ten14_11a2.pdf

ETA Advisory File Text

1 Attachment 2 A Resource Guide for Health Information Technology A Resource Guide for Health Information Technology is a reference providing program planners and service providers with practical information about the HHS Office of the National Coordinator for Health Information Technology ONC and its initiatives and grant investments to prepare the emerging Health-IT workforce. Table of Contents Background .2 Developing a Health IT Workforce ..2 Building a Regional Partnership .. .3 Understanding Health IT Occupations .. .. .. .5 Education and Employment Resources 9 Appendix A Key Definitions .12 Appendix B Health Information Technology Regional Extension Centers HITRECs 14 Appendix C Health and Human Services Office of the National Coordinator HHS ONC Community College Consortia Members 17 2 Background Developing a Health IT Workforce The use of technology across the health and human services industry is fragmented. Although some providers have implemented medical records management software there is still an extensive use of hard copies for forms exchanged between doctors labs hospitals clinics and other health and human services providers. The use of technology for information exchange has proven to save administrative time contain costs and reduce errors. Health and human service providers are currently taking advantage of a unique opportunity to implement and meaningfully use EHRs. The federal government has committed unprecedented resources to support the adoption and use of EHRs. The installment of an EHR system now is a solid investment for the future because It s where the profession is going 90 of medical students consider it important or very important to have an EHR where they choose to practice. 8 It s what patients want Four out of five adults believe that online personal health records would be beneficial in managing their health and health care. 9 It makes coordinated care a reality EHRs are an essential component of health care innovation efforts such as the Patient Centered Medical Home and Accountable Care Organizations. Incentives now available For healthcare providers that are eligible there is a limited window of opportunity to take advantage of Medicare and Medicaid EHR Incentive Programs designed to support the implementation of certified The Health Information Technology for Economic and Clinical Health HITECH Act enacted as part of the American Recovery and Reinvestment Act ARRA of 2009 promotes the adoption and meaningful use of health information technology HIT . The Office of the National Coordinator for Health Information Technology ONC located within the Office of the Secretary for the U.S. Department of Health and Human Services HHS is charged with coordinating the nationwide efforts to implement and use the most advanced health information technology to enable the electronic exchange of health information. The ONC set a goal for the utilization of an Electronic Health Record EHR for each person in the United States by 2014. To support this objective the ONC has coordinated a suite of investments to educate health information technology professionals. 3 EHRs. A fully functional certified EHR will be essential to participation in both public and private pay-for-performance programs expected in the future. Due to the legislative timeline and incentives to health providers to be early adopters of EHR many health and human services providers are changing existing workflows and processes to effectively implement EHR. Some have only just begun while others have not yet started. Building a Regional Partnership The information found in this resource is provided for use by workforce investment partners to support collaboration with the Health Information Technology Regional Extensions Centers HITRECs and schools in the Health and Human Services Office of the National Coordinator HHS ONC Community College Consortia see Attachment C to educate assess and employ the workforce required for EHR implementation efforts. In support of this collaboration we have developed an EHR competency model and the blocks represent competency areas that is the applied skills knowledge abilities essential to successful performance in the increasingly electronic environment of the health industry. The EHR model is posted and available for downloading on the Competency Model Clearinghouse CMC Web site at http www.careeronestop.org competencymodel pyramid.aspx EHR Y . We are asking workforce system leaders in regional areas to convene with interested stakeholders including health care employers and educators to discuss this critical workforce with the Health Information Technology Regional Extension Centers HITRECs . HITRECS offer technical assistance guidance and information on best practices to support and accelerate health care providers efforts to become meaningful users of Electronic Health Records EHRs . There are an estimated 70 HITRECs supporting primary care providers in achieving meaningful use of EHRs and enabling nationwide health information exchange in a defined geographic area. See Attachment B for a complete list of HITRECs to determine if there is a Center in your vicinity. Rural health providers and State Offices of Rural Health face special geographic challenges in their effort to deliver quality care. The realities of distance and attracting and retaining qualified professionals can complicate health care delivery. The widespread adoption of Health information technology health IT can help ameliorate some of those problems. However rural