我对改善农村地区美国人医疗服务的愿望
My Wish For Better Care For Americans Living in Rural Areas
尊敬的 Medicaid 主任、州领导及其他获批 Rural Health Transformation（RHT）拨款资助的重要合作伙伴：
你们的工作令人疲惫，却又永无止境——你们的付出有人看见，也有人听见。从老龄化的患者群体、慢性疾病、合并症和日益严重的无家可归问题，到 Medicare 和 Medicaid 报销金额并不总能对你们有利地平衡，再到最近的 Target 或电影院距离两小时车程、难以招募和留住医疗专业人员的困境，你们经常面对棘手的问题，却没有简单的答案。作为曾担任 Federally Qualified Health Center（FQHC）董事会成员、在健康 IT 领域工作数十年并服务于美国政府的人，我明白你们很容易会选择放弃，收拾行李，开车前往郊区或大都市地区那些条件更好的地方。但你们没有这样做。你们扎根下来，以同理心、创造力和解决问题的思维方式投入社区工作——而且往往手头可用的资源非常有限。
新的 500 亿美元农村医疗转型联邦拨款资金，是一个受欢迎的启动支持，将改善农村医疗公平差距。这笔资金为支持约 8500 万名生活在农村地区的美国人提供了一个可喜的机会。这些人通常需要行驶 20 至 30 英里才能获得初级医疗服务，但有时为了获得专科医疗服务，甚至需要行驶 100 英里或更远。距离和专科医疗服务可及性等障碍，往往导致人们放弃就医，并造成致命后果——正如一篇 Boston University Public Health 文章所指出的那样。
由以下机构呈现赞助文章自动化医疗机构内部：围绕人而非文书工作重新设计医疗服务通过减少行政负担并围绕人的需求重新设计工作流程，为最重要的事情创造空间：临床医生与患者之间的联结。
作者：Michael Blackman，MD、MBA，Greenway Health® 首席医疗官如果我处在你们的位置，思考如何最好地将这些资金投入社区，以下五件事会位列我的愿望清单之首。虽然技术是一个关键投资领域，但它本身并不能解决问题——技术能够让医疗系统的运行显著改善。健康数据交换和互操作性可以支持远程患者监测、居家医院以及与社区组织开展合作，因此绝对应该成为你们战略的一部分。
你们所在的州应与医疗服务提供者合作，升级其 Electronic Health Record——或同等系统——然后出资将其连接到州级或地方级 HIE。数据共享对于保持患者健康和安全、让患者无论身处何处都能获得医疗服务至关重要。加强数据交换，并确保有宽带和蜂窝网络服务为其提供支持，同样重要。各州或拨款受助方应围绕全州互操作性路线图，召集所有重要利益相关者，利用现有的 Health Information Exchanges（HIEs）和互操作性通道开展工作。许多这样的组织已经存在，无需重新发明轮子。现在正是接入本州更广泛的医疗服务提供者、付款方、实验室及其他重要资源网络的时候。
招募医疗队伍是一项挑战，但远程医疗的进步可以填补这些空缺。我们通常认为远程医疗是临床医生与患者之间的连接，但远程医疗也可以实现临床医生与临床医生之间跨越遥远距离的连接。借助适当的基础设施，专科医生可以远程参与操作或会诊。这还有助于开展交叉培训，并拓展农村医疗服务提供者的技能范围。我们还需要确保临床医生能够充分发挥其执业资质所允许的作用，并确保州法律对此提供支持。
AI 本身就是一个独立的话题，但为简单起见，必须明确一点：没有数据战略，就不可能拥有 AI 战略，而互操作性正是数据战略的基础。与其购买 AI 解决方案，不如先确定你们最重要的业务、运营或患者依从性需求，然后再了解 AI 可能在解决这些问题方面取得怎样的成效。我们在医疗领域看到的最成功的 AI 应用，主要与文档处理以及协助临床医生在客户门户中起草回复、供其审核有关。
利用资金改善、升级和翻新临床空间，使其更加高效，并适应不同层级的医疗服务。建立临床整合网络，实现资源共享——尤其是医疗设备、技术和人员的共享。这些基础设施改进将使患者获得更好、更高效的医疗服务，并减轻医疗服务提供者的负担。
