Sunday, November 13, 2011

Agency Programs Discussed

Available federal grants, cooperative agreements, loan, and contract programs were discussed in-depth at the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” on November 7th. As Neal Neuberger, Executive Director for the Institute for e-Health Policy explained, “Many of the agency funding programs and opportunities help to transition healthcare to where it is really needed not only in urban areas but also for rural and disparate populations.”

Overall, the $2 billion that was appropriated for health IT activities, supports new grant programs, established new committees and workgroups, and provided funding for dozens of new contracts, according to Matt Kendall, Director for the Office of Provider Adoption Support within the Office of the National Coordinator for Health IT.

As he sees the future, the health IT implementation trajectory from 2013 to 2014 points to the widespread adoption and exchange of data by 2015. In addition, breakthroughs will be achieved in healthcare delivery and in payment reform.

Tom Morris, Associate Administrator for Rural Health Policy at HRSA, emphasized the role that health IT investment can play in developing and maintaining health centers. To provide more funding for health centers, HRSA Administrator Dr. Mary Wakefield and the National Coordinator Dr. Farzad Mostashari recently announced $8.5 million available from the Affordable Care Act to fund the adoption of health IT in 85 health centers in 17 Beacon Communities.

Morris gave examples of several current grant programs that emphasize the use of telehealth. For one, the Telehealth Network Grant Program funds projects to demonstrate the use of telehealth networks to help in medically underserved populations in rural and urban communities. Secondly, the Telehomecare Grant Program focuses on placing telehealth technologies in the home, and lastly, the Telehealth Resource Center (TRC) Grant program establishes regional and national TRCs to provide experts to help others.

The EHR incentive program expects to make $18 billion in payments and produce better health, quality, along with a reduction in errors, according to Robert Tagalicod, Director for the Office of E-Health Standards & Services at CMS. He reports that the electronic health record program now has 114,000 registered with 10,600 providers paid, registered, and moving to “meaningful use”.

Wilson Washington, Public Health Advisor for the Substance Abuse and Mental Health Services Administration (SAMHSA) described how health IT fits into one of 8 strategic initiatives at SAMHSA. The agency’s HIT portfolio has multiple components for FY 2011 and expects to provide the HIT portfolio with $32.5 million.

He talked about several SAMHSA grant programs. For example, the agency provides one year supplement grants for $10 million (FY 2011) to achieve Primary and Behavioral Care Integration (PBHCI). The grants support HIT adoption, infrastructure support, and technology assisted treatment services by providing linkages and communication between primary and behavioral health care services.

A one year supplemental grant of $600,000 will be used to establish a PBHCI Technical Assistance Center (TAC). Other funding will support $3.2 million in sub-awards to go to five State Designated Entities (SDEs) to help them participate in HIEs and encourage behavioral health collaboration at the state level.

SAMHSA is also providing multi-year grants for their Substance Abuse Targeted Capacity Expansion (TCE) program. The (FY 2010) program has funding available for five existing grantees averaging $400,000 each. The funds support technology assisted treatment to expand service delivery through the existing TCE program for underserved communities and rural areas.

Vicki Seyfort-Margolis, Senior Advisor for Innovation for the Office of the Commissioner at FDA sees problems in monitoring massive amounts of very valuable information collected from a variety of sources. This data includes product submissions, adverse event reports, patient data from healthcare providers, along with results from basic scientific research.

As Seyfort-Margolis explained, “It is important for FDA to successfully not only integrate and analyze the data but FDA also needs to be able to analyze large scale clinical and preclinical data sets. In addition, FDA needs to refine methods for analyzing post-market data that requires mining data from large healthcare databases.

FDA is currently taking steps to unlock the data to be reviewed. For example, according to the FDA Strategic Plan “Advancing Regulatory Sciences at FDA” published last August, FDA is funding the “Partnership in Applied Comparative Effectiveness Science” project to detect which interventions will be most effective for which patients under specific conditions to find the right treatment for a particular patient.