health care providers face several barriers to health IT implementation. These include Lack of broadband internet access Limited career pathways for the health information workforce and Insufficient financial capital to implement electronic health record EHR systems. The ONC has developed a Rural Health IT Adoption Toolbox available on-line at http www.hrsa.gov healthit toolbox RuralHealthITtoolbox index.html that 4 includes useful information about getting started program planning and project staffing and management. The HITREC is a resource to help foster regional collaboration to meet the following objectives Describing the types of occupations associated with Health IT EHR professions in your region and the skills needed to perform successfully in these roles Locating sources of Health IT EHR training assessment vouchers and employment opportunities and Learning about transferrable skills and work experiences from prospective Health IT employers. The outcomes from a coordinated approach include Establishing a plan for continued collaboration with HITRECs Developing a process for working with local employers that have employment opportunities and Identifying training opportunities by working with local education providers. About this Resource This resource has four sections that will guide your conversation Developing a Health IT Workforce Understanding Health IT Occupations Education and Employment Resources Appendices o Key Definitions o Health Information Technology Regional Extension Centers HITRECs o Health and Human Services Office of the National Coordinator HHS ONC Community College Consortia Members 5 Understanding Health IT Occupations Successful EHR implementation requires enhanced workforce skills at several junctures Project management during implementation Training and staff support for ongoing operation and maintenance New and enhanced skills for staff who interact daily with new technology ONC initiatives and investments focus on training the IT workforce who will provide support for the implementation and maintenance of EHR. Over the past year the Employment and Training Administration ETA has worked with federal agencies and industry partners to identify the core competencies required to develop the training needed to prepare new and existing healthcare workers with the knowledge and skills to effectively use EHR. Refer to the EHR Competency Model for more information on the knowledge and skills required of the healthcare workforce. The Intersection of Health and IT in Figure 1 demonstrates the commonality of foundation competencies and the distinction in focus in the industry wide and industry technical competencies. Health workers need a broad knowledge of the health industry supplemented with IT concepts whereas the Health-IT worker needs a strong background in IT concepts as they might apply to the culture and business of healthcare delivery. Figure 1. 6 A Health IT worker depicted to the right in Figure 1 is someone who is qualified to support the adoption and implementation of Electronic Health Records EHRs information exchange across health care providers and public health authorities and the redesign of workflows within health care settings to gain the quality and efficiency benefits of EHRs. It is anticipated that implementation efforts will be supported a mobile project management team as well as a permanent support staff at a health provider s location. Mobile Project Management Team Positions The project management team must have leadership skills management ability patience and vision. The team must realize that the implementation of a health IT system is a large multifaceted project that will not always go as planned. The ability to deal with frustration constructively and seek opportunities in the face of adversity is a definite asset. Good communication skills both verbal and written communication skills among team members and with the administration are essential for ensuring that a project is well managed and organized. With the increasing complexity of clinical system implementations the need for well trained skilled project managers is expected to increase. These members of the workforce will support implementation at specific locations for a period of time and when their work is done will move on to new locations. They might be employed by regional extension centers hospitals critical access hospitals provider offices vendors or state city public health agencies. The team would consist of Position Workers in this role will Past experience and anti cipated training required Implementation support specialists execute implementation project plans install hardware as needed configure software to meet practice needs incorporate usability principles into design and implementation Experience in i nformation technology or information management Three to six month certificate training for individuals with technical training Practice workflow and information management redesign specialists conduct user requirements analysis to facilitate workflow design integrate information technology functions into workflow document health information exchange needs design processes and information flows that accommodate quality improvement and reporting work with provider personnel to Backgrounds in health care e.g. as a practice administrator or in information technology but are not licensed clinical professionals Three to six month certificate training for health care or information management backgrounds 7 implement revi sed workflows and evaluate process workflows to