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Rural HIT Network Development Program - Environment and Technology | HRSA EHBs

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Monday 23rd July 2012 04:58:19 P.M. ET

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Rural HIT Network Development Program
Instructions:
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The OMB control number for this project is 0915-0319. Public reporting burden for this collection
of information is estimated to be 3.77 hours per response, including the time for reviewing instructions, searching existing data sources, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room Rockville,
Maryland, 20857.
For help on this page, please click the ORHP Instructions link under Support at the top right of the page.

Program Selection
Admin Home

H9CRH22851: Alaska State Hospital & Nursing Home Association

Report Status: Not Started

Collection Periods
Grant Number: H9CRH22851 | Grantee: Alaska State Hospital & Nursing Home Association

Role Assignment

Current Report Period: 9/1/2011 - 8/31/2012 | Report Due Date: 9/30/2012
PDF Version
09/01/2011 08/31/2012

Environment and Technology
Network | Sustainability | Health Information Technology

Grantee Info
Grantee Infomation

Network
Please identify the total number of formal member organizations in the consortium or network, as well as the types of member
organizations by non-profit and for-profit status and organization type. Please [more]

Network Size

Baseline Number (prior to
9/1/2011)

Network Size

End of budget year
Number

Number of non-profit member organizations in the consortium or
network
Number of for-profit member organizations in the consortium or
network

Number of member organizations in the Consortium/Network

Baseline Number (prior to 9/1/2011)

End of budget year Number

Area Health Education Center (AHEC)
Community College
Community Health Center
Critical Access Hospital
Faith-based organization
Federally Qualified Health Center (FQHC)
Health Center Controlled Network (HCCN)
Health Department
Hospital
Migrant Health Center
Private Practice
Rural Health Clinic
School District
Social Services Organization
University/College
Other

Network Characteristics
Of the total, please provide the number of new member organizations that joined within the budget year. Please refer to the detailed
definitions for consortium/networks in the program guidance. Please [more]
Total number of health care providers in the network that are eligible for the Medicare and Medicaid EHR Incentive
Program
Number of eligible professionals

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Number of critical access hospitals
Number of hospitals

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Sustainability
If the total amount of additional funding secured is zero (0), please put zero in the appropriate section. Do not leave any sections blank.
Funding/Revenue
Annual program award
The annual program award based on box 12a of your Notice of Grant Award (NGA) or Notice of Award (NoA).
Annual network revenue
The amount of annual revenue (if any) for the Network.
Additional funding secured to assist in sustaining the project
The amount of additional funding secured to sustain the program.
Does the network have a sustainability plan that has been approved by the network’s membership?

Yes

No

Does the network have alternate sources of revenue?

Yes

No

If yes, what is the dollar amount?

$

Estimated amount of cost-savings due to participation in the network
Please provide the estimated amount of savings due to participation in a network/consortium (Consider shared staff, training, equipment,
etc.)

Sources of Network Revenue
Please identify the source(s) of revenue for sustainability and indicate whether you have developed a sustainability plan. Please identify
the types of sustainability activities that the network/consortium [more]
Network Business Revenue
In-Kind contributions
Project Member Dues
Fundraising
Contractual Services
Other
None

HIT Sustainability Activities (Partnerships)
Please indicate if you have a sustainability plan and select your sustainability activities.
The number of network members that participate in a state-designated Health Information Exchange (HIE)?
Program Collaboration Type
Local
State
Federal
Collaboration Programs
Regional Extension Centers (REC)
Health Center Controlled Network (HCCN)
Office of the National Coordinator
Regional Health Information Organization (RHIO)
Federally Qualified Health Center (FQHC)
Federal Communication Commission (FCC)
Other

HIT Sustainability Activities
Media Campaigns
Consolidation of activities, services and purchases (with Network partners)
Communication Plan Development
Economic Impact Analysis
Return on Investment Analysis
Marketing Plan Development
Community Engagement Activities
Business Plan Development
Incorporation

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Organization Bylaws
SWOT Analysis
Sustainability plan
Other
Did you use the HRSA Economic Impact Analysis tool?

Yes

No

Yes

No

Will Network sponsored-HIT training continue after HRSA/ORHP funding ends?

Yes

No

If HRSA/ORHP supported the maintenance of the EHR system, will maintenance of the EHR system continue after

Yes

No

If yes, what was ratio for Economic Impact vs. HRSA Program Funding?
Will the Network/Consortium sustain beyond the Federal funding period?
What activities of the Network/Consortium will sustain?

HRSA/ORHP funding ends?
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Health Information Technology
Please select all types of technology implemented, expanded or strengthened through this program. If your grant program did not fund
these activities, please select “Not Applicable.” Please select all [more]
Type(s) of technology implemented, expanded or strengthened through this program
Not Applicable
Computerized laboratory functions
e-prescribing
Inpatient pharmacy
Outpatient pharmacy
CPOE (computerized Physician Order Entry)
Practice Management System
Email
Electronic clinical applications
Certified Electronic Medical Records
Health Information Exchange
Patient/Disease Registry
Other
Are the EHR systems ONC certified?

Yes

No

How many of your members have attested to Meaningful Use?
How many of your network members have received Medicare or Medicaid incentive payments?

Medicare or Medicaid Incentive Payments Amount Received
Area Health Education Center (AHEC)
Community College
Community Health Center
Critical Access Hospital
Faith-based organization
Federally Qualified Health Center (FQHC)
Health Center Controlled Network (HCCN)
Health Department
Hospital
Migrant Health Center
Private Practice
Rural Health Clinic
School District
Social Services Organization

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University/College
Other

HIT Meaningful Use Stage 1 implementation
Eligible Professionals – 10 Menu Objectives
Please indicate the number of members that have achieved each HIT Meaningful Use Stage 1 implementation criteria listed.
Drug-formulary checks
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems
Capability to provide electronic syndromic surveillance data to public health agencies
Hospitals – 10 Menu Objectives
Drug-formulary checks
Record advanced directives for patients 65 years or older
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems
Capability to provide electronic submission of reportable lab results to public health agencies
Capability to provide electronic syndromic surveillance data to public health agencies

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