Population Health and HIE for the Rural Hospital

Population Health and HIE for the Rural Hospital

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A greater demand for quality outcomes and a rising cost of health care have led to a shift toward improved population health management. Population health management methodologies focus on understanding the health needs of the community, quantifying and assessing health status and developing collaborative programs that will improve health outcomes. This philosophy is challenging hospitals to develop population health approaches focused on prevention, improved chronic disease management and wellness activities. Each type of hospital, including the small or rural hospital, engages the local community by offering resources, sharing knowledge and developing relationships and skills to manage its challenges and leverage its advantages. Becoming an effective population health manager requires building effective partnerships with other hospitals and health care systems. Merging the resources and skills said partnerships with community partners is important for the integration and expansion of health management programs. Together, hospitals and care systems and their partners can create targeted population health programs that engage and communicate with the patient population and ultimately increase efficiency and quality of health care and improve health status in the community.

iStock_000026438999_ExtraSmallSmall and rural hospitals face unique demographic, financial, infrastructure and staffing challenges in providing health care services. Demographic challenges and resource limitations can hinder the success of population health programs coordinated by small and rural hospitals and care systems. Financial issues created from uninsured patients, Medicare and Medicaid payments and low census put additional pressures on the smaller hospitals. Without enough volume for certain medical procedures, rural hospitals are unable to meet certain quality standards or have adequate/accurate data, which can affect reimbursement. Rural hospitals trail behind urban health centers in establishing significant use for health information technology and are not as likely to recruit skilled and experienced healthcare workers.

In building and sustaining effective population health partnerships a balance needs to be obtained between the challenges and opportunities encountered. Engaging the community through location organizations such as, health departments, churches and municipal agencies provides the greatest chance for success. Working with urban health centers and bigger health systems, rural hospitals counterbalance costs and gaps in resources, as well as, increasing use of technology and partnering with other local health providers for care delivery.

Rural hospitals need to become effective by creating partnerships through networking. Examples of networking partnerships are health information exchanges and disease registries. The benefits of using HIE are numerous: reducing medication and medical errors, eliminating unnecessary paperwork and handling, provide caregivers with clinical decision support tools for more effective care and treatment, eliminate redundant or unnecessary testing, improve public health reporting and monitoring, engage healthcare consumers regarding their own personal health information, improve healthcare quality and outcomes and reduce health related costs. Patient safety is a high priority and one of the most promising advantages for HIE. If the right information about the right patient is available at the right time, up to 18% of the patient safety mistakes and as many as 70% of adverse drug incidents could be eliminated. HIE could make this positive move forward possible. Incentives, such as The California Health eQuality, managed by the UC Davis Institute for Population Health Improvement, provide an opportunities to received funding ($1 million in this case) for HIE implementation. Groups involved with these types of partnerships are providing data to each other for the joint benefit of data analysis and comparison. However, each organization has a different mission, vision and purpose for its program. To take it a step further, there must also be collaboration. With collaboration partners exchange information, share resources, possess one singular mission and vision statement and have combined the separate programs into a more formalized functioning model. This new cohesive organization gives each partner representation on a new board for program operations and decision making on the course of the group.

Gerald Wages, Executive Vice President, North Mississippi Health Services, Inc., Tupelo, MS sums it up nicely when he says, “As we move forward with health care reform, it will be particularly important in rural areas that providers work together, perhaps in network arrangements, to address the scarcity of resources that rural providers often face, and to improve the overall efficiency of care throughout the healthcare continuum.”

~ Julia Leslie


"Health Research & Educational Trust. (2013, June). The role of small and ruralhospitals and care systems in effective population health partnerships. Chicago, IL: Health Research &Educational Trust. Accessed at www.hpoe.org.

"The Opportunities and Challenges for Rural Hospitals." Trend Watch. American Hospital Association, Apr. 2011. Web.

Kaelber, David C., and David W. Bates. "Health Infomation Exchange and Patient Safety." Journal of Biomedical Informatics 40.6 (2007): 40-45. Health Information Exchange and Patient Safety. 1 Dec. 2007. Web. 08 Aug. 2013.

UC Davis Health System. One Million Dollar Incentive Program for Rural E-health Information Exchange Launched. One Million Dollar Incentive Program for Rural E-health Information Exchange Launched., 16 May 2013. Web. 08 Aug. 2013.