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For more information on broadband funding opportunities, see We have limited broadband in our area, what are our options?

If you have questions about whether or not a funding opportunity supports HIT, you can contact the agency or organization responsible for listing the funding opportunity or program and ask if the opportunity supports HIT initiatives and expenditures. Some funding opportunities and programs may support HIT efforts with spending restrictions, such as what can and cannot be purchased or what the overall percentage of the budget or allotment can be used for HIT expenditures.

RHIhub maintains a list of federal, state, and foundation funding opportunities for HIT in rural healthcare. You can contact us at As with any leadership role, succession planning for HIT leaders is an important exercise. Consideration should be given to how HIT activities would continue if HIT staff leave due to retirement or other reasons.

Facilities might consider training and career ladder programs to prepare the next wave of HIT leaders or look to outsource some of their HIT management in the event they lose their internal capacity. The HIT workforce is limited in rural areas and there has been a lack of adequate HIT workforce development in rural communities. Rural Health Information Technology Workforce Curriculum Resources provides planning and educational programs to train rural HIT workers, including an inventory of curriculum resources that includes detailed course descriptions and training materials.

It's a HIT!

Rural Health IT Workforce Training Program is a model developed to train rural healthcare providers and staff with the knowledge and skills to navigate HIT and assist with educating their peers. Networking can help rural hospitals and healthcare facilities manage HIT implementation. Rural HIT networks can provide many benefits, such as shared HIT staff, volume purchasing for software and training, health information exchanges HIEs , and data analytics services. HIE allows providers to discuss, plan, share, and coordinate patient health information and care between multiple healthcare facilities.

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Strategic uses of information technology in health care: a state-of-the-art survey.

The electronic exchange of protected health information between providers is being achieved in a number of ways. Traditionally, information that was carried or couriered in a paper or film format can now be sent to another provider in a digital format via HIE or media, such as a USB memory stick. Information that was mailed or faxed can be sent via Direct Secure Messaging and attached as either a PDF or in a structured data file. Just like in the paper-based process, all parties involved in the exchange of protected health information need to agree on the method and format of the data being sent and received.

Some rural hospitals contract out specialty services or other healthcare services not available at their facility. In these instances, imaging or other patient health information is exchanged electronically via a VPN point-to-point connection. With advances in broadband connectivity in rural areas, images or test results can be sent much faster that results in a faster turnaround time, ultimately improving patient care and safety. This risk assessment should look at all of the administrative, physical, and technological risks your organization faces.

It recommends a third-party be involved in the risk assessment to act as another set of eyes to identify any risks. Many agencies and organizations provide information and resources for providers, hospitals, and others to provide guidance on conducting security and privacy assessments:. Cybersecurity: How a Rural Alaska Hospital is Safeguarding Its Patients' Information identifies security and privacy concerns in rural communities and describes how healthcare providers in rural Alaska are protecting their patients' information.

HIT has significant potential to help patients engage more fully in their own healthcare. Patient engagement can happen at every interaction, both inside and outside the point of care. Online patient portals can be used to schedule appointments, review test results and immunization schedules, and request prescription refills. The factsheet, Using Secure Electronic Messaging to Support Patient and Family Engagement , lists many benefits secure electronic messaging can have for both patients and providers. It is important for rural providers to be aware of challenges their patients might encounter in accessing their information.

ONC's Patient Engagement Playbook is a resource for providers, hospital and practice staff, and others to learn successful strategies and best practices to increase patient engagement. A January Congressional Research Service report, Broadband Internet Access and the Digital Divide: Federal Assistance Programs , defines broadband as high speed internet access, cable, fiber, satellite, mobile and fixed wireless, and other advanced telecommunication connections and services that give users the ability to exchange data at adequate volumes and speeds to support their information technology applications in a variety of fields, including distance education, public safety healthcare, and more.

These data may be plagued by different coding schemes, suffer from problems of inaccuracy and incompleteness, and be distributed across dozens of organizations. There is no customer record as complex as the medical record.

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Multiple strategies are under way, many of these led by the federal government, to reduce the complexity of patient data. For example, data and transaction standards are under development, and their use is being enforced. In addition, health information exchanges, or marketplaces, are being introduced to create more complete sets of patient data.

