Today we celebrate the work of rural communities around the country that are working with ONC to bring health IT innovation into their practices, including initiatives that 1) help rural and poor communities locate financing and facilitate broadband connectivity to support health information exchange and telehealth infrastructure and 2) leverage health IT and Blue Button to improve care coordination for rural Veterans who seek care both within the VA and their local community providers.

In the past, Federal assistance programs focused on building essential brick and mortar infrastructure. Now, key infrastructure includes health IT, health information exchange and broadband access. Rural hospitals and doctors around the country often must find a way to invest in software and broadband connectivity that is essential for moving and using human- and machine-readable health records.

As part of ONC’s ongoing work in support of the Federal Health IT Strategic Plan and the Interoperability Roadmap, ONC is committed to working to assist rural providers and the patients they serve.

Below, I share some of our recent work with rural providers–including providers serving rural Veterans–to enable the use of tools and assistance programs already available across the Government to better coordinate care, including through the Collaborative Rural Health Financing Initiative (which started in 2012 to help rural communities find financing to upgrade their health IT infrastructure and broadband needs). For more information on our rural health outreach initiatives, read our joint blog posts with the Veterans Administration, the Federal Office of Rural Health Policy, the US Department of Education, and the US Department of Agriculture.

Reaching Out to Rural Communities

Kalispell Regional Medical Center drove me along a typical commute for doctors traveling across Frontier areas of North West Montana to reach their patients in remote clinics. Click for a larger image.

This past week I travelled to the Delta and Appalachian regions of Tennessee and Kentucky to meet with rural providers and staff from a variety of care settings. Our goal was to link communities in these regions with Federal, state and local financing assistance for health information exchange, telehealth and broadband connectivity, including specific Federal loan, grant, subsidy and incentive programs from the US Department of Agriculture, Delta Regional Authority, Appalachian Regional Commission, the Federal Communications Commission, and US Department of Health and Human Services.

We convened in Clarksville, Tennessee, and Hazard, Kentucky, so that Federal partners could hear from rural providers about their financing and broadband challenges, and link each of the providers to Government and non-Government financial assistance. The need was clear. In Hazard, Larry Combs from the Center for Rural Development told us that not only are the download speeds in rural Kentucky slower than elsewhere in the nation, but rural providers in poor communities of Kentucky are sometimes paying four times the average rate for access to broadband.

Despite the unique health care and economic challenges these providers face, I was struck by their “can do” attitude as we discussed their plans to use health IT to make health information available to providers, patients and their caregivers when and where that information is needed—as well as their efforts to prepare for a future where their payments are tied to performance through advance payment models (e.g., Accountable Care Organizations) or through Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) programs.

Rural-Based Veterans and Health IT-Supported Care

This bridge near Kalispell, MT carries a broadband line that helps connect providers like Kalispell Regional Healthcare to other providers throughout frontier and rural Montana. As we crossed the bridge, forest fires threatened the bridge, highway and area around us. Click for a larger image.

In September, I travelled to a frontier community in northwest Montana and met with providers in Kalispell who face similar challenges to providers in Kentucky and Tennessee. The Montanans are also taking the first steps to electronically link Veterans, Veteran’s Administration (VA) providers and community providers to better coordinate care through Health IT.

These providers work with Veterans to make sure that when they seek care both at the VA and in their communities that they have access to their own health data, and are able to contribute to the care.

Jason Schmidt, M.D., for example, is a family physician at the Community-Based Outpatient Clinic (CBOC) in Kalispell and treats about 1,200 veterans and helps them use MyHealtheVet (a portal to Blue Button) to foster better communication between patients and doctors. So far, about 100 to 150 of Dr. Schmidt’s patients are signed up for the portal.

Dr. Schmidt shared that “in regards to MyHealtheVet, I think it is a very important part of coordinating care and communicating patient-to-physician and from physician back to the patient and team.” He said that his inbox was overwhelmed with thank you notes from his patients who are now able to reach him quickly through the portal. In addition, and taking a page from the community providers’ patient engagement playbooks, Dr. Schmidt also is working to install a kiosk at the VA hospital so patients can sign up for MyHealtheVet when they come for a visit.

Dr. Schmidt has seen a number of benefits to the patient portal, which he says helps patients “have a hand in directing their own health care” by making sure their medications are ordered on time, they are aware of upcoming follow up exams, and have their medical records available for visits with specialists.

Meanwhile, Brent Pistorese, M.D., a pulmonary specialist at Kalispell Regional Healthcare, participated in the joint ONC/VA Summit on Transforming Veterans’ Care earlier this year to develop strategies to better coordinate community and VA health care using health IT. When he returned to his hospital, Dr. Pistorese developed a process to identify whether incoming patients were also Veterans. He realized that some of these Veteran patients thought that community providers were automatically made aware they also received VA health care and had existing VA records. Now, Dr. Pistorese is working with Dr. Schmidt to improve health information exchange between his hospital and the local VA CBOC and to empower Veterans to obtain electronic access to their health information.

While the interface between community providers and the VA is improving and use of health IT in rural health settings is growing, there is more work to be done and more progress to be achieved toward the seamless exchange of data in these communities. ONC is committed to continuing to help Veterans, rural residents, and the providers who serve them benefit from health IT advancements.

On this National Rural Health Day, we want to thank providers in rural communities for their commitment to their patients and to using health IT to achieve better care. Thank you!

If you have questions about ONC’s rural health outreach activities, email me at leila.samy@hhs.gov or leave a comment below.