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Ask Nicely

December 21, 2008
by David Raths
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Healthcare organizations looking for grant money must appreciate the art and science behind the process

For CIOs interested in seeking grant funding for IT projects, there are a few key questions:

Where should we start looking for funds?

How should we focus the grant application?

Is it necessary to form regional partnerships before applying?

From his years of working in hospital capital development, Michael Christopher can attest that most CIOs don't know where to find the answers to those questions. “I had talked to enough people who start ed down this road but were completely lost,” says the chief technology officer of consulting firm Healthcare IT Transition Group (Tulsa, Okla.).

Christopher sensed there was a market need for a guidebook to healthcare information technology funding sources. The CIOs he dealt with “didn't know where to start looking for grants. They knew about federal sources such as AHRQ (the Agency for Healthcare Research and Quality) and that's about it,” he says. (See sidebar on federal funding sources.)

What Christopher didn't realize when he began researching the Health IT Grant Resource Directory was that there were so many sources of funding that it would stretch to more than 5,600 entries in five regional volumes. “I was shocked in pulling it together how many sources there were, and how I could pull the criteria tighter from more general funders of healthcare projects,” he says.

Researching foundation and government Web sites and purchasing a directory can be good first steps, but Christopher stresses that organizations must send requests for guidelines from grant-making organizations and make contact with the people at foundations to get a clear sense of what their mission is. “A directory like ours can't replace that discovery process,” he says. “You have to go through it.”

Begin looking close to home

Most foundations make grants at the state or regional level, so it makes sense to start close to home. Stephen Banks, senior vice president of One River Grants (Troy, N.Y.), which helps healthcare organizations find and apply for grant funding, doesn't sugarcoat his message about how difficult the process is.

“I would tell CIOs that grant funding is tough,” he says. “Funders are interested in concepts that are new and unique. Electronic health records are not new. They are vital, but if you are looking for a foundation or state government to provide you with catch-up funding, you are probably going to be disappointed.”

An exception might be state governments that have mandated health IT adoption. For instance, a recently passed state law requires Minnesota healthcare providers to adopt electronic prescribing systems by 2011 and EHRs by 2015. To help providers meet the deadlines, the Minnesota Department of Health's Office of Rural Health and Primary Care recently awarded $3.5 million in grants.

In general, however, state governments are reluctant to get into this area because the needs are so vast, Banks notes. The state of New York has been an exception, but it has been focused on information exchange, not hardware and software at the provider level.

Put technology second

Experienced grant writers say that the first rule in writing a health IT grant is that it should target the broad initiatives that the foundation or government entity is focused on, and the technology shouldn't come first. “You want the grant narrative to be about people and patient safety or reaching out to underserved community members and how this project is going to make their lives better,” Christopher says. “That may sound cliché, but that is the type of language you should use.”

If CIOs are instigating a grant search, they should look at content areas such as chronic disease management that have an essential IT component, Banks says. For example, the New York State Health Foundation might fund diabetes care improvement, and if so, one of the elements would be IT-related, because it involves timely access to information.

Strength in numbers

Partnering with other healthcare organizations exponentially increases the likelihood of winning a grant, because foundations see it as a way to fund more than one organization at a time, according to grant writers. “A regional partnership increases the impact and leverage for the funding source,” Banks says. “Agencies like the federal Health Resources and Services Administration (HRSA) are looking for partnerships — and ones that didn't just form to get this grant, but that are ongoing in the community.”

On the other hand, partnerships complicate things. A strategic partnership between competing organizations can make meeting grant deadlines difficult. “It's hard enough to get a grant together with one hospital and affiliated clinics,” Banks says. “It's much harder to get cooperation across organizations.”

From the foundation's perspective

Organizations might think that the difference between proposals that get funded and those that don't involves the quality of the proposals' narrative. But as someone who reads a lot of health IT grant proposals, Jonah Frohlich, senior program officer for the California HealthCare Foundation (CHCF) in Oakland, Calif., says he tries to avoid paying too much attention to good writing.