New methods are available in which the computer assists the caregiver by highlighting the data that are likely to be relevant, given the patient's history, current complaints, and evidence-based treatment guidelines and protocols. These methods help prevent caregivers from becoming overwhelmed by the sheer volume of data. Also, we can anticipate advanced techniques that use pattern recognition and machine learning to correct deficiencies in the data; for example, noting that the patient's data indicate that he or she is a diabetic even though a diabetes entry isn't in the problem list.

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Methods that identify patterns in the data, such as a predictive algorithm that indicates a high readmission risk, are already in use. These methods enable clinicians to focus on the pattern and not the underlying data. At times, there isn't adequate clinical evidence to guide the care that a patient receives. At other times, there is evidence, but it is not followed. Either way, the result is high variability in care processes.

How advances in information technology will improve patient care

Care processes invariably traverse departments within a hospital or among specialists in the treatment of a patient with multiple chronic diseases or multiple care venues; this occurs, for example, with surgical procedures that require rehabilitation. Since these nodes do not always operate in the same way, and processes that traverse are often ad hoc and idiosyncratic, complexity is inevitable. Improving data liquidity through health information exchange enables each node to be aware of the care given and the results obtained by all parties involved in a patient's care.

Health Information Technology

A fundamental aspect of good care coordination is that everyone involved in a patient's care is aware of the others' actions. In addition to data accessibility, someone — often the nurse on an inpatient unit — must choreograph care processes. Information technology can provide orchestration support. Workflow engines can monitor care processes and alert caregivers if the steps in a process are occurring in a suboptimal sequence, or if the interval between steps is too long or steps have been skipped.

Joint care plan development and documentation also can assist team-based orchestration of care. Personal health records enable the patient to be more effective as a team member and orchestrate aspects of his or her own care. These efforts help to address complexity by informing caregivers when a process has crossed a boundary that is deemed undesirable or unacceptable. For example, a workflow engine can alert caregivers that no one has followed up on an abnormal result. It's like the indicators on your car dashboard that inform you of impending trouble.

In a similar way, IT-based support of care teams does not remove or hide complexity, but it does enable caregivers to identify complex processes that are no longer on track. Medical knowledge. For the caregiver, there is too much to know, and the body of knowledge changes and expands too frequently. Previous efforts to address this problem, such as creating subspecialties, have proven unsustainable and often simply move the complexity problem rather than solve it. For example, while subspecialization may enable a person to master an increasingly narrow body of medical knowledge, the result is increased care fragmentation.

The knowledge problem has become a process problem. There are several strategies that can be applied to address the medical knowledge complexity problem. Clinical decision support can guide the caregiver's diagnostic and treatment decisions. This support can use computerized provider order entry by, for example, reminding the clinician to perform a genetic test before ordering a particular chemotherapeutic regime.

Strategic uses of information technology in health care: a state-of-the-art survey.

Clinical decision support can guide documentation by highlighting the data that should be gathered to conduct a thorough health maintenance assessment. Several multifaceted "big data" efforts are under way. Some of these mine EHR data to identify patient characteristics that call for different treatment approaches. Other efforts bring together diverse types of data — EHR, molecular medicine and radiology images — to determine if novel combinations can lead to highly sensitive and specific diagnostic and treatment decision aids.

These efforts generally seek to shift the complex problem of knowledge acquisition, delivery and synthesis from the caregiver to the machine. Improving the quality, safety and efficiency of health care requires that we address the complexity of care delivery. This complexity has many sources. However, patient data, care processes and medical knowledge are fundamental sources.

Latest available findings on quality of and access to health care

Information technology has core capabilities that enable us to uncover, manage and create usable complexity. However, in health care today, our primary interest is in managing existing complexity. This management can take the form of hiding complexity, removing complexity, alerting caregivers if complex processes deviate in unacceptable ways and shifting complexity management from the person to the machine. The necessary core capabilities of IT are the exchange of health information; rules and workflow engines; algorithms and decision aids; and the support of team-based care.

These capabilities are not specific EHR features and functions.