Overcoming Challenges to Rural Health IT Infrastructure

September 01, 2016 - Critical access hospitals (CAHs) and small rural hospitals make up a large part of the healthcare industry in the United States.

Major internet service providers don’t provide strong service in these areas, making it difficult for CAHs to participate in health information exchange (HIE) with larger healthcare organizations.

Broadband service may be unavailable in some rural areas. Contacting the local DSL or fiber optic company may be necessary before even beginning to consider implementing health IT infrastructure elements.  

Patients may need to travel far to reach their closest medical practice or CAH, which makes HIE use even more important. If a patient needs to travel to see a specialist doctor in an urban area, it’s important the specialist has access to the most accurate and up-to-date medical record. Patients in critical condition can be treated much faster when their electronic health record is readily available.

CAH doctors could likewise benefit from increased health IT connectivity. They could consult other medical professionals (e.g., clinicians, pharmacists) in other parts of the country, which would likely improve specialist referrals and ensure patients receive appropriate care. Shareable records will also allow CAHs to easily transfer patients to local facilities for follow-up appointments.

Network connectivity is just one of many issues in rural healthcare. Shortage of IT staff is a common problem for CAHs. Without a dedicated and experienced IT staff, rural practices and CAHs are limited in their ability to build and maintain a reliable and secure health IT infrastructure.  

Through HealthIT.gov, the Office of the National Coordinator for Health Information Technology (ONC) has made available resources to assist CAHs with getting the technical expertise and funding to build a unique and successful health IT infrastructure.

Free toolkits are available for organizations to begin evaluating the needs of their current infrastructure. The Rural Assistance Center Rural Health Information Technology Toolkit  is a rural-specific evaluation tool funded by the Office of Rural Health Policy.

Additionally, the Stratis Health HIT Toolkit for Small and Rural Communities provides organizations with tools tested in the CAH environment to aid in planning for and making informed decisions about health IT selections.

CAHs may also lack the funding to implement and deploy a full network. The hardware and software themselves are quite costly, but extra fees may apply if broadband internet needs to be modified to allow an organization’s area to connect.

Federal funding opportunities are available for qualified CAHs to assist in funding utilities needed for full infrastructure deployment. The FCC’s Rural Health Care Program provides funding to eligible CAHs and rural practices for telecommunications services including broadband internet.  

The rural utilities service provides the following programs to finance rural telecommunications infrastructure:

• Broadband Loan Program
• Distance Learning and Telemedicine Program
• Community Connect Grant Program
• Telecommunications Infrastructure Loan Program

Obtaining the resources necessary for running a CAH health IT infrastructure is  possible, but rural areas still lack shortages in IT staff responsible for building and monitoring the network. To address that need, ONC funds the Health IT Workforce Development Program which trains current healthcare staff to manage and monitor the network.

Organizations can use health IT development programs as incentives for administrative workers to pursue careers in health IT by offering education reimbursement. Coordinating programs with local high schools, technical high schools, and community colleges can encourage loyalty to an organization and give limited IT staff assistance with simpler helpdesk tasks,

While many government assistance and funding programs exist to help CAHs to adopt technology their urban counterparts already use, there will always be obstacles. Even with broadband funding, outages are more likely to happen and make difficult the full adoption of cloud computing or virtualization technology. Higher maintenance wireless networks coupled with IT staff shortages can put strain on current IT department.

Turning to one or many of these government programs will relieve some of these common challenges and help CAHs and other rural medical practices build a modern health IT infrastructure.

Dig Deeper:

• Rural Healthcare Grants Tackle Population Health Management
• Broadband: The Missing Link to Rural Telehealth Success