HRSA’s Office of Rural Health Policy (ORHP) provided onetime funding for $25 million to help 16 rural grantees implement health IT pilot networks in an 18 month time frame. The funding for the program was through the Medicare Rural Hospital Flexibility (FLEX) Critical Access Hospital (CAH) HIT grants.
In December 2010, HRSA published the report “Evaluation of the Flexibility Critical Access Hospital HIT Network Implementation Program”. The report evaluates how the grantees established HIT programs and helped future providers and networks adopt HIT. The report describes how grantees designed, created, and implemented functioning CAH HIT pilot networks and also describes the experiences of partner organizations.
The grant program enabled grantees to establish HIT systems, but also allowed them to use the funds in a flexible way. Some of the grantee hospital programs already had systems in place but others had very little or nothing in place. As a result, the program started with the grantees at different levels of maturity.
Grantees worked on a range of HIT projects, to include developing systems for practice management, disease registries, care management, clinical messaging, personal health records, electronic health records, and health information exchanges.
In evaluating the HIT approach, two day site visits were conducted with four grantees at the University of North Dakota Center for Rural Health, Oklahoma State University Center for Health Sciences, South Carolina Office of Rural Health, and the Board of Regents of the University of Wisconsin System, to explore how the Flex CAH HIT grants were administered, how they were implemented, and the initial outcomes.
In general, the grantees experienced several challenges involving the timeframe allowed, governance issues, unclear evaluation expectations, and issues on how to sustain the activities of the grant. Grantees also raised technical support issues since although they knew that technical assistance resources existed, it was difficult to find information on the resources and how to access them.
Grantees want to see a longer grant funding period for future HIT planning and implementation grants. They also want to see governance structures standardized, see ongoing evaluations, support broader sustainability planning, see the vendor selection expanded, have assistance with procurement and implementation, have adequate staff education and training provided, have a mechanism for cross-grantee collaboration and networking established, and see a better ways to handle the larger issues inherent in large system implementations.
The grantees learned several lessons such as the need and importance for good project management for such a large and complex project, the need to focus on the process of change, the need for good financial planning along with fiscal management, time management, plus good communication and coordination among partners is needed.
Go to www.hrsa.gov/ruralhealth/pdf/cahhit_evaluation.pdf to view the report.