Second is developing statewide and regional networks through 5-year contracts, recently awarded to Colorado, Indiana, Rhode Island, Tennessee, and Utah. Third is establishing a National HIT Resource Center that will provide technical assistance, maintain a repository of best practices, and disseminate useful tools to help with technology adoption. The grant to develop the center was awarded to the University of Chicago (AHRQ, 2004b). Award of the HIT grants (community and statewide) requires the awardees to develop a comprehensive plan encompassing technology adoption, partnerships for interconnections, methods for overcoming barriers to adoption, staff responsibilities, technical assistance needed, an implementation timeline, budget, and measures for ongoing project evaluation (AHRQ, 2003b). The data exchange networks in rural areas are to include academic health centers and providers in urban areas.

The committee applauds these efforts, but is concerned that current funding may be inadequate to fully develop the NHII. Additional funding to rural and frontier areas will be needed to build infrastructure on a national scale. The committee encourages Congress to provide adequate resources to continue the award of grants at both the community and state levels to complete the development of the NHII. The HIT projects noted above and all new projects should incorporate a follow-on phase upon project completion that focuses on interconnections to the larger structure of the NHII. For regions with large rural areas, especially those with large frontier areas, follow-on plans may be coordinated at the state level.

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.

It should also be noted that building an ICT infrastructure must be an integral component of the health system reform demonstrations recommended in Chapter 2. As discussed in Chapter 1, the committee endorses the “bottom-up” approach to health system reform proposed in the earlier IOM report Fostering Rapid Advances in Health Care: Learning from System



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