Rural systems are in need of more resources and better support to catch up to their urban peers.
Despite major national investments to support the adoption of health information technology, critical access hospitals continue to confront barriers that inhibit that adoption and the use of advanced health IT capabilities in rural areas in particular. An article in this month’s Health Affairs, authored by several officials in the Office of the National Coordinator for Health IT, finds that Critical Access Hospitals (CAH) that have certain types of technical assistance and resources available to support health IT are more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals.
The researchers, using a survey of Medicare-certified critical-access hospitals, examined electronic health record adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption.
CAHs represent roughly 30 percent of hospitals nationwide, often providing critical healthcare services in underserved rural areas of the country. The good news is that, as of last year, 89 percent of CAHs had an EHR in place, although the extent and type of adoption varied greatly. Over 60 percent of CAHs with an EHR had a fully electronic health record system, while 27 percent had a health record system that was part electronic and part paper.
Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. Therefore, the authors concluded, it is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system.
Despite the importance of these medical facilities in their communities, the “smallest of the small rural hospitals” – some with a census of fewer than 10 patients – are struggling with financing and workforce-related obstacles to EHR implementation. In particular, limited access to capital remains a major obstacle for CAHs.
The ONC reports CAHs that pool resources with other hospitals are more likely to have EHR and capabilities related to health information exchange and care coordination, as compared to those that do not pool resources or engage in group purchasing. In response to this need, ONC and other federal agencies are partnering with non-governmental organizations to help CAHs identify and apply to financial assistance programs.
“It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system,” states the ONC article.
ONC and the U.S. Department of Agriculture piloted a public-private collaborative funding initiative, begun on September 30, 2013, that successfully generated over $32 Million in funding to critical access and rural hospitals across four states. To date, along with other partners including local philanthropies, the Appalachian Regional Commission, the Delta Regional Authority, Health IT Regional Extension Centers, State Offices of Rural Health, Telehealth Resource Centers, ONC and USDA have launched similar initiatives in eleven states: Iowa, Kansas, Texas, Illinois, Mississippi, Georgia, Michigan, Minnesota, Tennessee, Montana, and Missouri.
Still, in a 2013 survey, 60 percent of CAHs reported having at least one significant financial challenge to EHR implementation and use – more than any other potential roadblock. At the same time, ONC’s findings indicate that CAHs receiving technical assistance from outside parties are less likely to report significant workflow and staffing challenges, compared to hospitals without outside assistance.
