ONC and ORHP: Working to help rural health providers leverage health IT to improve quality and fuel economic development

This is one in a series of blog posts to coincide with National Rural Health Day. To follow the conversation on Twitter, look for #RuralHealth.

Since the summer of 2010, ONC and HRSA’s Office of Rural Health Policy (ORHP) have teamed up in support of rural health and rural economic development, with a focus on helping rural providers and hospitals leverage technology to optimize their communities’ health systems. Our goal is simple but not easy: improve care quality across the spectrum of care for rural communities.

The White House Rural Council and Secretary Sebelius’s Rural Health IT Task Force

In the summer of 2010, Secretary Sebelius convened an HHS Rural Health IT Task Force of seven member agencies (Indian Health Service, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Agency for Healthcare Research and Quality), co-chaired by ONC and ORHP. This Task Force helps rural communities in their efforts to adopt and meaningfully use health IT. In the summer of 2011, President Obama convened the White House Rural Council to streamline and improve the effectiveness of Federal programs serving rural America with an eye toward boosting healthcare and job creation.

With the backing of these two groups, we set out to accomplish the 6 goals outlined below.

ONC’s and ORHP’s Joint Rural Health Strategy and Goals

  1. Expanding funding for rural health IT.
  2. Improving care coordination and quality for rural veterans.
  3. Promoting rural health IT workforce development.
  4. Expanding access to affordable, sufficient and secure broadband connectivity for rural health care providers and hospitals and the communities they serve.
  5. Developing tools and resources to address the most pressing health IT needs of rural health care providers and hospitals.
  6. Extending local technical assistance to rural providers and hospitals working to achieve the first stages of Meaningful Use.

Collaborating with Federal and Private Sector Partners

To achieve these goals, we are coordinating with the US Departments of Agriculture, Veterans Affairs, Labor and Education, Federal Communications Commission, Appalachian Regional Commission, Delta Regional Authority, National Rural Health Association, National Rural Economic Development Association and many other Federal and private sector partners.

Expanding Funding for Rural Health IT

In August 2011, ONC and HRSA signed a Memorandum of Understanding (MOU) with USDA linking rural health clinics and hospitals to US Department of Agriculture (USDA) grants and loans to support the acquisition of health IT infrastructure (e.g., hardware and software).

We launched a series of activities and initiatives to implement our MOU. As an initial step, we convened a virtual meeting in February 2012 with more than 400 participants from across the country. Among other objectives, the purpose of this meeting was to convey the urgency and value of investing in rural health IT and assisting rural providers and hospitals achieve Meaningful Use. We also convened three regional meetings last year for USDA State Directors and HHS grantees to work together to link rural communities to funding from the USDA’s Community Facilities grant and loan programs. By the end of the year, our partnership with USDA generated $32 million in Community Facilities funding for rural health IT.

In 2013, we expanded our focus beyond the Community Facilities programs to all Rural Development funding and assistance programs. We launched a pilot initiative in the summer of 2013 that included workshops that took place in Kansas, Iowa, Mississippi, Texas and Illinois. By September 30, our pilot effort generated more than $38 Million in funding to participating CAHs and rural hospitals.

As a result of the success of the pilot, we are taking this joint initiative to scale nationwide in FY 2014. Last week, we launched the initiative in Georgia with an emphasis on some of the state’s poorest and most underserved counties.  Two hundred rural health professionals representing 46 rural and critical access hospitals attended the workshop. On December 5, we will launch the initiative in Michigan with a focus on rural hospitals and rural health clinics. We are also expanding the scope of these workshops beyond rural hospitals to include a range of rural safety-net providers (e.g., long-term-care facilities, mental health clinics serving rural veterans).

Improving care coordination and quality for rural veterans

Following the lead of the White House Rural Council, ONC and ORHP formalized a partnership with the Veterans Administration in August 2012 by signing an MOU to improve health care coordination and quality for rural veterans.

This September HHS and the White House Rural Council announced revised funding for the Flex Rural Veterans Health Access Program. We awarded a total of $900,000 to Maine, Montana, and Alaska to improve the quality of mental health and other critical healthcare services for veterans living in rural areas using health information exchange.

Over the summer and fall of 2013, ONC and the VA’s Office of Rural Health launched pilot projects leveraging MyHealtheVet’s Blue Button technology to help rural veterans gain access to their health information stored in the VHA system. This initiative helps rural veterans and rural non VHA providers serving these rural veterans use care coordination documents (CCDs) and Consolidated Clinical Document Architecture (C-CDA) to enable interoperability and exchange. This effort supports continuity of care for rural veterans by helping them seek care both within the VHA system as well as at their local rural clinic or hospital. Key partners in this effort include Health IT Regional Extension Centers and the Rural Health IT Network Development grantees.