validate or improve practice s systems Clinician consultants suggest solutions for health IT implementation problems in clinical and public health settings address workflow and data collection issues from a clinical perspective including quality measurement and improvement assist in selection of vendors and software and advocate for users needs acting as a liaison between users IT staff and vendors. Similar to the redesign specialist role listed above but brings to bear the background and experience of a licensed clinical and professional or public health professional Three to six month certificate training for health professionals Implementation managers apply project management and change management principles to create implementation project plans to achieve the project goals interact with office hospital personnel to ensure open communication with the support team lead implementation teams consisting of workers in the roles described above manage vendor relations providing feedback to health IT vendors for product improvement Experience in health and or IT environments as well as administrative and managerial experience. Training in any of the above plus administrative experience Permanent Support Staff Staff of healthcare delivery and public health sites will be needed for the ongoing support and facilitation of health IT systems across the health care industry in organizations such as office practices hospitals health centers long term care facilities health information exchange organizations and state and local public health agencies. These workers provide the support needed to train the health workers in the new processes and procedures to help them become efficient and meaningful users of that technology. Permanent support staff might include 8 Position Workers in this role will Past experience and anticipated training required Clinician l eaders Chief Medical Informatics Information Officer CMIO Chief Nursing Informatics Officer CNIO develop strategic plans for clinical systems and information management align clinical system capabilities with organizational needs oversee IT governance ensure that developments are in line with global trends in medicine informatics and information technology Medical Health Service Manager or Informatics Nurse Specialists One year certificate or masters degree in informatics on top of licensed health care public health professional status Technical software support staff interac t with end users to diagnose IT problems and implement solutions document IT problems and evaluate the effectiveness of problem resolution support systems security and standards Previous experience information technology or information management Six month certificate training for technical specialists Trainer s use a range of health IT applications preferably at an expert level communicate both health and IT concepts as appropriate assess training needs and competencies of learners design lesson plans structuring active learning experiences for user track training records of the users and develop learning plans for further instruction Experience as a health professional or health information management specialist. Classroom experience as a trainer in the classroom is also desired. Six month certificate program for health professionals or health information management specialists Health Information Management and Exchange Specialists support the collection management retrieval exchange and or analysis of information in electronic form in health care and public health organizations Bachelors and masters degrees in Health Information Management and related fields. Health Information Privacy and Security Specialists ensure the privacy a nd security of health information Bachelors or Masters degree in information science 9 Health Care and Public Health Informaticians These individuals will be highly-trained and highly-specialized for academic faculty positions and research and development in various public non-profit and for profit sectors of the health care industry. This workforce might include Position Workers in this role will Past experience and anticipated training required Research and development scientists support effo rts to create innovative models and solutions that advance the capabilities of health IT conduct studies on the effectiveness of health IT and its effect on health care quality Doctoral degrees in informatics or masters degrees for health professionals Programmers and software engineers b e cross -trained in IT and health domains thereby possessing a high level of familiarity with health domains to complement their technical skills in computer and information science Masters programs combining information computer science and health domains Sub -specialists have a knowledge of IT and deep knowledge drawn from disciplines ethics economics business policy and planning cognitive psychology and industrial systems engineering that inform health IT policy or technology Masters or doctoral training in such fields as ethics human factors interfaces cognitive psychology industrial systems engineering Education and Employment Resources Training the Workforce through Community College Consortia Over the past year the ONC provided funding to the Community College Consortia to develop or improve non-degree health IT training programs that can be completed in six 10 months or less. The ONC collaborated with the Department of Education to establish a technical assistance team that provided direction and support to the member institutions. The Consortia comprises five regional