An Interview with Leila Samy

by Beth Blevins

Leila Samy, MPH, is the Rural Health IT Coordinator at the Office of the National Coordinator for Health Information Technology (ONC), a position she has held since May 2012. Previously, Samy served as Special Assistant to the Deputy National Coordinator at ONC starting in 2010. Prior to that, she conducted evaluations of HHS programs at the HHS Office of Inspector General. Samy also worked at the World Health Organization's (WHO) Eastern Mediterranean Regional Office on community development, and at UMASS Memorial Medical Center on quality and outcomes improvement.  Samy is active on social media. She tweets @LeilaSamy and blogs for ONC's Health IT Buzz Blog on rural topics.

Samy has a Master of Public Health with a focus in health policy and management from Emory University. She has Bachelor of Science (with a focus on Biology and Proteomics) and a Major in French Literature and Francophone studies from the University of Michigan.

In her spare time, she likes to travel, play classical piano and do Pilates. She recently spent time finishing a book on Arabic grammar that her dad was working on before he passed away. Samy grew up speaking Arabic, English and French in her house, with her family splitting their time between Saginaw, Mich., and Cairo, Egypt, where her parents both worked at the American University in Cairo.

How did you get involved in rural health and health IT?

My mission and passion has always been to work to improve health quality and outcomes at the population level. Health IT is key here especially because I think of our aim this way: we are leveraging health IT to wire the health care system and implement improvements and efficiencies. In rural communities, the value of health IT becomes particularly evident. With increased adoption and use of health IT, rural communities stand to gain a great deal in terms of extending local access to care—particularly for rural veterans—and improving care coordination.  Another priority for me is economic development. Health IT can fuel rural economic development; it can offer good jobs to residents of rural communities.

Is there resistance to health IT in rural areas? For example, have you found providers who struggle with electronic health records (EHRs), who don't want to do telemedicine, etc.?

Based on what I'm hearing and seeing from across the country, this is a really exciting time for rural health IT. The feedback I'm getting from physicians and nurses in rural communities as well as CEOs and CIOs of critical access hospitals (CAHs) and rural hospitals across the country is that stage one meaningful use serves as a jumping off point, a diving board to help them go where they want to go. For example, for Harbor Beach Community Hospital in Michigan, meaningful use accelerated its timeline to implement Patient Centered Medical Home models and move closer toward its own goals.

I have had folks ask me about the value of patient engagement requirements under meaningful use. A key part of this big health IT push is focused on ensuring that a minimum percentage of patients (consumers) can actually access their health information from their health care provider or institution.

Do you have a personal perspective on the value of health IT and patient engagement?

A few years ago, when my father was emergently hospitalized without any previously related health condition, we were grateful to be in a great medical institution with terrific medical teams. We were also armed with all sorts of legal papers, such as a living will, that formally empowered us to be part of the team caring for my father. I wanted to ensure that each new team assigned to my father had all the key information and all the right information. We were in the ICU in a large institution with the medical teams constantly rotating. I wanted to play a role in coordinating the care. I wanted access to his health record, particularly each new test result we ordered. Over the course of a relatively short period of time, I had to make multiple, quick decisions about his care and his life. To make each decision, I needed enough information to know that I was making the right decision and the decision he would want.

Without access to the medical records, and unwilling to make blind decisions, I came up with a host of elaborate and exhausting approaches to get as much information as possible. For example, I stayed overnight in the ICU, staying awake sometimes 24 hours a day, to observe changes in his status and be present to update each new team and shift. I also made sure to be present when the doctors did their rounds so I could overhear what they reported out to the bands of doctors in training. Rounds were not by scheduled appointment with us, and I never knew when they would happen. So, in the morning, I'd wake up still in the ICU and I'd be too scared to go to the bathroom or get breakfast or coffee in case I missed the fleeting troupe of doctors doing rounds.

Several months after – after – my father passed away, I got a letter in the mail rejecting my request for his medical records! When I requested the medical records, I was in the hospital, standing next to the computers that contained the information, with the proper legal documentation giving me the right to make decisions on behalf of my father. I went through the whole exercise of filling out forms, emailing and faxing various forms in the hopes of gaining access to his most recent test results. The system was just not set up to give the patient and his caregivers access to the health record.

The system made it difficult for me to be an informed, active member of my father's health care team. The most underutilized resource in the health care system is often the patient and the patient's caregivers. Imagine the impact on health and quality of life of a health system optimized to tap into this resource. How many errors would be avoided by opening up the health and medical record to the health care consumer? With access to the same information available to the doctors charged with the care of a loved one, think of how much easier it would be for a caregiver to make difficult decisions quickly, particularly where she, not the docs, needs to make subjective decisions that impact the patient's quality of life and dignity.

Now the new patient engagement rules will help patients and their designated caregivers access, download and transmit vital health information. You can see how these new rules are so important.

How did you go from working mapping proteins of Cholera and Anthrax at your university, and working for the World Health Organization, to working on rural health IT?

