Accelerating Progress on Adoption and Meaningful Use of Health IT among Critical Access Hospitals and Small Rural Hospitals

An accident happens on a farm and a man is taken to the nearest hospital, a tiny Critical Access Hospital, the only urgent care facility in the area, an hour drive over unpaved roads from any other hospital. The medical team stabilizes the patient and then sends him by helicopter to the nearest tertiary care hospital. What if the Critical Access Hospital could electronically transmit the patient’s medical record, including his lab and imaging results, to the tertiary care hospital while the patient is still in flight? If the hospital is able to electronically transmit these records, the doctor could review her patients’ records and get a head start on saving his life before he is even wheeled through the hospital’s doors.

Critical Access Hospitals are the smallest of the small rural hospitals in the nation—25 beds or less and often with a census of less than 10 patients—and play a crucial role in providing and extending access to care for residents of rural communities. In some regions, such as frontier areas, a Critical Access Hospital may be the only local health care provider serving an area the width of the state of Rhode Island!

Consider a Critical Access Hospital, one relatively larger than in the example above. In this hospital, the communities’ babies are born; the integrated physician clinic and nursing home provide care. Residents go to this hospital for diagnostic tests, routine surgeries, rehab and emergencies. And, this Critical Access Hospital has an Intensive Care Unit (ICU), but because of the size of its community and its local workforce, it does not have an in-house intensive care specialist for the ICU. What if a specialist—anywhere in the country or even the world—could be monitoring and even teleconferencing with this Critical Access Hospital’s ICU patients to provide specialty care remotely? With the right technology, including electronic health records (EHRs), this hospital can keep its patients in their own community and close to their families.

We find Critical Access Hospitals in every region of the country. These hospitals can serve as the focal point for all health care services in a rural area. They provide essential local services supplemented with care from specialists based in urban settings who will, for example, cycle through these hospitals to help serve rural communities. Critical Access Hospitals also offer urgent care to their community, neighboring towns, tourists and others that may just be passing by. Access to local health care services powered by health IT applications is especially important in rural areas.

Because they are isolated and have limited resources, rural areas can have unique vulnerabilities to emergencies and extreme events. In large scale emergencies, like fires or hurricanes, a rural town may find itself further isolated if the one or two highways linking its community to other cities is blocked off. Critical Access Hospitals and rural hospitals play an important role in their communities’ emergency preparedness, response and mitigation. These hospitals allow their communities to be self-reliant in an emergency, especially when they are equipped with the proper technology enabling them to communicate with emergency responders and health care providers outside hospital walls.

For Critical Access Hospitals and other small, rural hospitals, the path to Meaningful Use is not easy. These hospitals—especially Critical Access Hospitals and rural hospitals with less than 50 beds—face unique challenges because of their:

1)      Remote geographic location,

2)      Small size and low patient-volume,

3)      Limited workforce,

4)      Shortage of clinicians,

5)      Constrained financial resources and

6)      Lack of adequate, affordable connectivity.

In these settings, the value of health IT becomes particularly evident. In rural areas where distances between clinics are great, and specialists may be a travel-day from a patient’s home, health IT can give health care providers instant access to information necessary to make timely treatment decisions that can save lives. For example, when a parent takes his child to the local, rural primary care provider, this provider may send the family on a trip to see a specialist, which could mean a few hours of driving and a day of missed work for the parent. All too often, when the family gets there, the specialist cannot find the paperwork.

A Challenge. A Call to Action

We at ONC would like to see 1,000 Critical Access Hospitals and small, rural hospitals meaningfully using certified EHR technology by the end of 2014.

To realize this goal, we need all hands on deck! We need everyone rowing in sync, including leadership and staff in every critical access and rural hospital, EHR vendors, hospital associations and state offices of rural health in every state, Rural Health IT Network Development grantees, ONC grantees, and many more public and private, Federal and local partners.

ONC is committed to providing up to $30 million for Regional Extension Centers (REC) to target Critical Access Hospitals and small, rural hospitals. These supplemental grant funds are for RECs to help as many as 1,501 of these hospitals—that’s about 90 percent of hospitals covered by the Small Hospital Improvement Program and 30 percent of all hospitals nationwide—get to Meaningful Use. We are committed to working with all 1,501 of these hospitals and we want them all to achieve Meaningful Use. At the same time, we recognize that not every health care provider may achieve Meaningful Use in the next two years and we are committed to working with them at their own pace.

