Inside states’ application for the federal rural health transformation program

States are poised to receive a share of $50 billion from the federal government to support investments to improve rural health care delivery, and state officials in a recent media briefing said enhancing data and tech infrastructure is one of their main priorities. 

The Rural Health Transformation Program, a federal funding opportunity announced in September, looks to help states implement more efficient data ecosystems and health care technology services, among other projects. State governments are eligible to receive payments over the next five years for the overall mission of boosting rural health care quality, access and outcomes. 

The Rural Health Transformation program can help “fast track” and “nourish” states’ ongoing efforts to modernize and upgrade rural health systems, said Puthiery Va, director of the Maine Center for Disease Control and Prevention, in a briefing hosted Monday by the Association of State and Territorial Health Officials. 

At the foundation of that work is an efficient data ecosystem, which is “the first step” to improve rural population health by enabling collaboration and partnerships among public and private providers like primary care clinics, federally qualified health clinics, mobile health care units, hospitals and others, Va said. 

That environment “ensures coordinated continuity of care among providers and provides better care for individuals and communities,” while also helping state leaders better leverage “clinical information [and] population-centered information to really inform public health policies and strategies as well,” she said. 

Maine officials, for instance, have applied for $500 million under the program, $25.1 million of which would support better health care data integration and exchanges in the state. Another  $121 million is allocated for expanding the utility, functionality and security of electronic medical record systems, according to a summary of the state’s program application. 

“These platforms often serve as the foundation into which telehealth, AI solutions, consumer tools and other health technologies are built,” officials wrote in the summary. 

“We recognize the need to invest and continue to invest in prevention and improve conditions that really keep people well, while also ensuring that the infrastructure is in place to respond when acute health care crises arise,” Va explained. “So health systems really must meet people where they are before, during and after illnesses.”  

Iowa similarly sees developing and improving data infrastructures as one of three primary goals for state officials under the Rural Health Transformation Program, said Robert Kruse, state medical director for the Iowa Department of Health and Human Services. 

“About 47.5% [of Iowans] live in rural census tracts … and that really means that any gap in access, workforce, transportation or infrastructure affects a very large share of our families and communities," he said. 

Iowa’s plan submitted to the federal program, called Healthy Hometowns, is “designed to strengthen our rural care today and ensure it still exists tomorrow,” Kruse said. If awarded, the state will receive more than $1 billion over five years to fund the initiative. 

A major priority for the state is to strengthen its health information exchange infrastructure to encourage more seamless data sharing, like the flow of discharge summaries and labs, among hospitals, clinics, emergency medical services, behavioral health providers and others, Kruse explained. 

The health information exchange initiative would enable the “sharing of patient records between health care providers across unaffiliated systems and diverse electronic health record systems … representing a data exchange partnership between providers committed to improving care for rural Iowans,” according to a project narrative released by the Iowa Department of Health and Human Services. 

This effort ultimately aims to reduce the burden on small rural facilities in “improving continuity of care, enhancing public health surveillance … especially in those counties with limited analytics capacity, and then also supporting interoperability … to have that bidirectional data exchange,” he said. 

The improved HIE will help drive Iowa's other goals under the federal program, such as its Hometown Connections initiative. The project aims to establish care networks across the state that expand residents’ access to telehealth and other specialized services, which depend on secure and efficient health data sharing, state officials said. 

“Rural health works best when it’s part of a coordinated system of care, not a collection of isolated facilities trying to sustain every service line independently,” Kruse said. “Having a system-wide approach,” he added, “is the only way to … improving the outcomes.”