groups of more than 70 member community colleges in all 50 states. Each college developed the admission criteria for the certificate programs designed to train mid-level career professionals for Health-IT positions. In late April 2011 HHS announced that 2 280 health information technology professionals graduated from community colleges with 3 000 graduates expected by the end of summer. These graduates represent a portion of the initial health IT workforce that will be trained through the HHS workforce development program this year. Many of the graduates have prior backgrounds in health care or information technology. They will be seeking employment with health providers to implement EHR systems in provider and hospital settings. Workforce Boards and One-Stop Career Centers are encouraged to collaborate with these colleges around training opportunities and to develop strategies for assisting the graduates to find employment. Appendix C contains a complete listing of participating colleges with contact information. Health-IT Competency Exam Potential Health-IT workers will generally require additional training to compete for the openings on implementation and support teams. In April 2010 ONC awarded 6 million in a two-year cooperative agreement to Northern Virginia Community College NOVA to develop health information technology health IT competency examinations for each of the positions on the implementation support team. These HIT Pro exams developed in partnership with Pearson Vu can be taken at 230 Pearson Professional Centers around the country. The competency exams were developed to confirm that an applicant has the experience and skills required to meet the nation s need for health information technology workers. For additional information visit the HIT Pro site at http www.hitproexams.org . The ONC is using the colleges in the Community College Consortia to reach out to perspective students but would also like to use state and local workforce agencies to access those individuals who are not enrolled in the Consortia program and have health care or IT backgrounds. The ONC has provided funds for 27 500 vouchers that enable individuals to take free exams. For more information about the availability of vouchers see http healthit.hhs.gov portal server.pt community healthit hhs gov competency exami nation program 2 1809 Employment Resources Potential sources for the graduate to seek employment include but are not limited to hospitals community health centers medical offices regional extension centers State 11 Offices of Rural Health SOHR vendors managed service providers and consulting firms. The following resources might be consulted to enhance the customary job search techniques such as networking job clubs and Web searches. Resource Web link Niche Job Board HIMSS JobMine http onchitjobs.himss.org home index.cfm site id 12238 Post Jobs Search Job Listings Post Resumes Regional Extension Centers RECs Contact List Appendix B http healthit.hhs.gov portal server.pt community healthit hhs gov rec pr ogram 1495 Health Care Services Hospitals Nursing Home Employer Locator http www.acinet.org employerlocator employerlocator.asp nodeid 18 Search by Industry Select Hospitals and Social Assistance Select a State Select Facility Type State Offices of Rural Health Directory of State Offices and Associations http www.hrsa.gov ruralhealth about directory index.html EHR Product Vendors Certified Health -IT Product List http onc-chpl.force.com ehrcert Search for Vendors View vendor Web site for Career Opportunities Managed Service Providers CompTIA http www.comptia.org membership communities healthcareIT.aspx Career Exploration There are numerous career information and exploration Web sites but there are two that were created with IT in mind. Health Information Careers developed by the Healthcare Information and Management Systems Society HIMSS is a resource to assist current Health-IT professionals to learn grow and advance in their careers. See http www.himss.org ASP CareerServicesHome.asp Health Information Careers developed by the American Health Information Management Association AHIMA is a resource for health information professionals to learn how to use their knowledge of information technology and records management to form the link between clinicians administrators technology designers and information technology professionals. See http www.hicareers.com 12 Appendix A Key Definitions Electronic Health Record EHR Health IT includes the use of electronic health records EHRs instead of paper medical records to maintain people s health information. The widespread use of a system of electronic health records EHR will provide access to a patient s total health information supporting better health care decisions and more coordinated care. A portable EHR makes a patient s health information available when and where it is needed. Electronic Health Records EHRs are longitudinal electronic records of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics progress notes problems medications vital signs past medical history immunizations laboratory data and radiology reports. The EHR automates and streamlines the clinician s workflow because it generates a complete record of a clinical patient encounter. EHRs can also support the collection of data for uses other than clinical care such as billing quality management outcome reporting public health disease surveillance and reporting. 