So far, more than 1,220 Critical Access Hospitals and  rural hospitals across the nation—as well as over 5,644 clinicians that work in these hospitals and provide inpatient and outpatient services—have enrolled with an REC for assistance on their path to Meaningful Use. This is great news because it provides data supporting the anecdotal evidence that Critical Access Hospitals and rural hospitals along with the clinicians working in these hospitals recognize the value of health IT and want to offer their communities health care services powered by the benefits of meaningfully using certified EHRs.

Again, this is a call to action: Let’s work together to get 1,000 Critical Access Hospitals and small, rural hospitals to Meaningful Use by 2014!




  1. Chuck Christian says:

    Thanks very much for ONC’s interest and continued support in this space. The small community and rural facilities provide critical services to the populations that they serve. Providing them that extra boost will allow them to move forward at a more rapid pace. Resources and capital will always be two of the major challenges that the smaller facilities will face, providing that addtional expertise will go a long way to help remove some of the barriers they experience in EMR implementation and adoption. Good Samaritan recently received their HIMSS EMRAM Stage 6 designation; the journey has not been with challenges and opportunities. Our 90 reporting period for Stage 1 MU is drawing to an end and attestation will be completed in early October. All the members of the GSH team are very proud of both accomplishments.

  2. Chris says:

    This effort is very deserving and support for rural and CAH is critical (pun intended). The best chance for success (in my humble opinion), is a joint effort between public (REC) and private sectors. There are consulting firms with specific MU experience sitting on the bench that can provide incredible value to this process. The RECs are trying to keep up with demand while servicing thousands of ambulatory providers. If there is a way to facilitate collaboration between pubic & private sectors in a way that fosters success of this initiative, that would ensure the ONC would hit their goal of 1,000 hospitals to MU by 2014. Thus far, in my experience, there has been an adversarial position taken by the RECs which creates an environment where we are not all “rowing in sync.” Get both sectors in the boat and we can win the race!

  3. Dan Engle says:

    This sounds remarkably like Thayer County Health Services in rural Nebraska. We also recently were awarded Stage 6 EMRAM from HIMSS and with our MU stage 1 attestation last year have seen a tremendous amount of change in the delivery of care. I am sure like a majority of other critical access hospitals similar thoughts and discussions have been had regarding improved quality of care. We have worked with the ONC on interoperability in the past and there are still a great deal of barriers to overcome with exchange and the sharing of health information. It is encouraging to see that momentum is improving and the meaningful use incentives are making an impact on electronic adoption. It is the shared goal among rural caregivers to keep the focus on the patient and make sure that what we are doing is improving care and safety in the long term.

  4. Scott says:

    Refreshing to read this. This segment is so often “forgotten about” with respects to innovative solutions and aid. In reflection, the rural and critical access providers should be looked upon as a group that get extra attention due to the fact that they are often times the only community means for health improvement overall. There are HIT solution providers out there that do focus on this market, but in order to be able to keep their overall low cost of ownership at affordable levels they have to maintain lean cost-structures themselves. This directly impacts their ability to effectively reach, educate and bring solution awareness to this vital segment.
    With an automated, again low cost and easy to use system(s) like cost accounting based BI, rural and CA’s can reduce the impacts related to limited staffing resources and at the same time drill down to the areas of their business (and its a business…) where they can cut cost-wastes and recognize the service lines that need process improvements. Reduces costs, increases profits and frees up staff that are otherwise to taxed to be able to step back and initiate proactive hospital improvements.

  5. Brent Mckune says:

    The KY Regional Extension Center (KY REC) is truly committed to CAH/RHs Meaningful Use acceleration. Working with CAH/RHs across the state of Kentucky has provided the KY REC with the unique opportunity to experience first-hand, the successful EHR implementation and MU attestation. The KY REC has delivered outreach, education, and technical assistance to CAH/RHs allowing them to accelerate the implementation of MU. Recently, the KY REC named Wayne County Hospital as a recipient of the 2012 Meaningful Use Vanguard (MUVer) Award for leading the state in the adoption of EHR technology. Wayne County Hospital, a rural health clinic and emergency center with only three staff physicians, attested to Stage 1 of MU in June 2012. Wayne County also established itself as a regional leader in HIT by becoming one of the first providers to connect electronically with the Kentucky Health Information Exchange (KHIE).

