Overcoming Integration Challenges for Rural Health Organizations

Overcoming Integration Challenges for Rural Health Organizations

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CoreTech Revolution’s Michelle Burton will be presenting at next month’s Indiana Rural Health Association (IRHA) Spring Conference on the topic of “Understanding True Electronic Health Record (EHR) Integration for Healthcare.” As a supplement to that presentation, we’ll outline in this article the current state of the rural health community, as well as how organizations can work together toward EHR integration and interoperability for the benefit of all.

Rural Health Defined:

According to Wikipedia, “rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments.” When we think of the word ‘rural,’ we often think of a remote or distant location without access to health care. However, many cities and towns throughout the state have a large population of patients, and may have access to hospitals and facilities in the larger hospital networks, but may not have the same resources as the urban area. An example of this includes Hendricks Regional Health, a rural health organization in Hendricks County, Indiana with a medical staff of more than 250 physicians located in six rural communities. However, rural health would also include regional locations of larger health organizations such as St.Vincent Hospital and IU Health, with dozens of hospitals and facilities and thousands of physicians throughout Indiana.

Providers and patients in each of these rural areas face different challenges than those in urban areas. According to the National Rural Health Association (NRHA), some of these obstacles include economic and educational limitations, lack of recognition by legislators, and geographic isolation. Some of the goals of the rural health community include:

  • Maintaining quality of care
  • Improving population health
  • Enhancing provider recruitment and retention
  • Improving quality of care
  • Expanded access to underserved areas

With disparate needs, goals and complexities at every type of rural health facility – from funding to decision-making -- every rural health organization must coordinate efforts to create a truly integrated health community. One of the keys to delivering on this promise is to work toward interoperability between rural and urban health systems through the use of technology --- particularly via electronic health records and healthcare information exchanges (HIEs).

Current state of the EHR system in Rural America

After the enactment of the American Recovery and Reinvestment Act, which required the adoption of Electronic Medical Records (EMRs) by 2014 for 70 percent of primary care providers, most rural health organizations have begun implementing some form of electronic health record (EHR) systems. In addition, Centers for Medicare & Medicaid Services (CMS) offered reimbursement incentives for providers meaningfully using EHRs starting in 2011, and expects full adoption, before they begin subjecting providers with financial penalties for non-compliance.

Slow adoption rates, lack of meaningful use and other issues have prevented the rural health community from fully using EMRs or HIEs. In order for rural health care providers to improve operational efficiencies through health IT and EHRs, they first must be aware of the issues unique to the rural healthcare setting. Some of these issues include:

  • Lack of IT leadership: Many rural areas lack a workforce with the technical expertise to oversee or implement an EHR or HIE integration. These organizations need a project leader that is willing to spearhead the implementation effort, as well as to facilitate buy-in from stakeholders and the community. Rural providers may need to supplement their efforts through recruitment of IT professionals, training of existing staff, or augmentation from a health IT consulting firm or regional extension center to help guide them.
  • Disparate systems, No Integration: To complicate health IT projects, each department within a rural health organization has separate systems. For example, the clinical lab system may run on an external application that is different than the system used by radiology, cardiology or other departments. Even with a shared coding system within a rural network, sometimes systems can get confused as to where the results are coming from, allowing patient health data to get lost or reported inaccurately. All of the systems within the organization must talk together and integrate with the EHR or HIE, which requires much time and development effort.
  • Lack of IT Infrastructure: What sometimes creates a greater challenge for rural health communities involves where all of the individual applications feed into the EHR. In some cases, data goes straight from the source system to the HIE. In other cases, it might originate at the interface engine and then to the HIE. Network connections also impact the complexity of the integration process.
  • Different Goals: When looking to integrate an EHR, competing factors often arise, as departments understand how their workflow fits into the EHR or HIE, but may have a hard time looking at the big picture. In order for an IT implementation to be successful, all parties have to work together toward a common goal.
  • Connections to larger Health Systems: Many rural health organizations are bound by parent institutions that make most of the corporate decisions related to IT. This makes it more difficult to implement an EHR integration or integrate into an HIE. Hospitals and clinics that are not part of other health care systems can be more flexible in the manner that they implement health IT.

Steps to a Successful EHR Integration:

In general, here are the basic steps required for setting up an EHR or HIE integration within a rural health community:

  • Define a project team for leadership, implementation and technical support
  • Develop a short- and long-term strategy, vision and budget
  • Identify resources for funding and governance
  • Understand present state of information, technology and exchange
  • Define architecture and framework as related to current workflow
  • Implement, integrate and test the solution
  • Train staff and begin utilization of technology

Rural health organizations are slightly behind urban health organizations in the implementation of health IT. However, despite limitations in resources, rural institutions have the capability to develop fully-integrated health IT systems that can begin to create efficiencies, enhance connectivity and improve overall patient care.