着眼于拓展以社区为基础的医疗服务模式。粮食不安全、交通和住房脆弱性、心理健康——这些问题通常被视为医疗服务的外围问题，但实际上却处于医疗服务的核心。在纽约州等地，为食品银行或与拼车服务提供商合作的项目建立社区转诊机制，已经产生了巨大作用，在你们所在的地区也可以做到这一点。以信仰为基础的组织、当地学校、图书馆或其他距离人们住所更近的社区聚集场所，都可以成为相互连接的医疗服务体系的一部分。这需要技术基础设施提供支持，但绝对是一项值得的投资。
长期以来，你们不得不依靠的不外乎运气、勇气和创造力来维持工作。农村医疗转型计划不会在一夜之间改变农村医疗危机的严峻现实。但这是一个受欢迎的开端。而且，通过审慎和创新地使用这些资金，这个开端最终可能真正带来转型。回顾一些以往政府资助项目的成果可以发现，在许多情况下，初衷是好的，但执行过程并未为未来的发展道路留下空间。
让我们从这些错误中吸取教训，确保这笔资金得到最充分、最有益的投入。在你们与州合作伙伴协作改善患者/公民的医疗服务和健康结果时，这些内容可以作为一些思考。我也预计，这笔资金将帮助减轻你们最沉重的负担。我们之所以都在医疗领域工作，是因为我们关心患者，也因为我们希望支持所有人的健康、幸福与长寿。
由以下机构呈现赞助文章医疗支付行业面临认知挑战医疗支付已不再只是交易问题，而是关乎控制收入周期。而且，这种控制越来越不掌握在 ISOs 手中。
作者：Lisa Brooks，医疗合作副总裁
在你们追求这一目标的过程中，我向你们致以最美好、最诚挚的祝愿——我与你们同在，随时为你们提供支持，并始终为你们加油。
作者简介：
Lynda Rowe
是一名健康 IT 顾问，拥有二十多年高级管理层经验，职业经历涵盖付款方、医疗系统、供应商、初创企业和联邦政府，包括在 CDC、InterSystems、Booz Allen Hamilton 和 J2 Interactive 任职。她的工作重点一直是互操作性、价值医疗以及支持国家公共卫生基础设施的数据系统。Lynda 长期倡导服务不足的社区，曾在 Federally Qualified Health Center 董事会任职 20 年，并将对公平的承诺融入其咨询实践和行业思想领导工作中。
图片：Niyazz，Getty Images
Dear Medicaid Directors, State Leaders, and other invested collaborators who were awarded Rural Health Transformation (RHT) Grant funding, Your job is exhausting and tireless — you are seen and heard. From aging patient populations with chronic illnesses, co-morbidities, and rising homelessness to the math not always adding up in your favor on Medicare and Medicaid reimbursements, to struggles to recruit and retain health professionals when the nearest Target or movie theater is a two hour drive away, you regularly face hard questions with no easy answers. As someone who has been on the board of an Federally Qualified Health Center (FQHC), worked in health IT for decades, and served our U.S. government, I get how easy it would be for you to throw up your hands, pack your car, and head to greener pastures in the suburbs or metro areas. But, you don’t. You dig in and show up for your communities with compassion, ingenuity, and a problem solver’s mindset — often with very few resources at your disposal.
