Joe Wivoda, Chief Information Officer
Transforming any industry is challenging. Health care is going through a multidimensional transformation right now: Reimbursement changes from volume to value, increased focus on quality, and implementation of IT systems and meaningful use. Every hospital, clinic, skilled nursing facility, and indeed all health care providers are coping with these changes. Rural facilities share many of the same challenges as their urban counterparts, but there are some that are uniquely rural.
Providing patients with timely access to their health information, and getting sufficient numbers of them to view, download, or transmit their data, is a challenging meaningful use requirement. This is much less of a technological challenge, more of a marketing and patient engagement challenge. In a rural hospital or clinic, implementation of the patient portal can be challenging due to the lack of IT resources, and HIT vendors that focus on rural are often too busy to implement the portals early enough to build a patient engagement campaign. It takes time to engage patients and get them setup to log in to access their health information and it is important that rural providers engage their community as a whole. Discussing the benefits of online access to your health information on the radio and at public events will go a long way to get patients excited about being more involved in their care. Rural has a significant advantage here, primarily because they are so close to the community.
Participating in health information exchange, particularly state-based exchange, has been frustrating. Technological changes, unsustainable business models, and low adoption levels have kept state HIEs struggling. In addition, many HIEs have focused their efforts on capturing the urban hospitals and integrated delivery networks first, essentially putting rural on the back burner. Query-based HIE, as opposed to Direct Secure Messaging, is difficult to implement. Exchange is so important for Stage 2 of meaningful use, and for high quality and safe patient care, that it can not be ignored. Rural providers should look to Direct for being able to exchange with their referral partners while working with their local HIE for future query-based exchange.
Rural clinics and hospitals that do not have a culture of process improvement are at a significant disadvantage when implementing an EHR. All too often I visit rural facilities that have no established process improvement program. Based on my experience, this is the single most important thing to have when implementing an EHR. Without PI you will implement an EHR in a way that will likely decrease productivity, or worse, decrease patient safety. The EHR is not built with idealized processes "baked in", you need to do the work. Understand how you do things today, understand how the EHR works, design a new process. We like Lean as a methodology, but PDCA or others are valuable. Rural facilities, who are usually stretched for resources and have staff wearing many hats, need to make PI a core part of the culture. Urban hospitals and IDNs have been doing this for years, and CAHs that have embraced PI have been shown to be financially sound and their EHR implementations go much better with less fixing after the go live.
Rural has the ability to move quickly. These are challenges that can be overcome. Continuous process improvement, workflow analysis and redesign, should be central to not just the EHR implementation (or improvement) but to the operations as a whole. HIE, patient engagement, and improved utilization and efficiency from the EHR will follow once good process improvement activities are made central to the work.
What do you think are HIT implementation challenges in rural?
