• The Indian Health Service should develop a strategy for transitioning all of its provider sites (including those operated by tribal governments under the Self-Determination Act) from paper to electronic health records.

  • The Health Resources and Services Administration should develop a strategy for transitioning community health centers, rural health clinics, critical access hospitals, and other rural providers from paper to electronic health records.

  • The Centers for Medicare and Medicaid Services and the state governments should consider providing financial rewards to providers participating in Medicare or Medicaid programs that invest in electronic health records. These two large public insurance programs should work together to re-examine their benefit and payment programs to ensure appropriate coverage of telehealth and other health services delivered electronically.

The ultimate goal is to establish a national and even global health information infrastructure that allows for the exchange of patient data between authorized users in a secure environment. The NHII will likely be built community by community, with local or regional health information infrastructures adhering to national data standards. In October 2004, the Agency for Healthcare Research and Quality awarded $139 million in contracts and grants to communities and health systems to enhance ICT capabilities. The committee applauds this effort, but is concerned that current funding is too limited.

Recommendation 11. The Agency for Healthcare Research and Quality’s Health Information Technology Program should be expanded. Adequate resources should be provided to allow the agency to sponsor developmental programs for information and communications technology in five rural areas. Communities should be selected from across the range of rural environments, including frontier areas. The 5-year developmental programs should commence in fiscal year 2006 and result in the establishment of state-of-the-art information and communications technology infrastructure that is accessible to all providers and all consumers in those communities.

Rural communities, like urban areas, are embarking on a period of enormous change. Communities will need both technical and educational assistance to make this transition smoothly and successfully.

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