1 EHRs can support better follow-up information for patients for example after a clinical visit or hospital stay instructions and information can be effortlessly provided to the patient and reminders for other follow-up care can be sent easily or even automatically to the patient. EHRs can improve patient and provider convenience patients can have their prescriptions ordered and ready even before they leave the provider s office and insurance claims can be filed immediately from the provider s office . Electronic Health Record Technology is defined for the purposes of the Medicare and Medicaid Incentive Programs. The software technology must offer the necessary technological capability functionality and security to meet the meaningful use criteria. Electronic Medical Record EMR Sometimes people use the terms Electronic Medical Record or EMR when talking about Electronic Health Record EHR technology. Very often an Electronic Medical Record or EMR is just another way to describe an Electronic Health Record or EHR. Health providers and software or application vendors sometimes use the terms interchangeably. There is however a distinction between EMR and EHR. The EMR can be thought of as the recording of patient information and medical findings in an electronic format. In plain terms it is an electronic version of a patient s chart maintained by medical professionals or treatment facilities. The EMR is specific to and generally the property of the provider. There are numerous software applications available for EMR. EHR technology products and systems are secure can maintain data confidentially and can work with other systems to share information. It is the requirement that EHRs have the capability to share information with other systems that separates them from EMRs. 13 Personal Health Records PHR In addition to EMRs and EHRs you may come across the term Personal Health Record or PHR. A Personal Health Record PHR is an electronic record of health information maintained by the patient. A PHR might contain information about medical conditions allergies medications and doctor or hospital visits. The PHR makes it possible for the patient to store in one place and share information with others as needed. The patient controls how the information is used and who can access it. PHRs are usually accessed through the Internet so information is available anytime or anywhere. See http www.medicare.gov navigation manage-your-health personal- health-records personal-health-records-overview.aspx 14 Appendix B Health Information Technology Regional Extension Centers HITRECS Contacts State Regional E xtension Center Name Email AK Alaska eHealth Networkr rebecca ak-ehealth.org AL Alabama Regional Extension Center info al-rec.org AR HIT Arkansas jfuchs afmc.org AS Hawaii-Pacific HI GM AS CNMI REC aito hawaiihie.org AZ Arizona Health-e Connection AzHeC melissa.rutala azhec.org CA CalHIPSO North info calhipso.org CA CalHIPSO South info calhipso.org CA CalOptima Foundation emoscaritolo caloptima.org CA HITEC-LA HITEC-LA lacare.org CNMI Hawaii-Pacific HI GM AS CNMI REC aito hawaiihie.org CO Colorado Regional Extension Center CORHIO palbritton corhio.org CT eHealth Connecticut scleary gosmacpartners.com DC eHealth DC info ehealthdc.org DE Quality Insights of Delaware bschindele wvmi.org FL Center for the Advancement of Health IT Rural and North Florida Regional Extension Center info AdvanceHealthIT.org FL South Florida Regional Extension Center Collaborative info southfloridarec.org FL PaperFree Florida jwolfson hsc.usf.edu FL Central Florida REC info ucf-rec.org GA Georgia HITREC dmack msm.edu GM Hawaii-Pacific HI GM AS CNMI REC aito hawaiihie.org HI Hawaii-Pacific HI GM AS CNMI REC aito hawaiihie.org IA Health Information Technology Regional Extension Center Iowa HITREC IowaHITREC ifmc.org ID Washington Idaho Regional Extension Center WIREC peggye qualishealth.org IL Chicago Health Information Technology Regional Extension Center CHITREC info chitrec.org IL Illinois Health Information Technology Regional Extension Center IL-HITREC info ilhitrec.org IN HealthBridge Tri-State IN KY OH REC dgroves healthbridge.org IN Purdue University marrowsm purdue.edu KS Kansas Foundation for Medical Care Inc. KFMC recsupport kfmc.org KY HealthBridge Tri-State IN KY OH REC dgroves healthbridge.org KY University of Kentucky Research Foundation kyrec uky.edu LA Louisiana Health Care Quality Forum bikerd lhcqf.org MA Massachusetts Technology Park Corporation rodenstein masstech.org 15 MD Chesapeake Regional Information System for Our Patients info crisphealth.org ME HealthInfoNet info hinfonet.org MI Michigan Center for Effective IT Adoption M - CEITA mceita.info altarum.org MN Regional Extension Assistance Center for Health Information Technology REACH info khaREACH.org MO Missouri HIT Assistance Center EHRhelp missouri.edu MS Mississippi Regional Extension Center rbordelon eqhs.org MT Mountain-Pacific Quality Health Foundation MPQHF kurbanek mpqhf.org NC University of North Carolina AHEC REC tom bacon med.unc.edu ND Regional Extension Assistance Center for Health Information Technology REACH info khaREACH.org NE Wide River Technology Extension Center info widerivertec.org NH Regional Extension Center of New Hampshire jmonahan maehc.org NJ New Jersey Institute of Technology NJIT info njhitec.org NM Lovelace Clinic Foundation-LCF Research Lyndi.Dittmer- Perry LCFResearch.org NV HealthInsight sdonnelly healthinsight.org NY New York eHealth Collaborative NYeC pwilder nyehealth.org NY NYC REACH aparsons health.nyc.gov OH HealthBridge Tri-State IN KY OH REC dgroves healthbridge.org OH Ohio Health Information Partnership OHIP info OHIPonline.org OK Oklahoma Foundation