The new $50 billion in rural health transformation federal grant funding is a welcome jumpstart that will improve rural health equity gaps. This funding is a welcome opportunity to support the approximately 85 million Americans living in rural areas, who frequently need to travel 20-30 miles for primary care, but sometimes up to 100 miles or more for specialty care. Barriers like distance and access to specialty care often result in people skipping care, with fatal consequences — as noted in a Boston University Public Health article By Michael Blackman, MD, MBA Chief Medical Officer, Greenway Health® Below are five things that would be at the top of my wishlist if I were in your shoes, wondering how best to invest these funds in my community. While technology is a key area of investment, it doesn’t solve the problem — it enables the healthcare system to work significantly better. Health data exchange and interoperability allow for remote patient monitoring, hospital at home, and community-based organization collaborations, and should absolutely be a part of your strategy.
Your state should work with healthcare providers to upgrade their Electronic Health Record— or the equivalent— and then pay to connect them to the state or local HIE. Data sharing is essential to keeping patients healthy and safe, facilitating their care wherever they go. Shoring up data exchange and making sure that broadband and cellular services are there to support this is equally important. States or grant recipients should be convening all important stakeholders around a state-wide interoperability roadmap using existing Health Information Exchanges (HIEs) and interoperability pathways. Many of these organizations already exist- there is no need to reinvent the wheel. Now is the time to connect into the broader network of providers, payers, labs, and other vital resources in your state.
Workforce recruitment is a challenge, but advancements in telehealth can fill in those gaps. We often think of telehealth as a connection between clinician and patient, but telehealth can also be clinician to clinician, across great distances. With the right infrastructure, specialists can be present for procedures or consultations remotely. This additionally helps with cross-training and expanding the skillsets of rural health care providers. We also need to make sure clinicians can work at the top of their license and that state laws support that.
AI is a topic all unto itself, but to keep things simple- one cannot have an AI strategy without first having a data strategy, and interoperability is the foundation of that data strategy. Rather than shop for AI solutions, determine your greatest business, operations, or patient compliance needs, and then see what kinds of success AI might have in solving those problems. The greatest AI successes we’re seeing in healthcare are related to document processing and assisting clinicians with drafted responses in their client portals for their review.
Use funds to improve,upgrade and renovate clinical space to make it more efficient and conducive to different levels of care. Create clinically integrated networks that allow sharing of resources — especially medical equipment, technology and staff. These infrastructure improvements will allow for better and more efficient care of patients and reduce burden for providers.
Look to expanded, community-based models of care. Food insecurity, transportation and housing vulnerability, mental health- these are all things that are often treated as the periphery of healthcare, but in reality are at its core. Establishing community-based referrals for food banks or programs with rideshare providers have made the world of difference in places like New York state, and can in yours too. Faith-based organizations, local schools, libraries, or other communal gathering spaces which are closer to people’s homes can become part of the connected fabric of care. It requires a technical infrastructure to support it, but is very much a worthy investment.
For too long, you have had to get by on little more than luck, pluck, and ingenuity. The rural health transformation program is not going to change the stark realities of the rural healthcare crisis overnight. But, it is a welcome start. And, with thoughtful and innovative uses of the funds, this beginning may turn out to be truly transformative. Looking back to outcomes of some prior government funded programs, in many cases, the intent was good, but the execution did not allow for a future path.
Let’s learn from those mistakes, and ensure this funding is invested to its fullest and greatest good. These are some things to think about as you and your state partners collaborate to improve the care and outcomes of your patients/citizens. I also anticipate the funding will help to alleviate your heaviest burdens. We all work in healthcare because we care about patients, and because we want to support health, happiness, and longevity for all.
My best and sincerest wishes to you in this pursuit — I am with you, here for you, and always cheering you on.
Author bio:
Lynda Rowe
is a health IT consultant with more than two decades of senior-level experience spanning payers, health systems, vendors, start-ups, and the federal government, including roles at the CDC, InterSystems, Booz Allen Hamilton, and J2 Interactive where her work has centered on interoperability, value-based care, and data systems that support national public health infrastructure. A long-time advocate for underserved communities, Lynda has served on the board of a Federally Qualified Health Center for 20 years and brings that commitment to equity into her consulting practice and industry thought leadership.
Photo: Niyazz, Getty Images