Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released an important report last week. The report finds that implementing health information technologies, like electronic health records, can help improve health care quality in rural areas. Specifically, the report examines the Columbia Basin Health Association (CBHA) in Othello, Washington, the technologies they implemented, and the resulting improvements in healthcare.
According to Secretary Sebelius, the CBHA is just one example of how “health information technology and electronic health records (EHR) have helped ensure patients get better care.” She goes on to report that technologies like EHRs “can reduce paperwork, make care more efficient, and let doctors spend more time practicing medicine and less time filling out forms.” In addition, many practices are financially better off after implementing an EHR, because the resulting efficiencies can reduce operating costs and allow practices to see more patients.
As a case in point, CBHA used their electronic systems to track diabetic patients. Prior to implementing their EHR systems, only 31% of CBHA’s diabetic patients received their recommended foot and only 37% their eye exams. After implementing their EHR, the numbers rose to 86% and 63%, respectively. In addition, CBHA now ranks in the 95th percentile nationally for total medical and dental productivity.
While implementing EHR systems can benefit any practice, rural areas seem to have the most to gain. Many rural areas fall under federally-classified “Health Professional Shortage Area,” which means there may not be enough physicians to satisfy local demand. EHR systems can help physicians in these shortage areas by allowing them to see more patients per day without an increase in overhead.
However, physicians in rural areas should be careful when selecting an EHR system. Many rural areas lack critical infrastructure that could pose a challenge to implementation. High speed internet, for instance, is still not available in all areas. Similarly, physicians may have trouble finding qualified computer support technicians. Office staff may lack basic computer skills, which can slow down implementations and require more expensive training.
Despite these limitations, rural physicians should continue their EHR search. Instead of purchasing one of the complicated, expensive market-leading systems, physicians should purchase a simple, cost-effective EHR that doesn’t require a full-time internet connection. Simple systems are easier to install, and easier to learn and use, especially for physicians and staff with little computer experience. Last but not least, the HITECH stimulus act offers increased EHR reimbursement payments for physicians in rural “Health Professional Shortage Areas.”
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Ryan Ricks
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ICMCC News Page » Health Information Technology Improves Rural Care - Oct 7, 2009
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Marshall Maglothin - Oct 11, 2009
The first two HITECH priority grant programs, funded through the Recovery Act, support the national implementation of electronic health records (EHRs) initiative.
Approximately $598 million is being made available through the Health Information Technology Extension Program (Extension Program), to ensure that comprehensive support is available to health technology users.
Under the State Health Information Exchange Cooperative Agreement Program $564 million will be awarded to support efforts to achieve widespread and sustainable health information exchange (HIE) within and among States through the meaningful use of certified Electronic Health Records.
State Health Information Exchange Cooperative Agreement Program
The State Health Information Exchange Cooperative Agreement Program will help States and Qualified State Designated Entities (SDEs) to develop or align the necessary policies, procedures and network systems to assist electronic information exchange within and across states, and ultimately throughout the health care system. A key to this program’s overall success will be technical, legal and financial support for information exchanges across health care providers.
The Extension Program will provide grants for the establishment of Regional Health Information Technology Extension Centers (Regional Centers) that will offer technical assistance, guidance and information on Electronic Health Records best practices. These estimated 70 (or more) Regional Centers each will serve a defined geographic area. The Regional Centers will support at least 100,000 primary care providers, (and receive $5,000 for EACH PROVIDER that is successful at “meaningful use”) through participating non-profit organizations, in achieving meaningful use of EHRs and enabling nationwide health information exchange with direct, individualized and on-site technical assistance in:
Selecting a certified EHR product that offers best value for the providers’ needs;
Achieving effective implementation of a certified EHR product;
Enhancing clinical and administrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care, including patient experience as well as outcome of care; and,
Observing and complying with applicable legal, regulatory, professional and ethical requirements to protect the integrity, privacy and security of patients’ health information.
The Extension Program will also establish a national Health Information Technology Research Center (HITRC), funded separately, which will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.
Grants under the Extension Program will be awarded on a rolling basis with an expected 20 grants awarded in the first quarter of FY2010, another 25 in the third quarter and the remaining awards in the fourth quarter of FY2010. The initial funding includes approximately $598 million to ensure that comprehensive support is available to providers under the Extension Program beginning early in FY2010, with an additional $45 million available for years 3 and 4 of the program. Federal support continues for four years, after which the program is expected to be self-sustaining. Of the total federal investment in this program, about $50 million is dedicated to establishing the national HITRC, and $643 million is devoted to the Regional Centers.
The law requires that Regional Centers be affiliated with a U.S.-based, nonprofit institution or organization, or an entity thereof, that applies for and is awarded funding under the Extension Program. The program anticipates that potential applicants will represent various types of nonprofit organizations and institutions with established support and recognition within the local communities they propose to serve.
The performance of each Regional Center will be evaluated every two years by a HHS-appointed panel of private experts, none of whom are associated with the center being evaluated. Continued support for the Regional Center after the conclusion of the second year of performance will be contingent on the panel’s evaluation being, on the whole, positive and on HHS’ determination that such continued federal support for the center is in the best interest of the program.
The Regional Centers will focus their most intensive technical assistance on clinicians (physicians, physician assistants, and nurse practitioners) furnishing primary-care services, with a particular emphasis on individual and small group practices (fewer than 10 clinicians with prescriptive privileges). Clinicians in such practices deliver the majority of primary care services, but have the lowest rates of adoption of EHR systems, and the least access to resources to help them implement, use and maintain such systems. Regional Centers will also focus intensive technical assistance on clinicians providing primary care in public and critical access hospitals, community health centers, and in other settings that predominantly serve uninsured, underinsured, and medically underserved populations.
The Extension Program expects all Regional Centers to be operating at full capacity by the end of December 2010. In addition, it is expected that by the end of December 2012, the Regional Centers will be largely self-sustaining and their need for continued federal support in the remaining two years of the program will be minimal.
Additional information is available at http://healthit.hhs.gov/extensionprogram
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