As a high school student in the small town of Devils Lake, North Dakota, Mary K. Wakefield ministered to the community's most vulnerable residents, caring for newborns at the local hospital where she worked nights and attending to the needs of elderly residents at a nearby nursing home.
"I loved working with people whose lives I could affect in a very positive way," said Wakefield, who was inspired by her experiences to become a nurse.
Four decades later, Wakefield is still working with isolated populations, but now she is looking for solutions to a much larger set of problems than can be found in a small town hospital.
In February 2009 Wakefield, 55, took charge of the Health Resources and Services Administration (HRSA), in Rockville, Md., an agency of the Department of Health and Human Services. HRSA has a far-reaching mandate to improve access to healthcare services for people who are uninsured, isolated or medically vulnerable.
A key part of her strategy for success is using IT to improve the health of the people HRSA serves. "Technology is a vehicle for helping to eliminate health disparities for people who are medically vulnerable or uninsured or isolated," said Wakefield. "It touches almost every one of our programs."
Growing up in a town where her crop duster father could land his airplane on most any road he chose and not be in danger of hitting something, Wakefield has never strayed far from her rural roots.
Indeed, the health needs of people living in rural areas are a chief concern of HRSA. Its National Health Service Corps offers education scholarships to clinicians in exchange for two to four years of service in rural or other highneed areas. Some 30,000 clinicians have served in the corps since 1972.
"From my teaching and practice, I had a real sense of challenges you could face in terms of access to service," Wakefield said. Prior to joining HRSA, she was associate dean for rural health at the School of Medicine and Health Sciences at the University of North Dakota, Grand Forks, and director of the university's Center for Rural Health.
Wakefield singles out telehealth, encompassing both videoconferencing and streaming media, as an area of health information technology that holds great promise for helping HRSA's constituents, particularly those in remote areas.
The Home Nursing Agency, in Altoona, Pa., for example, received $312,500 from HRSA in 2008-2009 to work on a telehealth program in central Pennsylvania. Patients enrolled in the program input their vital signs into a tele-monitor that conveyed the data to a nurse for review. Discovery of an abnormality triggers a home visit or a call from the nurse to discuss the patient's medications.
Insider and outsider
Despite her small town roots, Wakefield is no stranger to Washington, D.C. While teaching nursing at the University of North Dakota, she pursued a summer internship on Capitol Hill to learn more about health policy. She stayed for 15 years, learning how Congress works and eventually serving as chief of staff to two North Dakota senators, Kent Conrad and Quentin Burdick. Wakefield also served as director of the Center for Health Policy, Research and Ethics at George Mason University, in Fairfax, Va.
Wakefield believes her dual experience in the practical and policy arenas of healthcare prepared her to lead HRSA. "I know something about healthcare delivery, having taught all different disciplines to medical and nursing students," she said.
Among the myriad issues HRSA works on"maternal health, maintaining the organ donor database, supporting community health centers"technology emerges as a common thread.
One example of how HRSA promotes technology is the Rural Health IT Toolbox, developed by HRSA's Office of Rural Health Policy. The online resource has eight modules that take healthcare providers through the steps of how to plan for, use and evaluate different forms of technology in their practices. HRSA also has two other online toolboxes" a general introduction to using IT and one tailored for healthcare providers that serve children. Others are on the way. An e-referral program that HRSA funded cut the time between a patient's referral request and an appointment with a specialist from 56 days to about 3 days. "You can see the power of the technology," said Wakefield.
Even so, not everything connected to technology has gone smoothly. In February, the Los Angeles Times reported that a national database of disciplinary actions against clinicians overseen by HRSA was incomplete. The failure of state health licensing boards to release their records to database managers provided cover for potentially thousands of people who had been disciplined.
"We take this very seriously," said Wakefield in the article. A March follow up story reported that Wakefield had replaced the database's managers and offered technical aid to states. In addition, HRSA officials said Wakefield ordered an audit of the system and, along with HHS secretary Kathleen Sebelius, sent a letter to governors requesting help with compliance.
Such challenges notwithstanding, HRSA continues to rely on health IT to support its mission. As part of the American Recovery and Reinvestment Act (ARRA), the agency received $2.5-billion to invest in healthcare infrastructure and train health care professionals.
HRSA will use $851 million of the $2.5 billion it received in ARRA funds for capital improvement grants. Among other projects, more than 650 health centers will use the money to upgrade equipment and purchase health IT systems, and nearly 500 centers will promote the expansion and adoption of electronic health records.
The money is significant, as financing the start-up costs and structural maintenance of health IT systems is among the greatest challenges facing providers who care for the underserved. Wakefield is prepared to help lead the charge.
"We are promoting the adoption and meaningful use of health IT," she said. "We want to prevent the digital divide for communities that care for these patients."