“The Indian Health Service (IHS) provides healthcare for a specific population of 1.9 million American Indian and Alaska Native people in 35 states and manages federal hospitals, outpatient clinics, and health centers. The IHS manages tribally operated facilities plus urban Indian health programs”, reports Dr. Howard Hays, Acting Director for the Office of Information Technology, at the Indian Health Service.

He noted that the Resource and Patient Management System deployed at over 300 facilities nationwide and similar to the VA’s VistA system, is a comprehensive, integrated suite of clinical, business, practice management and infrastructure applications and is the only certified EHR in the federal space.

Telehealth plays an important role in Indian country. Some examples include, the Alaska Federal Healthcare Access Network (AFHCAN) providing store and forward telehealth, Joslin Vision Network Tele-Ophthalmology providing screenings and consultations for diabetic retinopathy, a tele-behavioral health center of excellence operating in Albuquerque New Mexico, a tele-trauma consultation services available in Gallup New Mexico, home monitoring available for disease management plus teledermatology, chronic disease management, nutrition, and other specialty services.

The IHS achieves health information exchange by moving laboratory orders and results, by exchanging immunization data with the states, using electronic prescribing, monitoring prescription drug usage, and enabling epidemiologic surveillance.

Trent Harkrader, Chief of the Telecommunications Access Policy Division at FCC, gave an update on the existing FCC program referred to as the Rural Health Care “Primary” Program supporting telecommunications and internet access. In 2010 alone, $90 million was spent on the program with figures based on Universal Service Administrative Company estimates.

He reports that a three year pilot program supports broadband deployment for healthcare networks. The pilot funds up to 85 percent of the costs associated with deploying dedicated broadband networks needed to connect providers in rural and urban areas within a state or region. Presently there are 50 active projects operating with total funding of $417 million

Other examples of pilot programs underway include the new California Telehealth Network to eventually connect 863 healthcare facilities by using video and audio streamed through a closed-circuit system to connect smaller hospitals and clinics to physicians, specialists, and other networks at larger hospitals.

Secondly, the West Virginia Telehealth Alliance is a statewide network to connect approximately 450 facilities to improve connectivity for rural health centers. The Alliance has two components a fiber ring connecting 3 teaching hospitals connected to internet2 backbone and WAN connecting to rural clinics via internet2.

Jessica Zufolo Deputy Administrator for the USDA Rural Utilities Service (RUS) along with Aaron Morris Community Programs Specialist at USDA both reviewed the numerous USDA RUS grant and loan programs.

These programs include the FY 2012 Telecommunications Infrastructure Loan Program to build telecommunications service in rural communities of less than 5,000, the Rural Broadband Loan Program to provide loans to build and upgrade broadband services in rural high cost areas in communities with less than 20,000, the Broadband Initiatives Program (BIP), awarded $3.5 billion in loans and grants and building projects in 45 states and one U.S. territory but the program is now closed, and parts of the Farm Bill passed in 2008, containing provisions that apply to parts of the Telecommunications Infrastructure Loan Program.

In addition, there are other programs such as the Distance Learning Telemedicine (DLT) program with both grants and loans to help rural residents living in communities of 20,000 or less obtain needed health IT. DLT so far has awarded $465 million awarded in grant and loans and in FY 2011, $24.9 million was available with 209 applications received.

In FY 2011, the Community Connect Grant program had $13.4 million available, received 140 grant applications, and awarded 19 grants. The project provides free broadband service to critical community facilities in the community for at least two years and provides a community center with at least 10 computer access points within the proposed service area.

The application windows for FY 2012 for the Distance Learning and Telemedicine and the Community Connect programs has not yet been announced. Funding availability is usually announced in the January/February timeframe with a 60 day application window.

The Congressional Luncheon Seminar Series is a project managed by the Institute for e-Health Policy and coordinated by Neal Neuberger. The Capitol Hill Steering Committee on Telehealth and Healthcare Informatics will hold a session on Wednesday November 16th from 12:00 to 1:45 to hear officials from CDC to discuss how biosurveillance technologies can improve public health. Representative Phil Gingrey (R-GA) will kick off the program. To receive an announcement, email Neal Neuberger at or call (703) 508-8182.