HRSA-07-140 Page 1
Flex CAH HIT Network Implementation Program
U.S. Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
FLEX CAH HIT Network Implementation Grants
NEW COMPETITION
Announcement NumberHRSA-07-140
Catalog of Federal Domestic Assistance (CFDA) No. 93.241
PROGRAM GUIDANCE
Fiscal Year 2007
Application Due Date in Grants.gov: June 29, 2007
Letter of Intent due: June 8, 2007
Date of Issuance: May 16, 2007
George Brown
Public Health Analyst
Office of Rural Health Policy
Telephone: 301 443 7321
Fax: 301 443 2803
Authority: Section 1820(g)3 of the Social Security Act
Table of Contents
I. Funding Opportunity Description
Purpose
Authority
General Considerations
Background
II. Award Information
1. Type of Award
2. Summary of Funding
III. Eligibility Information
1. Eligible Applicants
2. Cost Sharing and Matching
3. Other
IV. Application and Submission Information
1. Address to Request Application Package
Application Materials
2. Content and Form of Application Submission
Application Format Requirements
SF 424 Non Construction – Table of Contents
Application Format
3. Submission Dates and Times
Notification of Intent to Apply
Application Due Date
4. Intergovernmental Review
5. Funding Restrictions
6. Other Submission Requirements
V. APPLICATION REVIEW INFORMATION
1. Review Criteria
2. Review and Selection Process
3. Anticipated Announcement and Award Dates
VI. Award Administration Information
1. Award Notices
2. Administrative and National Policy Requirements
3. Reporting
VII. Agency Contacts
VIII. Definitions
ix. Tips for Writing a Strong Application
X. Sample Memorandum of Agreement
XI. Resources for Applicants
XII. HRSA REQUIRED PERFORMANCE MEASURES
APPENDIX A: HRSA’s Electronic Submission User Guide
1.Introduction
1.1Document Purpose and Scope
1.2Document Organization and Version Control
2.Noncompeting Continuation Application
2.1Process Overview
2.2Grantee Organization Needs to Register With Grants.gov (if not already registered) – See Appendix B
2.3Project Director and Authorizing Official Need to Register with HRSA EHBs (if not already registered)
2.4Apply through Grants.gov
2.4.1Find Funding Opportunity
2.4.2Download Application Package
2.4.3Complete Application
2.4.4Submit Application
2.4.5Verify Status of Application
2.5Verify in HRSA Electronic Handbooks
2.5.1Verify Status of Application
2.5.2Manage Access to Your Application
2.5.3Check Validation Errors
2.5.4Fix Errors and Complete Application
2.5.5Submit Application
2.6Submit Signed Face Page
3.Competing Application
3.1Process Overview
3.2Grantee Organization Needs to Register With Grants.gov (if not already registered) – See Appendix B
3.3Apply through Grants.gov
3.3.1Find Funding Opportunity
3.3.2Download Application Package
3.3.3Complete Application
3.3.4Submit Application
3.3.5Verify Status of Application
3.4Submit Signed Face Page
4.General Instructions for Application Submission
4.1Narrative Attachment Guidelines
4.1.1Font
4.1.2Paper Size and Margins
4.1.3Names
4.1.4Section Headings
4.1.5Page Numbering
4.1.6Allowable Attachment or Document Types
4.2Application Content Order (Table of Contents)
4.3Page Limit
5.Customer Support Information
5.1.1Grants.gov Customer Support
5.1.2HRSA Call Center
5.1.3HRSA Program Support
6.FAQs
6.1Software
6.1.1What are the software requirements for using Grants.gov?
6.1.2Why can’t I download PureEdge Viewer onto my machine?
6.1.3 I have heard that Grants.gov is not Macintosh compatible. What do I do if I use only a Macintosh?
6.1.4What are the software requirements for HRSA EHBs?
6.1.5What are the system requirements for using HRSA EHBs on a Macintosh computer?
6.2Application Receipt
6.2.1What will be the receipt date--the date the application is stamped as received by Grants.gov or the date the data is received by HRSA?
6.2.2When do I need to submit my application?
6.2.3What emails can I expect once I submit my application? Is email reliable?
6.2.4If a resubmission is required because of Grants.gov system problems, will these be considered "late"?
6.3Application Submission
6.3.1How can I make sure that my electronic application is presented in the right order for objective review?
6.4Grants.gov
Appendix B – Registering and Applying Through Grants.gov
I. Funding Opportunity Description
Purpose
The Office of Rural Health Policy (ORHP) was established by the Administration in August 1987, subsequently authorized by Congress in December 1987 and located within the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (DHHS). ORHP is charged in Section 711 of the Social Security Act with advising the Secretary of DHHS on the effects of current policies and proposed statutory, regulatory, administrative and budgetary changes in the programs established under Titles XVIII and XIX, the financial viability of small rural hospitals and other health care providers, the ability of rural areas (rural hospitals in particular) to attract and retain physicians, including other health professionals and access to (and the quality of) health care in rural areas.
