system change is a fundamental part 
of improving patient care and related health outcomes.

Goals for OHIT Network Activities

    Given that the HCCN grants are administered by OHIT and that they 
have a proven track record in promoting HIT adoption, OHIT is 
considering possible ways to modify the HCCN grant program to further 
promote effective adoption and implementation of HIT initiatives, 
including EHRs, which result in improved quality of care and patient 
outcomes. HRSA plans to utilize the authorities cited above to fund 
HCCNs. Although only entities receiving section 330 funding are 
eligible to be the applicant/lead grantee, an HCCN may include 
organizations in addition to section 330 grantees that are community 
based and have similar goals and missions such as Federally Qualified 
Health Center Look-A likes, locally funded clinics, etc.
    The purpose of developing and implementing new strategies and 
changing the direction of HRSA's network activities is to take the 
lessons learned from the previous HRSA grant programs, continue to 
build on these successes, and create more network solutions for 
promoting HIT adoption by 330 grantees and other safety-net providers. 
HRSA is considering restructuring the HCCN grant program to focus 
solely on projects that promote HIT adoption. These HIT-focused 
projects could be funded in two phases: (1) Planning and implementation 
and (2) innovation and sustainability. This possible move to an HIT-
focused grant program would advance the President's goals related to 
HIT and the adoption of EHRs. The intent would be to fund HIT-focused 
projects that will result in improvements in patient outcomes and 
quality. To be considered successful, these HIT initiatives must result 
in measurable increases in EHR adoption by health centers, and in 
clinical and operational improvements in quality and patient health 
outcomes.

Request for Comments

    The Office of Health Information Technology is requesting comments 
on the future direction of investments and strategy in HIT using the 
HCCN model. Respondents should take into account the likelihood that 
HRSA programs may not grow substantially in the near future and that we 
may face budget limitations. The following areas provide guidance for 
the type of feedback we are requesting:
    1. Challenges and opportunities in restructuring the HCCN grant 
program. Other approaches to consider in promoting quality of care and 
improvements in patient outcomes through HIT adoption for minority and 
underserved populations.
    2. Key considerations that should be taken into account when 
designing the new funding opportunities to reach the ultimate goal of 
using HIT via the HCCN approach to increase EHR adoption and to improve 
quality of care and health outcomes.
    3. Types of HIT investments, other than EHRs, that HRSA should 
consider investing in, to improve quality of care and health outcomes.
    4. Benefits of funding networks to provide HIT support to health 
centers and other safety net providers. Types of incentives, if any, to 
encourage health centers, and other HRSA grantees to join networks.
    5. Capacity needed for a network to promote HIT among a group of 
health centers and other HRSA grantees, such as number of health 
centers and/or number of patients included.
    6. If and/or how HRSA should consider retaining the HCCN 
administrative, financial and clinical core services in the proposed 
funding opportunities as they relate to promoting HIT adoption?
    7. Model practices in other parts of the safety net or private 
industry to build key HIT capacities in under-resourced environments.
    8. Quality and safety issues that could be addressed with the 
appropriate use of HIT in the safety net organizations.
    9. The role of Telehealth in the overall HIT strategy.
    10. Linking quality of care and improvement of patient outcomes to 
these strategies to ensure that the ultimate goal of improving care is 
met.
    11. Performance measures (process and/or outcome) to indicate 
progress/success of HRSA-funded HIT initiatives.
    12. Expectations for networks around sustainability, including 
long-term sources of funding.
    13. Collaboration between Primary Care Associations (PCAs) and 
HCCNs in the adoption of effective HIT by safety-net providers and the 
use of HIT to improve quality and patient outcomes.
    14. Approaches to include State Medicaid agencies, public health 
departments, other HRSA grantees, and other providers and stakeholders 
in HIT adoption. Approaches to a coordinated approach in a State or 
community for health information technology/exchange use and support.
    15. Any other comments related to OHIT's policy direction related 
to networks and the use of HIT to expand EHR adoption and improve 
quality and patient outcomes.
    Collection. All comments will become a matter of public record.

    Dated: September 7, 2006.
Elizabeth M. Duke,
Administrator. 1
 [FR Doc. E6-15489 Filed 9-18-06; 8:45 am]
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