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

Working recommendations to improve the utilization of health data

• Create next-generation interoperability across clinical, research and administrative data

• Ensure patients have access to and control over their health data

Data UtilizationRegulatory

Connectivity Reimbursement