Additionally, ORHP is mandated to oversee compliance with the requirements of section 1102(b) of the Social Security Act and section 4083 of the Omnibus Budget Reconciliation Act of 1987. It is mandated to establish and maintain a clearinghouse for collecting and disseminating information on rural health care issues, research findings relating to rural health care and innovative approaches to the delivery of health care in rural areas. ORHP is charged with coordinating rural health activities within the Department, with particular attention to the Centers for Medicare and Medicaid Services and its programs. This will also include related activities of other Federal agencies such as the Veterans Administration, the Department of Agriculture, the Department of Defense, the Department of Transportation, the Department of Housing and Urban Development and the Commerce Department. ORHP is to also work with States, State hospital associations, private associations, foundations and other organizations to find solutions to rural health care delivery problems.
The Department of Health and Human Services has identified furthering the use of health information technology (HIT) as a key priority. This focus also supports the President’s goal of universal adoption of electronic health records for all Americans by 2014. This guidance promotes the implementation of HIT and electronic health records (EHR) in CriticalAccessHospitals (CAHs) and the providers they work with directly.
The purpose of this solicitation is to provide funds for up to 15 grantees to support the development of one (1) Flex CAH-HIT Network pilot programs in each State that is awarded a grant. Examples of HIT may include practice management systems, disease registry systems, care management systems, clinical messaging systems, personal health record systems, electronic health record systems and health information exchanges.
Through this solicitation, HRSA is asking each State Flex grantee that receives this CAH-HIT funding to identify either a single CAH or up to three CAHs and their associated network of providers that together provide a full continuum of care for rural residents in their service area. The network to be identified by the grantee may include up to three CAHs as well as a common larger referral hospital to which they typically refer more complex patients. It is critical that the proposed network developed by the Flex applicant follow common patient referral patterns in order to build upon existing patterns of care. The network would also need to include local partners for the CAHs in the network including but not limited to private practice physicians, Medicare-certified Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), nursing facilities, home health agencies, public health departments and emergency medical service providers. The CAH-HIT Network proposed by the applicant should cover a service area that reflects the natural flow of patients served by the CAH and its associated providers.
HRSA is limiting the network to three CAHs and their associated partners in order to maximize the funding impact. The awarded Flex grantees should be able to ensure that the development of a network of natural partners is formulated to support the sharing of patient information across the broadest possible local continuum of care. The goal of this solicitation is to ensure that for patients, served by the participating CAH-HIT Networks, clinical information is accessible to providers as they migrate from ambulatory care to acute service delivery sites along established care and referral patterns. Initial analysis by the Flex Monitoring Team shows that in many States CAHs often will refer more complex cases to the same common tertiary care center. The FLEX Monitoring Team consists of the Rural Health Research Centers at the Universities of Minnesota, North Carolina, and Southern Maine, under contract with the federal Office of Rural Health Policy are cooperatively conducting a performance monitoring project for the Flex Program. The project assesses the impact of the Flex Program on rural hospitals and communities. Additionally, the project assesses the role of states in achieving overall program objectives, including improving access to and the quality of health care services; improving the financial performance of Critical Access Hospitals; and engaging rural communities in health care system development. The goal of the CAH-HIT program is to concentrate funding within a smaller service area to increase the likelihood of creating a pilot project that will be sustainable and may serve as a model to other areas of the State and nation.
HRSA acknowledges that within the application time all applicants may not be able to formally identify all of the potential partners for the Flex CAH-HIT Network given that it must look across its State and identify the partners that will most likely be able to take advantage of this opportunity to build a pilot network. In those cases where an applicant cannot identify the exact network partners the applicant should be able to explain a process by which it will select the specific partners for the network. In these situations, it is expected that any applicant awarded funds under this competition that cannot immediately identify all network partners will do so within 30 days of receiving their notice of grant award. All application materials should reflect this time frame in their planning and throughout the application as appropriate.
HRSA acknowledges that there are many challenges and barriers involved with implementing successful HIT and EHR projects including the large financial investment. Flex CAH HIT Network funds will provide the financial resources and training needed to address many of the barriers associated with implementation.
The aims of this grant funding opportunity is to support the intent of using HIT as a tool to improve the safety, quality, efficiency, and effectiveness of health care delivery. The aims include the adoption and effective use of HIT; the creation of sustainable business models for deploying HIT in Flex CAH networks; enhancing the ability of safety net providers to leverage initiatives and resources as well as improving quality and performance improvement in the Rural Hospital Flexibility Grant Program.
HRSA seeks projects with an active quality improvement program that can provide evidence of the utilization of data to improve care, and that can demonstrate the value and effectiveness of CAHs and their partners in the marketplace. One example of such a program is participation with the Center for Medicare and Medicaid Services’ Hospital Compare website working through the Medicare Quality Improvement Organizations.
This funding opportunity provides an opportunity for Flex grantees to work with a pilot project network of up to three CAHs and the providers through which they offer a full continuum of care. Ideally, this initiative will align information system goals and objectives to focus on patient and clinical care. Projects should support the move to a clinical information system through an integrated system with a common architecture. This will provide the best clinical and administrative solution to the marketplace and will eliminate both disparate clinical database sources and the fragmentation of clinical data and information.
