Rural hospitals are prime examples of how telemedicine, health information technology and meaningful use can benefit the healthcare industry as they may increase specialty care access, improve quality and decrease costs. However, according to a study recently published in Health Affairs, rural hospitals lag behind other hospitals in HIT and EHR adoption.
Researchers analyzed American Hospital Association survey data on 3,233 U.S. hospitals from 2008 to 2011, the year federal incentives for the meaningful use of EHRs began. According to the study, small, nonteaching and rural hospitals adopt EHRs more slowly than other hospitals. Only 19.4 percent of rural hospitals had comprehensive EHR systems in 2011 — the lowest rate.
If rural hospitals are struggling to adopt EHR systems, it is likely they are also struggling to meet meaningful use. After serving as an information technology manager and CIO at multiple rural hospitals, Kelly Cariker, current CIO of North Valley Hospital in Tonasket, Wash., knows firsthand how rural hospitals struggle with the resources and workforce to implement EHRs and meet meaningful use. Here he discusses six common challenges for rural hospitals.
1. Economy of scale. Rural hospitals often have smaller IT departments, placing a large amount of pressure to implement enterprise-wide HIT and meet federally mandated deadlines on a small staff. “When you have a small staff, trying to roll out new software or implement an EHR can be difficult. Employee absences can become a major barrier because vacations, illnesses and extended leaves severely slow down productivity. There may be no one to cover another employee’s work when they are gone,” says Mr. Cariker. Rural hospitals have to do more with fewer employees, less money and less time. “You have to encourage as much efficiency as possible to meet deadlines for meaningful use,” says Mr. Cariker.
2. Computer skills. Many rural hospitals do not have computers in all areas of the hospital so employees may not be as familiar or as comfortable with basic computer best practices. “Being a rural health facility, many staff members don’t have basic computer competency. Before we can move forward to meet meaningful use, we have to take a step backward and train the staff so they are comfortable with computers,” says Mr. Cariker. Basic computer competency is less common in rural areas because rural hospitals may not have had the incentive or capital to invest in the technology enterprise-wide. If employees are not trained, the transition can be a big cultural shock. Computer best practices that may be second nature to advanced users such as rebooting the computer when it freezes, running anti-virus updates or troubleshooting are more difficult for new users. “We need to go back and build a strong computer foundation so the nurses and staff can be confident when using the technology. Problems can’t throw them into a panic when they are using EHRs. Everyone needs to be comfortable before we can start pursuing meaningful use,” says Mr. Cariker.
3. Hospital staff buy-in. Rural hospitals may have difficulty with staff buy-in for HIT implementation and meaningful use. The sentiment of “we have done it this way for years, and it has always worked,” can be prevalent. The hospital executives, IT department or employees involved with meaningful use attestation need to educate hospital employees on how the meaningful use criteria is beneficial to everyone. “The hospital staff needs to see that HIT and meaningful use will help the hospital deliver world-class healthcare in a local setting through connections and exchanges with local, regional and even national healthcare organizations. Once they realize that HIT provides better care, they’ll be on board,” says Mr. Cariker.
4. Physician, clinician trust. Building trust among the physicians and the clinical staff is important, yet difficult, and can hamper a rural hospitals transition toward HIT and meaningful use “When the IT department or the CIO negates a specific department’s implementation request, it is because they are thinking of what is best for the hospital as a whole. Sometimes the physicians and the staff do no understand that, and it can cause problems,” says Mr. Cariker. The various departments may not realize hospital-wide protocols are integral to successful HIT utilization. “The staff needs to come to trust that the CIO sees the overall picture. A single department may want to do something differently but it could affect the hospital’s entire meaningful use process. Even a small change in admitting processes can greatly affect the billing department,” says Mr. Cariker. Communication is key for easing worries and building trust. Giving the physicians and staff explanations for implementation procedures will help them to understand the bigger goal.
5. Small margin of error. While no hospital wants to make a mistake with an EHR or HIT implementation, rural hospitals have to be extremely careful since the technology budgets tend to be minimal. Executives may not know what to look for in HIT software or what questions to ask, and this can lead to problems. When issues arise with EHRs and HIT, it slows down a hospital’s progression toward meaningful use. “We can’t afford to make mistakes in software or vendor choices. We have to make sure everything that is implemented works right,” says Mr. Cariker. Unfortunately, North Valley Hospital knows the importance of this very well. The hospital had been using a clinical EHR for a couple of years, but the software could not seamlessly share data across departments without affecting a clinician’s ability to see patient data. “The system wasn’t billing patients in a timely manner, and it was costing the hospital money,” says Mr. Cariker. North Valley eventually switched vendors, but other rural hospitals may not have the capital for trial and error with EHR systems. Any issues or delays severely limit meaningful use attestation timelines.
6. Vendor scheduling. One of the biggest challenges for rural hospitals is overcoming needless barriers and scheduling vendor meetings to stay on par with the federally mandated meaningful use deadlines. “In order to meet meaningful use, you need to follow and build modules in a certain order. If any of the steps get out of order, it can push back the attestation dates. Unfortunately, little problems and distractions arise, pushing steps out of order and delaying deadlines. Hospitals need to be mindful of each step on the way to meaningful use, keeping a close eye on the timeline. If one step is delayed one or two days, the next step could be delayed three to four days — the whole process may begin to snowball,” says Mr. Cariker.
Problems meeting deadlines increase when health information technology and electronic health record vendors are hard to schedule. “Everybody is under the same pressure and the same timeline so it can be hard to get analyst time with vendors. The vendor might be implementing your medication reconciliation, but for another 19 hospitals as well, so you have to carefully schedule when the analysts will work with various departments. If the schedule is thrown off, the vendor could be busy for the next three weeks to three months. It is hard to make sure both the needs of your hospital and vendor availability match up,” says Mr. Cariker.
While rural healthcare stands to benefit greatly from HIT and meaningful use, often times rural areas struggle more with adoption. Policy makers and healthcare leaders need to focus on hospitals that are slow moving and develop programs to address common barriers.