There is a clear common thread with my work across these areas. I always focus on solving problems, improving public health and delivering results. To deliver results, I need to bring together folks from vastly different disciplines or from different cultures who speak different languages. I need to be a good listener and a good problem solver.

At UMASS Memorial Medical Center you led a quality surveillance and outcomes improvement initiative. Do you draw on your clinical work in any way in your present position?

Yes. Definitely. It all ties together. For one thing, I know how hard it was to track clinical quality measures. As Farzad Mostashari once said, paper records are great, if you're Harry Potter! With health IT, we're moving in a direction where physicians can have patient statistics at their fingertips.

What exactly does "rural health IT" encompass?

When we're looking at accelerating progress toward meaningful use of certified health IT, we are specifically focused on EHR technology. When we're talking about addressing infrastructure challenges and problems associated with limited broadband, financing and workforce, we need to apply a broader definition of health IT to include mobile health, telehealth and electronic health record technology.

What does ONC do to promote rural health IT?

Our rural health IT strategy has three parts:

1. Meaningful use acceleration among CAHs and small rural hospitals. In 2012, ONC issued a nationwide challenge calling for "all hands on deck" to see 1,000 (60 percent of) CAHs and small rural hospitals successfully adopt and use health IT by 2014.  In the summer of 2013, we announced that these rural safety-net hospitals had achieved and passed this milestone. As of July 31, 2013, over 1,100 (over 65 percent) had achieved meaningful use. As of November 2013, over 1,400 (about 82 percent) had achieved meaningful use.  In 2014, we're focused on seeing CAHs and small, rural hospitals transition to 2014 certified EHR technology.
2. Leverage partners to streamline programs that serve rural areas. With support from the White House Rural Council and in partnership with the Department of Health and Humans Service's Office of Rural Health Policy, we collaborated with federal and private sector partners, including the U.S. Departments of Agriculture, Labor and Education, the Veterans Administration, the Federal Communications Commission, the Delta Regional Authority and the Appalachian Regional Commission—to identify and address health IT challenges in rural communities. For example, we launched a pilot initiative in the summer of 2013 that included workshops that took place in Kansas, Iowa, Mississippi, Texas and Illinois. By September 30, our pilot effort generated more than $38 million in funding to participating CAHs and rural hospitals. I posted a blog that's more like a report card on these partnerships. It covers ONC's partnerships in support of rural health IT from late 2010 through 2013.
3. Convene a Rural Community of Practice with leaders and experts from across the country to identify and address the most pressing rural health care and rural health IT needs. We monitor data from a range of sources, and develop tools and resources to address the most pressing needs. Then we handpick the best resources and make them available on ONC's Rural Health "landing page." We've got tools from Wisconsin, Iowa, Minnesota, Washington, Florida, California, you name it. These tools are developed and used by rural health "rock stars" on our Rural Community of Practice.

What funding is available for rural health IT?

USDA Rural Development has a host of programs that offer grants, loans or loan guarantees to support rural health care needs. If folks could remember just one thing from this interview it would be: Ask your USDA Rural Development state office about "Red Leg" zero percent loans!

The FCC's Rural Health Care Program, which includes the new Health Care Connect Fund, provides funding for telecommunications and broadband services. Also, the Delta Regional Authority recently rolled out a new rural health IT funding program.

There are ways to rack and stack all these programs too.

What are the ongoing challenges in implementing rural Health IT?

We posted a data brief with information about key challenges faced by CAHs nationwide. The data brief has charts and graphs.

Here's a quick rundown of key challenges:

1. Remote geographic location,
2. Small size and low patient-volume,
3. Limited workforce,
4. Shortage of clinicians,
5. Constrained financial resources and
6. Lack of adequate, affordable connectivity

How important is workforce to health IT?

Health IT is a real opportunity for rural communities to fuel economic development. It's an area where folks can pursue good jobs. The idea behind ONC's partnership with the Department of Labor is to help train and develop a workforce that is available in sufficient numbers and armed with the appropriate skills to support rural health IT needs. We also aim to help professionals get good jobs supporting health IT needs of rural health care providers and hospitals. (For more on rural health IT job opportunities, see Samy's 8/8/13 blog post).

You blog and tweet about rural health IT. Do you think it's important for federal agencies to maintain a social media presence?

I'd say it depends on your agency's mission. Certainly for the work we do at ONC, I believe it is important.  As ONC'ers, our agency's identity is "trusted transformer"—the idea is that ONC needs to be both a change agent as well as a trusted, reliable public servant. We are trying to promote a nationwide transformation within a short time frame. To do so, we need to highlight bright spots and get the word out about leading practices as soon as they are discovered. We cannot wait to share our data—we need to be more immediately transparent with rural health providers, pharmacies, hospitals, community colleges, HHS grantees, patients and health care consumers. Social media and blogs are ways for us to listen and share.  They're a good complement to more traditional publishing mechanisms.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Winter 2014 Issue