for Medical Quality Inc. OFMQ Dgolder ofmq.com OR Oregon s Health Information Technology Extension Center O-HITEC info ohitec.org PA Quality Insights of Pennsylvania Eastern asomplasky wvmi.org PA Quality Insights of Pennsylvania Western asomplasky wvmi.org PR Ponce School of Medicine jgarcia psm.edu RI Rhode Island Quality Institute RIQI info riqi.org SC Center for Information Technology Implementation Assistance in South Carolina CITIA-SC thornbur mailbox.sc.edu SD healthPOINT amy.townsend dsu.edu TN Qsource jmcanally qsource.org TX North Texas Regional Extension Center info ntrec.org TX West Texas Health Information Technology Regional Extension Center WT-HITREC info wtxhitrec.org TX CentrEast Regional Extension Center tduke tamhsc.edu TX Gulf Coast Regional Extension Center pamela.d.slayer uth.tmc.edu UT HealthInsight sdonnelly healthinsight.org VA VHQC Virginia Health Quality Center lfisher vhqc.org VT Vermont Information Technology Leaders Inc. pforlenza vitl.net WA Washington Idaho Regional Extension Center WIREC peggye qualishealth.org 16 WI Wisconsin Health Information Technology Extension Center jwang metastar.com WV West Virginia Health Improvement Institute Inc. cstandre spreadinnovation.com WY Mountain-Pacific Quality Health Foundation MPQHF kurbanek mpqhf.org NIHB National Indian Health Board NIHB tkauley nihb.org 17 Appendix C Health and Human Services Office of the National Coordinator HHS ONC Community College Consortia School City State Region A Lead Bellevue Community College Bellevue College Bellevue Washington Dakota State University Madison South Dakota Lake Region State College Devil s Lake North Dakota Montana Tech Butte Montana North Idaho College Coeur d Alene Idaho Portland Community College Portland Oregon Pueblo Community College Pueblo Colorado Salt Lake Community College Salt Lake City Utah Region B Lead Los Rios Community College District Butte College Oroville California College of Southern Nevada Las Vegas Nevada Cosumnes River College Sacramento California East LA College Monterey Park California Fresno City College Fresno California Los Rios Community College District Sacramento California Maricopa College Phoenix Arizona Mission College Santa Clara California Orange Coast College Costa Mesa California Pima College Tucson Arizona San Diego Mesa College San Diego California Santa Barbara City College Santa Barbara California Santa Monica College Santa Monica California 18 University of Hawaii College - Kapiolani Honolulu Hawaii Region C Lead Cuyahoga Community College District Cincinnati State Technical Community College Cincinnati Ohio Columbus State Community College Columbus Ohio Cuyahoga Community College Cleveland Ohio Delta College University Center Michigan Des Moines Area Community College Ankeny Iowa Johnson County Community College Overland Park Kansas Kirkwood Community College Cedar Rapids Iowa Lansing Community College Lansing Michigan Macomb Community College Warren Michigan Madison Area Technical College Madison Wisconsin Metropolitan Community College Omaha Nebraska Milwaukee Area Technical College Milwaukee Wisconsin Moraine Valley Community College Palos Hills Illinois Normandale Community College Bloomington Minnesota Sinclair Community College Dayton Ohio St. Louis Community College St. Louis Missouri Region D Lead Pitt Community College Atlanta Technical College Atlanta Georgia Broward College Coconut Creek Florida Catawba Valley Community Hickory North Carolina Central Piedmont Community College Charlotte North Carolina Chattanooga State Community College Chattanooga Tennessee Dallas County Community College District Dallas Texas 19 Delgado Community College New Orleans Louisiana Dyersburg State Community College Dyersburg Tennessee Florence Darlington Technical College Florence South Carolina Hinds Community College Raymond Mississippi Houston Community College Houston Texas Indian River State College Ft. Pierce Florida Itawamba Community College Tupelo Mississippi Jefferson Community Technical College Louisville Kentucky Midland College Midland Texas National Park Community College Hot Springs Arkansas Pitt Community College Winterville North Carolina Santa Fe College Gainesville Florida Tulsa Community College Tulsa Oklahoma Walters State Community College Morristown Tennessee Region E Lead Tidewater Community College Bristol Community College Fall River Massachusetts Bronx Community College Bronx New York Brookdale Community College Lincroft New Jersey Burlington Community College Pemberton New Jersey Camden County College Blackwood New Jersey Capital Community College Hartford Connecticut Community College of Allegheny County Pittsburgh Pennsylvania Community College of Baltimore County Baltimore City Maryland Community College of DC Washington District of Columbia Community College of Vermont Waterbury Vermont 20 Essex County College Newark New Jersey Gloucester County College Sewall New Jersey Kennebec Valley Community College Fairfield Maine Northern Virginia Community College Annandale Virginia Ocean County College Toms River New Jersey Passaic County Community College Paterson New Jersey Raritan Valley Community College Branchburg New Jersey Southern Maine Community College South Portland Maine Suffolk County Community College Brentwood New York Tidewater Community College Virginia Beach Virginia West Virginia Northern Community College Wheeling West Virginia Westchester Community College Valhalla New York For additional information http healthit.hhs.gov portal server.pt community healthit hhs gov community c ollege program 1804