congressional luncheon seminar series - e-health policy · pdf file ·...
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Congressional Luncheon Seminar Series
The Information Technology Infrastructure: Public/Private Sector Broadband Buildout for Rural, Minority, and Underserved Communities
Odell TuttleHealthland CTO
July, 2011
My Assertion
• Healthcare costs are out of control. US healthcare is the most expensive (and among the least effective) among industrialized nations.
• Rural healthcare in the US is poor and is going to get worse, and more expensive.
• Electronic Medical Records and Tele-health technologies can greatly improve this situation, but both require more broadband.
• The United States is lagging most industrialized nations in broadband build-out.
• We need to get aggressive about broadband delivery in rural America to drive down healthcare costs, and improve outcomes.
Transforming community healthcare:One patient chart. One community.
Long-term Care
Home Health
Ambulatory Clinic
Hospital
Home Health
Largest HIS vendor
•~500 customers in 41 states
•23% CAH market share
•1500+ years experience
Founded in rural
Minnesota
• Glenwood, MN• Minneapolis, MN• Louisville, KY• Waco, TX
Community
Support
•Strong ties to small communities
•Volunteerism•Philanthropy
Healthland Rural Experience
HealthlandThe Only Company Focused 100% on <50 bed market
Healthland25%
18%
15%8%
7%
6%
Other21%
Small Community Hospital Market (≤50 Beds)
• Comprise 37% of the total U.S. hospital market
• Critical Access Hospitals represent 73% of Small Hospital Market
Target Market$2.7B
Medium/Large Hospitals*(3,111)
Small Hospitals (1,786)• ≤ 50 beds (481)• Critical Access Hospitals (1,305)
37%
63%
Increasing regulations
Internet & digital age
Transparency
Consumer drivenhealthcare
High fixedcosts
Changes in patient volume
Resourceshortages
Attract & retainclinicians
External & Internal Pressures
• Healthcare spending in the United States is the highest among the world’s industrialized nations.
• U.S. healthcare costs are projected to exceed $4.6 trillion by 2019 (19.6% of GDP or $13,653 per person).
• U.S. ranks last on indicators of patient safety, efficiency, and equity of treatment when compared to similarly industrialized countries.
• Demand for costly healthcare services is increasing.
Healthcare Costs
Healthcare Costs & Quality – Global Comparison
USA has the highest cost of industrialized nations, while producing some of the poorest outcomes.-- Organization for Economic Co-operation and Development (OECD)
Cost
Life
Exp
ecta
ncy
Greatest Challenge: Federal Mandate, EMR by 2015
•Improved quality of care•Reduction in unnecessary tests•Clinical decision support processes
Patient and Insurer
Benefits
•Higher productivity•Higher revenue•Lower costs
Hospital Benefits
•Lack of financial resources•Lack IT resources and support•Lack of staff support
Barriers
U.S. Hospital EMR and Adoption
The ≤ 50 bed hospital segment has the lowest EMR penetration to-date.
3% 7%13%
23% 23%
43%
56%
66%
64% 69%
54%
37%
21%13% 8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
≤ 50 Beds 50-99 Beds 100-299 Beds 300-499 Beds 500+ Beds
Fully Penetrated Partially Penetrated Unpenetrated
(1) American Hospital Association, 2007.
EMR Market Penetration by Hospital Size1 Stimulus Impact for Small Hospitals:• 14% dedicated to the
small, rural and CAH market:– Average, $1.5M/site– 1,786 hospitals < 50 beds
• These hospitals:– Have lowest EMR penetration– Are converting from paper to electronic– Must act by 2015
• A traditional barrier to HIT adoption has been the lack of in- house IT expertise in small and medium provider practices to oversee deployment and provide IT support.
• SaaS and SOA-based applications with robust vendor support for network deployment and troubleshooting are key differentiators.
Barriers to EMR Adoption: Technical Complexity
Cloud Computing …The answer?
Systems Operator
Care Provider
Patient
Clinical Facility
Data Center
The Rural Healthcare Dilemma
• Rural population is aging disproportionately with urban areas (15% >65 years old, country as a whole: 12%).
• Lower income, lower educational attainment, and a higher dependence on social security income.
• Fewer providers per capita and higher per capita costs in sparsely populated, remote areas. Difficult to attract doctors, nurses, and other service professionals.
• The range of services is narrower, healthcare is less accessible and more costly to deliver.
Top 10 Rural Healthcare Reform Issues
-- Jon M. Bailey, Center for Rural Affairs (2009)
1. Economy Based on Self-Employment & Small Businesses
2. Public Health Insurance Plans: Dependence and Need
3. A Stressed Health Care Delivery System
4. Health Care Provider and Workforce Shortage
5. An Aging Rural Population
6. A Sicker, More At-Risk Population
7. Need for Preventive Care, Health and Wellness Resources
8. Lack of Mental Health Services
9. Increasing Dependence on Technology
10. Effective Emergency Medical Service
Tele-medicine
• Removes geographic barriers for physicians and clinicians.
• Used in rural healthcare facilities today.
• Will be used “at home” in the future.
• Moving from purpose-built devices to software applications.
Quality of Care in Remote/Rural Areas
Study by Journal of American Medical Association (2011):
Critical access hospitals (CAH’s) provide lower-quality of care, and worse outcomes.
Mortality Rates:• 23.5% versus 16.2% for acute myocardial infarction• 13.4% versus 10.9% for heart failure• 14.1% versus 12.1% for pneumonia
Proposed Best Practices Include:• Telemedicine• e-ICU’s• e-consults
Rural Tele-medicine
Harvard University Study (July, 2011):
• The problem most critical access hospitals face: No Specialty Coverage.
• Study: Copper Queen Community Hospital in Bisbee, Arizona saved $500,000 in 6 months with tele-medicine.
Canadian Tele-health Study (June, 2011):
• Saved $730 million, plus $440 million in patient savings.
• Tele-health use has grown by 35% annually for the past 5 years.
• Challenging to provide service in areas of low population density, such as to farmers, ranchers, and small towns.
• Harder to recover equipment costs as rural customers may require expensive equipment to get connected.
• Only 46% of rural Americans have an internet connection, compared to 63% nationally.
• Rural citizens less likely to pay for it than those in urban areas.
Challenge: Broadband Availability
Customer Testimony
• Broadband build-out extremely slow• Only one real broadband option• If a line gets cut we would be without:
• e-Prescribing• Physician Dispensing• Tele-stroke communication• Staff Email• Disaster Recovery backup vault• SAN (Data Storage) replication• The ability to send images to CRL
The cloud would be beneficial to smaller hospitals who don't have enough capital to build their own infrastructure, but they first need a big enough (and redundant) broadband pipe to connect to it.
Tony Alsleben, IT Director Heidi Engle, CIO
It's expensive and time-consuming to install and maintain EHR-related hardware and software. Cloud computing could be the answer.
What's stopping rural healthcare facilities from going down this path?
• Broadband access. Rural facilities don't have access to more than one high-speed Internet Service Provider (ISP).
• With cloud computing, access to at least two different high-speed Internet Service Providers (ISP) is required to allow for redundancy.
Broadband Investment – Global Comparison
Broadband Investment – Global Comparison
Summary/Conclusion
• Healthcare costs are out of control. US healthcare is the most expensive (and among the least effective) among industrialized nations.
• Rural healthcare in the US is poor and is going to get worse, and more expensive.
• Electronic Medical Records and Tele-health technologies can greatly improve this situation, but both require more broadband.
• The United States is lagging most industrialized nations in broadband build-out.
• We need to get aggressive about broadband delivery in rural America to drive down healthcare costs, and improve outcomes.
