Health Information Technology Value in Rural Hospitals

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Project Details -
Completed

The national discussion of quality and patient safety has only recently begun to identify and understand the unique quality and patient safety issues facing rural hospitals, as opposed to those of their much larger and far more complex, urban counterparts. Serious questions arise about whether commonly proposed health information technology (health IT) interventions for quality and patient safety issues actually make sense in rural hospitals. Moreover, very few rural hospitals currently have the necessary health IT capacities because of expense, limited in-house health IT expertise, and mismatches among health IT applications. This project was designed to meet the special needs of rural hospitals for assistance with planning health IT enhancements to address patient's safety and health care quality concerns. This project was developed in response to RFA HS-04-012 which states that "AHRQ is specifically interested in...applications that explore the unique barriers faced by rural and small community providers in adopting HIT and opportunities for overcoming these barriers" and "Research areas that are of particular interest to AHRQ include: development and evaluation of toolkits...that can be used by...decision-makers to help them understand the value of health IT and assist them to make health IT purchasing and implementation decisions." First, we documented the patient safety and health care quality challenges unique to rural hospitals. Second, explored the current health IT capacity in rural hospitals, the potential use of health IT by rural hospitals to address their unique patient safety and health care quality issues, and the unique barriers faced by rural hospitals in adopting health IT. Third, measured value derived from health IT in rural hospitals and identified which health IT solutions for enhancing patient safety and health care quality have the greatest potential in terms of generating a positive return on investment. Fourth, created decision-making health IT toolkits to address barriers and provide solutions that are appropriate for rural hospitals. Once the toolkits were developed, we made them available to rural hospital decision-makers. The toolkits facilitate rural hospitals' ability to utilize current and emerging evidence to guide health IT investment and implementation decisions that fit their particular health care environment.

Marcia M. Ward, PhD
When it comes to using information technology (IT) in hospitals, there is no one-size-fits-all approach. This is especially true for rural hospitals, which often lag behind their urban counterparts in adopting health IT.

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.