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

Mat Kendall and Leila Samy | September 26, 2012

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!