    As champions of the MU, MUVers serve as local leaders, advocates and role models for implementing EHRs and improving the accuracy, efficiency and accessibility of critical health information.
    This is only one example that illustrates not only our commitment to serving CAH/RHs throughout the state of KY, but also demonstrates our determination to meet the ONC challenge of 1,000 critical access and rural health centers meaningfully using CEHRT by 2014. The KY REC’s footprint across the state of Kentucky demonstrates our devotion to serving some of the most underserved populations in KY. We understand that implementing EHR technology and utilizing HIT in rural and critical hospitals is often a challenge. However, the KY REC recognizes that these initiatives are imperative to improving the health of Kentuckians, as they provide coordinated, comprehensive, efficient and accessible care. Furthermore, the KY REC wholeheartedly accepts this ONC challenge and will continue to strive to serve the unique needs of Critical Access Hospitals in the state of KY.

  6. Kevin Driesen says:

    We appreciate ONC’s support of rural hospitals. The expanded use of electronic medical records in rural hospitals is vital to improving care coordination, access to specialty care and, down the road, increasing patient access to clinical history information. Another positive outcome associated with EMRs is the increased capacity of rural providers to monitor and improve quality of service. Regarding this latter goal, it is especially important that federal standards for quality reporting remain coherent and consistent so that rural hospitals can develop their IT systems with a high degree of confidence about future federal requirements and standards. Right now there is a lot of change in how health services are being financed and many rural health service providers are anxious about the demands associated with EMR systems and about how they are going to sustain their HIT systems. In Arizona, we see the challenges but look forward to working with ONC and HRSA in achieving 2014 Meaningful Use goals.

  7. Kay Gooding says:

    The ONC funded Region D Workforce Development Program, under the leadership of Pitt Community College, is piloting a project aimed at helping critical access and small rural hospitals grow their own health IT workforce. We will develop and offer custom training based on the needs described by the hospitals. Individual hospitals may request customized training based on skills needed and their employees’ positions (e.g., clinical, administrative, IT). Stipends may be available for those students successful on post assessment quizzes. Please reach out to me, Kay Gooding at kgooding@email.pittcc.

  8. Jon Mertz says:

    This is a needed call to action. I grew up on a farm in South Dakota and have seen the role that critical access hospitals in rural areas play. It is an important one, and they cover a vast area of territory.

    Although being rural carries certain challenges with it, using a certified EHR connected to an HIE assists in continuing care of patients when they move to more urban centers for added care. Relevant information needs to go with the patient. It ensures greater accuracy and quality of care and limits added costs.

    Through the RECs, my hope would be that health IT conversations happen between rural areas and between urban and rural areas. There are lessons to be shared and learned as well as best practices. We need to have the conversations in order to lift up all care no matter how many beds or what the area is being served. It is time!

  9. Michael Barber says:

    Critical Access Hospitals really do present a great opportunity to extend care into more rural communities. Over the next decade, I would actually expect there to be more of these types of care centers in smaller communities and less of the large metro hospitals we know today. Through electronic medical records, urgent care and telemedicine, we have the opportunity to extend care at the neighborhood level, even allowing patients to see doctors without leaving their homes. The challenge exists in the availability, reliability and the consumer trust of the technology to support these. Demand has surpassed the implementation and when companies that create and install such systems charge $50-200 million dollars to do so, it makes it difficult get the adoption necessary to make it ubiquitous.

    Imagine one day you come home from work and aren’t feeling very well. You take a drink some water, take an over the counter medicine and take a nap. When you wake up, you aren’t feeling any better. You pull out your tablet, call up your telehealth provider, speak with an NP or doctor within 2 min. By the time you are speaking with them they have already pulled up your health record. You tell them your conditions, share with them a couple of photos, they see that you had similar conditions about a year ago and a particular antibiotic successfully treated you. They prescribe the medication and send it to your corner pharmacy (or have an Amazon drone deliver it!) where you can pick it up in an hour. We have the technology, just not the coordination.

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