Health Information Technology in Rural Healthcare
Health information technology (HIT) has great potential to improve the quality, safety, and effectiveness of health services in rural communities, as well as help providers manage population health. However, implementing, maintaining, and optimizing HIT can be a challenge for rural facilities and providers with limited resources and technology expertise.
HIT includes using technology to store, protect, retrieve, and transfer information electronically within healthcare and community settings. Key elements of HIT include:
- Electronic health records for patients, instead of paper records
- Secure electronic networks to deliver up-to-date records whenever and wherever the patient or clinician may need them
- Electronic transmittal of medical test results
- Telehealth applications to enhance access to providers
- Confidential and secure access for consumers to their personal health information online
- Electronic communication between healthcare providers, as well as patients and community caregivers
- Electronic prescribing of medications and medical tests to help avoid medical errors
- Decision support systems to provide clinicians with information on best practices and treatment options to improve quality of care
- Mobile devices to make information available at the point of care
Frequently Asked Questions
- Are there health information technology resources specific to rural facilities?
- How can health information technology improve healthcare delivery and the quality of care in rural facilities?
- What are considerations for rural facilities when implementing an EHR system including working with vendors?
- What is the relationship between health information technology and telehealth?
- What are some health information technology funding opportunities for rural providers?
- Are rural providers meeting federal meaningful use requirements?
- Does EHR implementation pay off financially for rural providers?
- What are some health information technology workforce issues in rural facilities?
- How have rural HIT networks contributed to their members’ success in implementing HIT?
- How do rural providers exchange information with other providers?
- What is HIE and how does it work?
- How do we ensure the security and privacy of our electronic information?
- How can providers engage patients in electronic health information?
- Why is broadband important for HIT? How can we tell if broadband is available in our community?
- We have limited broadband in our area, what are our options?
Are there health information technology resources specific to rural facilities?
Yes, the Office of the National Coordinator for HIT within the federal government makes resources available that are specific to rural providers. The Rural Health Resources section of its website includes information on the benefits of HIT for rural providers, implementation resources for Critical Access Hospitals and other small hospitals, information about meaningful use, training webinars, and toolkits.
In addition, the Healthcare Information and Management Systems Society (HIMSS), maintains Rural Health IT Resources for the HIMSS Rural HIT Community. The website includes toolkits, case studies, and frameworks for selecting, implementing, maintaining, and improving EHRs in rural facilities.
How can health information technology improve healthcare delivery and the quality of care in rural facilities?
HIT systems improve quality of care by avoiding duplication of tests and medical errors. Because many patients receive care from multiple healthcare providers, HIT works to ensure efficient, coordinated and secure information exchange.
HIT systems can also help ensure that physicians and other healthcare professionals have the most current information about the conditions they are treating. Through the use of HIT, researchers may learn more quickly about new treatments and therapies.
HIT also allows patients to get engaged in their healthcare by tracking health conditions and accessing provider visit notes and test results.
What are considerations for rural facilities when implementing an EHR system including working with vendors?
There are many considerations for rural facilities when selecting and implementing an EHR system, including the services, goals, and capacity of the facility. Considerable planning is necessary to ensure a good fit and optimal use of the EHR system that is ultimately implemented. The Health Information Technology Toolkit for Critical Access and Small Hospitals stresses the importance of strategic planning:
“Your hospital needs to develop a plan that describes its long range goals for acquiring and achieving effective use of HIT. Without a guiding roadmap, you are in a reactive position, responding to what a vendor offers or what appears to be a regulatory requirement. Getting true value from HIT comes from setting your own course, communicating expectations, engaging all stakeholders, and celebrating success.”
The following websites have resources that address planning and working with vendors:
- Rural Health Resources, Office of the National Coordinator for HIT
- HIT Selection and Implementation in Rural Settings, Health Resources and Services Administration
- Health Information Technology Toolkit for Critical Access and Small Hospitals, Stratis Health
What is the relationship between health information technology and telehealth?
Health information technology and telehealth are related and complementary activities, both using technology to improve care and efficiency within the healthcare system, but in quite different ways. HIT refers to storing and exchanging healthcare data, such as in the use of electronic health records and clinical decision support tools. Telehealth is about using communications technologies to provide healthcare services, communicate with patients, or train providers, all at a distance. For more information on telehealth, visit the Telehealth Use in Rural Healthcare topic guide.
What are some health information technology funding opportunities for rural providers?
Not a lot of funding programs exist specifically for funding HIT initiatives. However, many grant and loan programs focus on issues in which HIT initiatives can play a part, such as healthcare quality, access to healthcare, healthcare workforce, and improving efficiency of care provided. Such grant and loan programs may be able to pay for HIT as part of a bigger initiative.
The following federal organizations and agencies may offer grant opportunities that support HIT efforts:
- Agency for Health Research and Quality (AHRQ)
- Health Resources and Services Administration (HRSA)
- Federal Office of Rural Health Policy (FORHP)
The USDA has loan and grant programs that do fund HIT initiatives, including the Community Facilities program, the Distance Learning and Telemedicine program, and the Rural Economic Development Loan and Grant (REDLG) program.
If in doubt, contact the agency or organization responsible for the program to ask about support for HIT initiatives and expenditures. Some funding programs may support HIT efforts, but might have restrictions on how the money can be spent and what the overall percentage of the budget or allotment can be used for HIT expenditures.
Are rural providers meeting federal meaningful use requirements?
Yes. According to the Office of the National Coordinator for HIT, over 65% of rural providers including Critical Access Hospitals have met meaningful use. However, they lag urban providers and larger hospitals. The Health IT Dashboard allows you to access state- and provider-level detail on meaningful use attestations.
Does EHR implementation pay off financially for rural providers?
