Health IT Strategic Framework

Attachment 2

II. Background - Statement Of Problem: Rural and Medically Underserved Requirements

The Rural Public Health Research Agenda of April 2004, held at the University of Pittsburgh Center for Rural Health Practice, identified the following core themes for Rural Public Health:

• Rural communities differ significantly across and within geographic regions. Such differences necessitate local solutions to local challenges that include economic factors, demographic makeup, population density, terrain, and distance from urban areas, community resources and public health presence.

• The vast majority of rural public health workers have no formal public health training. An additional barrier to needed education and training is the inability to take time away from often understaffed local health departments.

• There is a need for surveillance systems to be sensitive enough to address small number issues and broad enough to track emerging infections. The systems should have the capability of communicating across county or at state lines. ¹

According to the Health Resources and Services Administration (HRSA), "medically underserved" communities may be rural or urban in nature, and consist of residents experiencing a shortage of personal health services such as primary, mental or dental services, and may face cultural, linguistic, or economic barriers. See HRSA Definitions in Appendix A.

VA has always recognized that special care and attention is needed to address health delivery to these target populations. For instance, as part of the dramatic transformation of the Veterans Health Administration (VHA) health care delivery of the 1990's under the direction of Kenneth W. Kizer, M.D., M.P.H, the homeless veteran was recognized as an important recipient of VHA care. Half a decade ago, in Dr. Kizer's testimony to the U.S. House of Representatives Committee on Veterans Affairs' Subcommittee on Health, he stated VHA's fifth goal as:

VHA's fifth mission is to provide medical services and other support for homeless veterans. Today, VHA is the single largest direct care provider for homeless persons in the country, and we are a critically important - although often unrecognized - element in the nation's public safety net. ²

Likewise, at the 2004 National meeting of the VA Health Services Research and Development, VA researchers presented a study that demonstrated that health status scores are lower for veterans that live in rural settings when compared to scores for other veterans. The study concluded that "innovative" strategies are needed to address the health needs of these veterans. An example of current innovation within VA is the creation of VHA Telehealth Toolkits (e.g., Telemental Health Toolkit, Teledermatology Toolkit, and Home Telehealth Toolkit.) These toolkits help VA provide timely, accessible, and convenient health care in a safe, appropriate, and cost-effective manner. ³

The provision of telehealth technologies to veterans located in rural areas is but one area where VA has taken an active role to provide affordable technologies to address the needs of this population. On-going collaborations that will share the benefit of VA electronic health record capability with expanded populations provide other examples. VA is presently working with HHS Centers for Medicare and Medicaid Services (CMS) to develop a public domain electronic health record optimized for office-based practices and clinics. This tool, which would be available at substantially less expense then a commercial product, could directly support care to rural veterans and others who ordinarily would not benefit from such capabilities. It also would provide a strong basis from which VA could transfer lessons-learned and knowledge to other organizations and partners who work with rural and medically underserved communities.

Today VA continues to provide special programs and initiatives specifically designed to help homeless veterans live as self-sufficiently and independently as possible. Although limited to veterans and their dependents, VA's major homeless-specific programs constitute the largest integrated network of homeless treatment and assistance services in the country. The program includes aggressive outreach, clinical assessment and referral for healthcare, long-term case management and rehabilitation, employment and housing support. ⁴

VA's success in providing health care services to populations that have challenges in seeking their own health care services within the traditional hospital and clinic environments is well documented. Approaches such as equipping mobile vans with clinical and patient care technologies provide unparalleled care in the veterans' home communities. VA has great breadth and depth in experience using health information technologies to support such programs. VA is well-poised to share its experience across government lines and in cooperation with DoD for the benefit of those rural and medically underserved communities that remain out of reach of traditional medicine delivery methods.

VA is reaching out through the State Veterans Homes by providing access to VistA for implementation as well as providing access to clinical information for those veterans residing in State Veterans Homes. VA supports The Computerized Patient Record System (CPRS) Read Only as a software tool which enables medical centers to grant authorized users read-only access to veterans' individually-identifiable health information, and to restrict a user's access to a specific set of patient records. Over 50 State Veterans Homes now have CPRS Read Only access. Over 100 State Veterans Homes have expressed an interest in obtaining CPRS Read Only access to patient data in VistA for a limited number of their clinical staff. Work is proceeding to expand access in order to facilitate continuity of care.

¹ The Rural Public Health Research Agenda, 2004, Bridging The Health Divide, University of Pittsburgh Center for Rural Health Practice, pp. 4-5

² Statement of Kenneth W. Kizer, M.D., M.P.H. Under Secretary For Health Department of Veterans Affairs on the Future of the Veterans Healthcare System before the Committee on Veterans Affairs' Subcommittee on Health U.S. House of Representatives June 17, 1998

³ http://vaww.va.gov/telehealth/toolkits.htm

⁴ http://vaww1.va.gov/homeless/

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