HRSA recognizes that there are many EHR products available for purchase. Applicants can use any type of HIT (including open source systems and public domain systems created by Federal agencies such as the Veterans Administration and the Indian Health Service). HRSA encourages applicants to work with their peers who have already implemented successful HIT projects.
Applicants will be expected to demonstrate that an integrated and networked integrated network HIT infrastructure will be developed through the following four phases that support the aforementioned aims:
1. A finalplanning phase where the network will finalize a HIT implementation plan and complete contract negotiations with a vendor. The implementation plan should focus Federal funding on the implementation activities of the proposed project. It is expected that some initial planning would have already taken place for the participating partners in this project. Successful applicants should be ready to have the HIT applications implemented within 14 months of the notice of grant award.
2. A testing phase where the plan will be thoroughly tested and modified as necessary. Money under this grant program may be used during this phase (and/or during the planning phase as well) to purchase software and licenses, hardware, and to obtain implementation assistance and any technical staffing necessary.
3. An infrastructure building phase where grant funds will be used to not only build infrastructure but also to help transition workflow. A secure platform for communication and sharing of clinical and other key data will be established during this phase. These data should facilitate the development of at least five performance outcome measures with national benchmarks. Measures required by HRSA under this solicitation are diabetes control performance indicators and cardiovascular health improvement (see Appendix E for descriptions of these measures). Sustainability should be emphasized here.
4. An implementation phase where the HIT project will be rolled out to participants of the project in a coordinated and integrated approach. These grant funds shall not be used for the ongoing maintenance of technology.
Authority
This grant program is under the auspices of the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS). Projects are overseen by HRSA’s Office of Rural Health Policy. The funding for this opportunity is in accordance with Section 1820(g) of the Social Security Act.
General Considerations
In selecting applications for funding, special consideration will be given to geographic distribution and applications that can identify a clear and rational service area that quantitatively demonstrates that it includes the broadest continuum of care for the patients served by the CAHs in the CAH-HIT network.
Background
To be successful in the health care arena, it is essential that CAHs have state of the art information systems. According to a report from the Flex Monitoring Team (Briefing Paper No. 11, The Current Status of Health Information Technology Use in CAHs, May 2006), CAHs are facing some challenges in adopting HIT. Only 20 percent of CAHs have some form of an electronic health record while only 25 percent use electronic prescription order entry.
HRSA’s experience has shown that it is cost effective to utilize networks of health care providers to develop health information technology systems. HRSA is interested in programs that can measure the impact of HIT in terms of outcomes that support the aims of this funding opportunity. As described in the Organizational Information section, applicants should have past experience with the use of quality improvement programs. HRSA requires at least five performance outcome measures two of which HRSA defines to include diabetes control and heart disease risk reduction (see the appendix or the evaluation section of this guidance for a description of these performance measures). The applicant should utilize measures to support the aim of enhancing the effectiveness, efficiency, safety and quality as related to HIT implementation.
- Effectiveness. The extent to which integrating a clinical quality improvement program with HIT will improve both health outcomes and systems of care. For example, a network may use clinical decision support systems to generate reminders that promote preventive care to manage chronic diseases and to improve population health.
A network shall aim to promote the adoption and effective use of HIT. Specifically, it may:
- Measure and effectively report on quality of care and health outcomes in FLEX CAH-HIT Provider Network.
- Reduce health care costs that result from inefficiency, medical errors, inappropriate care and incomplete information and duplicated tests and procedures at upstream hospitals.
- Increase the availability and transparency of information related to the health care needs of the patient and to support physician decision making.
- Ensure the integration of clinical information with business information systems.
- Prepare the CAH-HIT Networks to enhance revenues through participation in pay-for-performance plans/systems.
- Support the ability to provide a rapid response to both natural and man-made disasters, including those due to bioterrorist acts.
- Further develop continuity of care across settings for CAH-HIT Network patients. This continuity of care is not only for patients as they move from outpatient to urgent, emergency, and inpatient care, but also for when they may move between geographic areas either voluntarily or involuntarily as in the case of a disaster.
- Efficiency. The extent to which inefficiencies such as lost medical records, lab results, and inadequate appointment systems are diminished through the implementation of HIT the projects which should be able to project return on investment. This projection can be related to time saved, increases in revenue, increased tracking and or reporting of patient’s quality and health outcomes.
A network shall aim to achieve efficiencies in its HIT implementation. Specifically, it should: promote a more effective marketplace, increase competition and systems analysis, enhance quality and improve outcomes in the CAH-HIT Network. It should also enhance the capability of the providers to enter into collaborative strategies that leverage initiatives and resources (including knowledge, experience, and funding) already present in their communities.
3. Safety and Quality. The extent to which mechanisms, such as computerized provider order entry (CPOE), enhance patient safety and improve risk management practices by preventing medication and other medical errors.