“It's easy for us to read proposals that have all the right buzz words and get drawn in, but upon review we have to ask ourselves if they have addressed the important issues,” he says. “Where is the need, the pain? If we can't find that, it sets off an alert for us.”

Leigh burchell

Leigh Burchell


The foundation, whose projects are almost exclusively in California, has more than $900 million in assets and distributed about $38 million in grants for its fiscal year that ended in March 2008.

Like many foundations that support health IT initiatives, CHCF focuses on how technology can improve collaboration between labs, clinics, nursing homes and hospitals. “When we see a collaboration of hospitals, clinics, and long-term care facilities taking a holistic approach to healthcare, we are drawn to that model,” Frolich says. “We are less interested in one-off EMR implementations than in new approaches that are replicable by other organizations, and that will not require continuous support after adoption.”

Frolich cites the example of the California Networks for Electronic Health Record Adoption program, which was initiated to speed adoption and lower the overall cost of electronic records in California community clinics and health centers. In 2006, CHCF joined with the Blue Shield of California Foundation and the Community Clinics Initiative in committing $1.5 million to a three-year effort to assist community clinics in implementing EHRs in a networked fashion.

“We believe they are creating a foundation that can be built upon after grant funding is gone,” Frolich says. “We want to support new models like that rather than reducing an existing burden.”

Frolich says another red flag in a grant proposal is a lack of commitment from leadership. “There should be a letter from a CEO or from people who are part of a partnership,” he says, “but if it seems like something just comes out of a grant-writing department without that, it's a problem.”

CIOs usually play an active role in grant-seeking efforts, whether they are writing the grant themselves or working with staff grant writers, says Frolich. And CHCF seeks out CIOs to act as advisers about what its focus areas should be and which particular projects to fund. “They are closer to the pain points and issues that need to be confronted, so we ask them to help us select projects to fund and research areas to pursue,” he says. “Provided, of course, that there is no conflict of interest for them.”

Working with vendors

Healthcare IT product vendors can also be a source of funding, through assistance in writing grants or in-kind donations. For instance, telemedicine equipment provider Tandberg (New York) has an eight-person grant services team that refers hospitals to grant-writing specialists and provides support. Having gone through the process of helping other groups apply for federal grants many times, the company can offer tips and feedback to rural hospitals and consortia, says Joe D'Iorio, Tandberg's manager for telehealth.

The Center for Community Health Leadership (Raleigh, N.C.), an Allscripts organization founded in 2006, is awarding grants of software worth up to $10 million and provides guidance on health information exchange to community organizations striving for improvements in healthcare delivery through broad-scale EHR adoption.

So what are the center's executives looking for in grant applications? “We like to get a sense that a community has already had conversations about data sharing, rather than seeing this as an opportunity to begin that conversation,” says Leigh Burchell, director of the center. “They should have a clearly defined goal for the project, and at least the beginnings of a sustainable business model to indicate that they understand the process of getting an HIE off the ground and embrace the full process. Overall, communities interested in data exchange need to think beyond the up-front funding and work through recurring finance models and some of the sticky governance issues to ensure long-term success.”

The center's first grantee was a group in New Haven, Conn., led by 511-bed Hospital of Saint Rafael. The hospital championed the effort to win the $3 million grant and worked with local community physicians and healthcare agencies. Burchell says Gary Davidson, vice president and CIO, and John Drury, M.D., chief medical information officer at the hospital, played key roles in initiating the project.

Vendors sometimes ask grantees to provide research data. The center asks that they be willing to share data points — qualitative and quantitative — about return on investment, both in terms of patient health and improved efficiencies.

Measurable results

Some CIOs seek out grant-writing consultants, especially if they work in smaller organizations. Larger hospitals do have development offices, but tend to focus on fundraising and community events. When it comes to grants that require evidence-based interventions, it requires a different kind of writing that may not be the hospital's focus. But whether organizations seek outside help or not, One River's Banks advises taking the time to become aware of the goals, interests and requirements of the funding agencies. “They each have an agenda and a level of sophistication about measurable results they expect in the grant, so get a good sense of that early on.”

Healthcare Informatics 2009 January;25(13):42-45

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