Researchers Help Rural Hospitals Get Health IT Boost
The reasons for this are varied. Some rural hospitals cannot afford the expense of IT investments and have limited in-house health IT expertise. In addition, many health IT tools are designed with larger hospitals in mind. And while rural hospitals have basic IT systems in place for business applications, they are behind their rural counterparts in adopting technology for clinical use. For example, a survey in Iowa found that more than 80% of Iowa's urban hospitals, and between 30% and 40% of the rural hospitals, reported using computers to collect basic clinical information for potential use in an electronic health record (EHR) and computerized provider order entry (CPOE) system.
To help rural hospitals across the United States make more informed investments in technology, Agency for Healthcare Research and Quality grantee Marcia Ward and colleagues examined barriers to health IT adoption in rural Iowa hospitals. As part of the grant, project leaders wanted to better understand the patient safety and health care quality challenges that are specific to rural hospitals. In addition, the researchers examined rural hospitals' health IT capacity, barriers to using technology, the costs of such technology for rural hospitals and which technologies were most strongly linked to better care for patients. Next, researchers identified which technologies could have the greatest applicability for these hospitals, especially in the state's Critical Access Hospitals (CAHs).
Through literature reviews, surveys and interviews with hospitals in the state, researchers found several roadblocks to IT adoption in rural hospitals. These included high costs related to infrastructure and software, technology that was not ready for a hospital environment, and a lack of reimbursement for the use of technology.
As part of their effort to better understand these barriers, researchers formed the Iowa CAH Health IT Interest Group. The group met several times a year over a three-year period and became the de facto "networking club" for the key people at each hospital who had responsibility for implementing EHRs, says Marcia Ward, the project's principle investigator. The group discussed everything from how to store back-up data and where to get free software to how to write a request for proposals when seeking information from an IT vendor.
Because there is scant research available to guide rural hospitals in implementing health IT, Ward and colleagues also gathered input from the CAH Health IT Interest Group and created Web-based tools to provide hospitals with information that would help them make better Health IT investments. The toolkit included tips from members on how to get multiple Health IT systems to work together, how to train clinical staff to use technology, in addition to:
Research on best practices for Health IT in rural hospitals;
A list of technology vendors that rural hospitals used most often;
Sample Request for Proposals (RFPs) for soliciting health IT bids;
Lists of free or low-cost software;
Tips and federal security requirements for keeping health care data secure;
A hospital referral toolkit to refer patients who have had a heart attack or need coronary artery bypass surgery to the nearest hospital with the best outcomes for that patient; and
A cost calculator to help hospitals estimate the expenses involved in implementing an EMR system.
Ward, Professor and Associate Head of the Department of Health Management and Policy in the College of Public Health at the University of Iowa, says the key to success for this project was bringing so many hospitals to the table to solve a common challenge.
"When you have transparency, and working together, it's just a different place," Ward says.