Yes, but the payoff may take some time. How long it takes depends greatly on how well the providers implement the system, including workflow redesign and other factors.
Besides financial considerations, there are many other benefits to implementing an EHR. Benefits for Critical Access Hospitals and Other Small Rural Hospitals lists numerous benefits, which include instant access to patient information, better ability to coordinate care, improved disease surveillance, and many others.
What are some health information technology workforce issues in rural facilities?
The HIT workforce is limited in rural areas, and there has been a lack of adequate HIT workforce development in rural communities. The workforce gap can be attributed to the aging rural population, which is compounded by the influx of baby boomers retiring in rural areas and the out-migration of talented youth to urban areas in search of a broader array of educational and job opportunities.
When policy changes push for improving HIT infrastructure and achieving meaningful use, the challenge becomes more complex for an already strained rural healthcare system to make these transitions while still providing quality health care. For example, the rural healthcare system, which currently does not have a sufficient workforce, will have more difficulty achieving HIT adoption and meaningful use standards, as the standards involve all staff utilizing the EHR and physicians achieving optimal use of the EHR.
How have rural HIT networks contributed to their members’ success in implementing HIT?
Networking can help rural healthcare facilities manage the implementation of HIT. Rural HIT networks can provide shared HIT staff, volume purchasing for HIT software and training, health information exchanges, and data analytic services.
The Rural HIT Network Development Program, a three-year pilot program funded by the Federal Office of Rural Health Policy (FORHP), demonstrated 88% of the grantee networks saw all or some of their members achieve Meaningful Use stage 1 and 2 by the close of the program in August 2014. Over 90% of the grantees had all or some of the network members receive Medicare or Medicaid incentive payments.
How do rural providers exchange information with other providers?
The electronic exchange of protected health information between providers is being achieved in a number of ways. Traditionally, information that was carried or couriered in paper or film format can now be carried in electronic format, such as a USB memory stick or CD/DVD-ROM. Information that was faxed can be sent via Direct Secure Messaging and attached as either a PDF or as a structured data file, such as a Continuity of Care Record (CCD). Just like in the paper-based process, each party has to agree on the communication method and the data format being delivered.
What is HIE and how does it work?
HIE stands for “Health Information Exchange” and includes directed exchange, query-based exchange, and consumer-mediated exchange. Directed exchange uses secure messaging, called Direct, to send information from one person to another, usually providers or health information departments. Query-based exchange involves a data repository or record locater to find records for a patient that has presented, say in the Emergency Department. Consumer-mediated exchange involves the patient bringing, or transmitting via Direct, their pertinent health information to a provider. ONC’s Healthit.gov site has a resource on this topic, What is HIE?
CCD, or Continuity of Care Document, is a type of XML file that is structured in a standard way to be read by an Electronic Health Record. This standard package is useful for transmitting information between providers. The current standard is the Consolidated Clinical Data Architecture, or C-CDA, and is required for Meaningful Use.
For more information on HIE, see the HIE Toolkit from the National Rural Health Resource Center.
How do we ensure the security and privacy of our electronic information?
HIPAA regulations are designed to provide a minimum standard for compliance with privacy and security, and one of the requirements is to perform an annual risk assessment. This risk assessment should look at all of the administrative, physical, and technological risks your organization faces. It is recommended that a third-party be involved in the risk assessment. Another set of eyes can be very helpful in identifying any risks. The ONC resources, Health Information Privacy, Security, and Your EHR and Security Risk Assessment Tool, provide information and resources that may be helpful.
How can providers engage patients in electronic health information?
Health information technology has significant potential to help patients engage more fully in their own healthcare. Patient engagement can happen at every step in the interaction with patients, both inside and outside the point of care. These include the pre-visit (labs and directions), scheduling, rooming, provider encounter, and checkout (visit summary, follow-up appointments). Patients may utilize an online patient portal to schedule appointments, review test results and immunization schedules, and send messages to their provider.
It is important for rural providers to be aware of challenges their patients might encounter in accessing their information. The NORC briefing paper, Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities, identifies challenges for underserved populations that are due to community and population-related factors. Those factors include:
- Limited health and technological literacy
- Language and cultural factors
- Comfort level in interacting with the healthcare system
- Access to technology and the internet
Why is broadband important for HIT? How can we tell if broadband is available in our community?
Broadband refers to high-speed, always-on internet access. It plays an important role in the ability of rural healthcare providers to successfully use electronic health records and other HIT applications. Broadband is particularly important to any functions that allow for communication, information exchange, or telehealth functions. Lack of broadband availability in the community is also a barrier for patient engagement with EHR systems.
You can find out if there is broadband availability in your community, as well as others across the country, by using the National Broadband Map. The tool can be used by providers in the EHR Incentive Programs who need to document broadband download speed for exclusion criteria. In addition, the tool allows you to map and analyze broadband availability.
We have limited broadband in our area, what are our options?
There are a number of programs that healthcare facilities or their local telecom providers may be able to take advantage of:
- FCC Rural Health Care Program – This program consists of three separate funding opportunities, including the Healthcare Connect Fund, the Telecommunications Program, and the Rural Health Care Pilot Program.
- USAC Rural Health Care program – Reimburses qualified health care providers for the difference between their broadband costs and an urban setting.
- USDA Community Connect Grants – Offers grants to applicants that will provide currently unserved remote or rural areas with broadband service that fosters economic growth and delivers enhanced educational, healthcare, and public safety services.
- USDA Rural Broadband Access Loan and Loan Guarantee Program – Provides funds for the costs of construction, improvement, or acquisition of facilities and equipment needed to provide broadband service.
- USDA Telecom Infrastructure Loans and Loan Guarantees – Provides financing for the construction, maintenance, improvement and expansion of telephone service and broadband in rural areas.