11 Oct Rural hospitals playing a game of IT catch up
Milwaukee, Wis. – It’s no secret that smaller rural hospitals lag behind their larger urban counterparts in the deployment of information technology, but gradual progress is being made in Wisconsin’s rural and urban hospitals both in terms of IT deployment and the thornier challenge of patient data exchange.
The $22.5 million in contracts awarded to nine health information exchanges for trial implementations of a nationwide health information network, announced last week by Health and Human Services Secretary Mike Leavitt, will help the latter, but Wisconsin’s rural hospitals also have received grant funding to accomplish the precursor – the deployment of healthcare IT.
And not a moment too soon for those who observe how rural hospitals struggle to keep up with healthcare IT.
While some rural hospitals are part of large chains with the resources, including staff, to provide advanced IT, others are playing catch up with their urban counterparts.
“For the most part, they are very likely to have IT to support administering of patients and preparing bills, which is just about impossible without IT these days, but they are less likely to have a complete electronic patient record than are the larger hospitals,” said Wes Rishel, vice president in the healthcare provider group at Gartner.
Taken for granted
St. Joseph’s Memorial Hospital in Hillsboro, Wis. and Tomah Memorial Hospital will participate in a $1.6 million grant program designed to help rural hospitals share healthcare information systems.
The grant will help reduce the start-up (implementation and software) costs for early adopters, according to Louis Wenzlow, health information technology director of the Rural Wisconsin Health Cooperative.
While as many as 10 to 15 rural Wisconsin health organizations are good candidates, about six of the rural hospital cooperative’s 32 members have been part of the final planning for the Rural Wisconsin Health Cooperative Information Technology Network.
In addition to Tomah and St. Joseph’s, the six hospitals include Memorial Hospital in Darlington, Boscobel Healthcare, Veroqua Hospital, and Mounds View Memorial in Friendship.
Other facilities in the cooperative are either owned by larger, tertiary care centers that provide IT for them, or they are farther advanced in their adoption of IT than others.
The network will serve healthcare facilities with integrated information technology, including electronic medical records.
The ITN is a collaborative approach to implementing healthcare IT at facilities that would not be able to afford them individually. While additional grants are possible, each facility that decides to participate is expected to engage in business planning and commit funds.
About 80 percent of the associated costs, which have yet to be determined, will be paid by participating hospitals.
Whatever the source of the funding, “there is a business case for the model,” Wenzlow said.
The cooperative currently is involved in selecting a vendor for the project, with contract negotiations to follow.
There still is an opportunity for any of the six organizations engaged in the process to back out. “We plan to have folks sign on or off by early November,” Wenzlow said.
The “go-live” date for Phase I applications, which will include those serving lab and radiology, is July of 2008. Clinical systems like EMRs and bar coding are scheduled to “go-live” in January of 2009.
One facility that is unlikely to back out is Tomah Memorial Hospital, which has seen a variety of business benefits from the deployment of healthcare IT. CEO Phil Stuart said the hospital is “far down the information technology highway” with electronic medical records and computerized, bar-coded medication administration. He said connecting with the Rural Wisconsin Health Cooperative, and the infrastructure and support it provides, will go a long way toward reducing costs and saving money.
The problem that small, independent hospitals face is that they can’t afford to have a sizeable IT staff. To install and maintain an electronic medical record requires capital and expertise, and those needs become magnified with each additional IT piece.
“For each hospital to hire an IT professional to provide back-up storage and maintenance and support would be expensive,” said Stuart, whose facility employs 4.5 (full-time equivalency) workers in IT. “We estimate savings of $100,000 or more.”
Consolidation also could save the facility about $10,000 a year in software licensing, but the real patient centric benefits will come with patient data exchange. There are barriers to overcome, both in rural and urban hospitals, but upgrading IT internally is the first step.
“That will benefit all of the facilities that have that technology,” Stuart said. “By being connected, it will get us to that position faster. That (patient data exchange) will happen at some point.”
Regarding patient data exchange, hospitals owned by the same company tend to be more advanced, Rishel said. Rural hospitals are not terribly far along, but neither are the big-city hospitals. With notable exceptions like Indianapolis and Cincinnati, few cities have advanced beyond the planning stage.
For a variety of reasons, Madison and Milwaukee have yet to reach the implementation stage. Madison hospitals had hoped to launch a patient data exchange system this calendar year, but the project has hit a snag on the handling of mental health records, a situation that may require a legislative remedy.
Meanwhile, the Wisconsin Health Information Exchange, which is developing a healthcare information network in southeastern Wisconsin, is testing a patient data exchange system for emergency rooms.
WHIE, which has received federal funding from the Connecting Communities for Better Health program and from the state of Wisconsin, is building out its Emergency Department Linking Project. ED Link, a two-year project that is tied to the broader adoption of electronic medical records in metropolitan Milwaukee, is an initial step toward providing emergency room physicians with specific patient data.
Hospitals are working toward providing basic information, including a patient’s most recent medications and medical tests, to doctors who often have no information on the history of patients that are taken to the emergency room. The system, supported by a $3 million funding commitment, gradually will be expanded in terms of the data provided and the number of facilities involved.
Beyond emergency-room care, one of the issues the exchange is working through is a system where the exchange can serve individual member facilities, according to Dr. Ed Barthell, a co-founder of WHIE. Under one scenario, when patients register for care at a given hospital, a copy of the registration message would be electronically sent to the regional exchange. The exchange would then aggregate the medical information on that patient and send it back to the hospital that originated the registration message.
The message only pertains to data on the patient under the hospital’s immediate care. To protect individual patients, “there would be no browsing capability,” Barthell said.
Rural vs. urban
Barthell, who has worked in a number of rural hospitals, said urban and rural hospitals are facing many of the same technology issues, in part because people are mobile and tend to get their care from multiple providers.
“Forty to 50 percent of the medical records,” he recalled, “were from outside the immediate neighborhood.”
Fortunately, the federal and state governments have not ignored rural hospitals. Among other methods, Rishel said Medicare and Medicaid reimbursement rates are deferential, and he noted that a Federal Communications Commission program offers high-speed Internet service to rural hospitals based on a small charge assessed on phone bills.
“The good news is that there are funding sources available to rural hospitals that aren’t available to larger markets, and that’s because the federal government and many state governments recognize that running a hospital in a small area is just never going to be profitable or self-sustaining,” Rishel said. “It needs help in order to get the basic healthcare out to the people who live in those rural areas.”
• Federal bill would set healthcare IT standards
• Bill would provide federal aid for healthcare IT
• Siemens health services president calls IT benefits “unassailable”
• DHC 2007: Barriers to electronic data exchange include the law
• IRS ruling could speed healthcare technology adoption