Promoting Rural Health IT Training and Workforce Development

In 2012, we signed another MOU with the Department of Labor to help build a better health IT workforce. Our goal is to help train and develop a workforce that is available in sufficient numbers and armed with the appropriate skills to support rural health IT needs, including adoption and meaningful use of health IT. Through this MOU, we also aim to help professionals get good jobs supporting health IT needs of rural health care providers and hospitals. Our agreement builds on current collaborations between HHS and DOL. The White House Rural Council highlighted this partnership in a press release outlining the Administration’s actions to support the needs of rural America.  Later in 2012, as part of an effort to coordinate funding opportunities and workforce programs across our agencies, DOL highlighted ONC’s Health IT Workforce Development programs when it announced $500 million in further funding.

Building on the ONC-funded Health IT Workforce Development programs, the White House Rural Council encouraged us to expand our model to rural communities.  As a result, in September of this year, ORHP provided more than $4 million to support 15 Rural Health IT Training Networks. These ORHP-funded networks will have three years to develop a rural health IT training program and then enroll and graduate its first class by the end of its third and final year of funding.  The curriculum developed by these grantees will then be shared with rural-serving community and technical colleges across the nation. ONC provided assistance to ORHP in developing the framework and guidance for this program.

Expanding access to affordable, sufficient and secure broadband connectivity by rural health care providers and hospitals and the communities they serve

ONC and ORHP have also been collaborating with FCC (both formally and informally) to help rural health care providers and hospitals as well as the rural communities that they serve benefit from Universal Service programs and reform activities. Our objective is to ensure FCC programs support connectivity sufficient to support telehealth services and foster robust health information exchange in rural settings.

Follow this link to a data brief with information about key infrastructure challenges faced by CAHs nationwide, including challenges associated with broadband cost, access and speed.

Developing tools and resources to address the most pressing Health IT needs of rural health care providers and hospitals

The HHS Rural Health IT Task Force created a web-based rural health IT toolkit to share information about a wide range of existing resources with rural health care providers. The toolkit built upon and added to the HHS Rural Assistance Center.  Administered by HRSA, this website serves as a source of information on available HHS programs, funding, and research to improve the quality of health and human services provided to rural communities.

In 2013, ONC launched a new Rural Health landing page on healthit.gov specifically targeting the needs of rural and critical access hospitals. This resource complements and builds on information available on Rural Assistance Center. Both websites are cross-linked.

Extending local technical assistance to rural providers and hospitals working to achieve the first stages of Meaningful Use

As part of our combined rural health IT strategy, ONC and ORHP realigned the focus of its programs in 2010 and 2011 to allocate approximately $42 Million in grants to support rural health IT.  Specifically, ONC made available approximately $30 million for the Health IT Regional Extension Center program to offer targeted boots-on-the-ground technical assistance to critical access and small, rural hospitals nationwide. ORHP also announced a $12 Million Rural Health IT Network Development grant program to offset the costs of health IT acquisitions for networks of rural health care providers.

The progress we’ve seen over the past two years has been remarkable: As of July 31, 2013, 62% (approximately 822 of 1,332) of CAHs and 77% (approximately 293 of 383) of small, rural hospitals had attested to meaningful use of EHRs.


  1. Edward Gamache says:

    This work is supporting the efforts of rural providers to stay relevant, be part of the health information technology transformation, and add value to the larger healthcare system as partners in care transitions.

  2. Tim McCullough says:

    Up until recently I was able to secure repetitive and simple routine procedures such as physical therapy and E-ray treatment at local facilities here in Sonora CA. My home near Sonora is both miles and hours from VA facilities that provide such services. As of 1/1/14 the Va has contracted out the coordination of providing such services outside of VA facilities. The people that have contracted with does not, or has not negotiated for the providing of the needed procedures anywhere hear Sonora; therefore depriving me of access of the procedures unless I am able or willing to drive long distances to secure them. Prior to 1/1/14 I was able to acquire this service at home, post 1/1/14 I am not. Maybe good for the Va and the service provider, but most definitely not the veteran.

  3. David Willis MD says:

    As CMIO for the MyHealthStory partner to the rural care coordination program occurring in Florida, we are excited to hear the comments from our rural veterans about being able to share their VA health information with their civilian providers. I still see patients, and have the pleasure of hearing these comments and benefiting from the better access to patient health information first hand. BlueButton technology is opening doors for our veterans and caregivers of veterans to take a more proactive role in their care and avoid some of the frustrations that so often occurs when different health providers aren’t aware of each other’s actions. Those of us civilian providers participating in Florida through our MyHealthStory HIE are excited to see the opportunities of coordinated care with the VA blossom.

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