Even with the proposed extension of the timeline for eligible professionals and hospitals to complete Stage 2 Meaningful Use and begin Stage 3, eligible providers still face the challenge of meeting the thresholds for patient engagement required by next phases of the EHR Incentive Programs. This challenge is particularly more pronounced for healthcare organizations and providers working in rural areas where limited access and capability create significant obstacles.
“We’re getting ready for Stage 2,” says Bambi McQuade-Jones, DNP, of the Boone County Community Clinic in Lebanon, Ind. “We’re now working on secure messaging. Our patient portal is not fully functioning due to our EHR, so we’re in the process over this month and next month of really fine-tuning how that patient portal and secure messaging will work.”
While the first phase of meaningful use led to changes in how the rural health clinic used its personnel, Stage 2 Meaningful Use and its successful demonstration require that the rural provider get its patients and other providers to complete required activities.
As it turns out, educating the patients is not the hard part. In fact, patients at the Boone County Community have taken to the idea quite openly, reveals McQuade-Jones.
“When you look at rural areas (and I’ve done this for 12 years), patients are more able to adapt to something they think is going to help them,” she explains. “They’re not a spoiled population; they don’t have access to everything. They’re very good about understanding that new concepts will bring them better care and they’re all excited about it.”
What turns out to be the larger challenge is the capability of clinical partners whose adoption of necessary health IT lags behind.
“Part of our struggle is the fact that we’re in a rural community and our rural community hospital unfortunately is slow,” notes McQuade-Jones. “They’re not on Docs 4 Docs yet and that’s our means of interfacing with the hospital, so we’re not interfaced with them. That’s part of our struggle, but we understand that they will be onboard in January.”
Docs 4 Docs is one of many services provided by the Indiana Health Information Exchange (IHIE) that allows users to access to lab results, radiology reports, discharge and transport reports, among others from participating organizations. It and the Indiana Network for Patient Care (INPC), country’s largest inter-organizational clinical data repository, are integral to the meaningful electronic exchange of patient information.
Irrespective of Stage 2 Meaningful Use, having these capabilities goes a long way toward McQuade-Jones and her staff being able to care for their patients. At present, the use of these services is uneven.
“The bigger hospitals that surround us, which are a half hour away, they are obviously on Docs 4 Docs and IMPC,” she continues. “It’s easy for me to get information — that exchange of information is beautiful, but for our own community hospital where 75 percent of my patients go for all their testing, referrals, and emergency room visits I don’t have that functionality yet.”
This creates a different set of clinical workflows for different types of patients, the insured and uninsured, because of variations in the availability and use of interfaces.
“Patients who are insured their labs go to LabCorp and we are interfaced and it is seamless,” says McQuade-Jones. “But 50 percent of our patients who are uninsured, their labs or other things go to the hospital. Their in-kind support to the community is the labs for these patients. Patients don’t get charged for the lab work and the hospital uses the full amount to write it off, so 50 percent of our labs we are not interfaced to view.”
In January, the rural community hospital plans to go live with Docs 4 Docs, which should improve the care coordination of patients at Boone County Community who rely on the former for certain services. Until that happens, McQuade-Jones and her staff face the reality of health IT adoption characteristic of rural communities which cannot afford to move as quickly as their more resourceful counterparts.
