- Rural healthcare providers support approximately 40 to 45 percent of the U.S. population, which extrapolates to 150 million people across America. These organizations operate on the slimmest of financial margins, severely hampering their move to emerging care models in the areas of health IT integration and implementation.
“If you want to use data analytics to transition to a wellness delivery model, you’re going to need the technology to do that. But if you only have four or five days’ cash on hand, you don’t have the resources to make capital investments to actually position yourself strategically. You’ve got to worry about making payroll and keeping the lights on for the next 30 days,” according to Sean McPhillips, health IT program/project manager at CTG, an IT solutions and services company.
McPhillips has devoted much of his career to supporting large-scale healthcare integration and interoperability projects, including the build-out of core components for British Columbia’s interoperable EHR and management of Kentucky’s grant-funded Regional Extension Center (REC) project. He’s also collaborated with the Department of Health and Human Services (HHS) to coordinate annual events within Kentucky and Tennessee during which federal funding resources are matched up with health IT needs at rural hospitals and Federally Qualified Health Centers.
HealthITInteroperability.com asked McPhillips where things would go from here in regard to IT support for rural healthcare facilities.
“In Kentucky, the state auditor conducted a physical count and financial assessment of rural health organizations and found that many have less than seven days’ cash on hand,” he explained. “If they have one minor blip in cash flow, they could literally go under.”
Indeed, examples are scattered across the rural landscape. The University of North Carolina’s Center for Health Services Research has documented 57 rural hospital closures from January 2010 to the present. Mercy Hospital in Independence, Kansas (population 9,000) is expected to be the 58th closure, according to a New York Times report published earlier this month. In similarly populated Hancock County Georgia, about 100 miles from Atlanta, residents have access to more funeral homes (two) than hospitals (zero).
Broadband expansion will be a big factor in reversing the trend. “Organizations in downtown areas are getting connected, but a focus of the success of health information technology to drive wellness-driven care, patient-engaged care, is that the patient needs direct access,” said McPhillips (pictured). “Patients don’t necessarily have high-speed access in their home, so they may be reliant on their phone. Those deficiencies need to be breached in order to bridge the digital divide that exists between outlying communities and major metropolitan areas.”
At the facility level, organizations also need funding for technological investments “to attain meaningful use of EHRs, to be able to hand off or have interoperable exchange with state registries and syndromic surveillance, and for practice analytics so they can benchmark their data,” noted McPhillips.
“What is very real — and this has happened in Kentucky — is that we have hospitals who say, ‘We can’t afford to stay open,’” said McPhillips. “When they close, and they’re the only hospital in a 30- to 40-mile radius, it’s a big deal for a lot of people.”
Part of the solution will be continuing outreach from federal entities, according to McPhillips. HHS has rolled out workshops in about 14 states to raise awareness of funding sources from the U.S. Department of Agriculture, the Federal Communications Commission, the Appalachian Regional Commission and others. “There’s money available that [rural] organizations don’t know about,” he noted. “Let’s get them in a room and shake hands. These events have been successful nationwide, helping millions of dollars flow to some of these organizations. I’m hoping this year will be another success.”
He points to direct experience with critical access hospitals (CAHs) in Kentucky. The state’s REC figured out a way to waive the cost of technology assistance to CAHs through grant arrangements. “We were able to assist with [EHR] vendor selection, generalized consulting services, and provide them with some physician-level analytics and workflow redesign to take advantage of whatever health IT investment they had made in order to receive meaningful use dollars,” said McPhillips. “We helped them get a big chunk of money that kept them afloat. We also helped them with audits at no cost.”
Looking forward, “the most important and most underutilized technological utility that could benefit rural health is telemedicine,” according to McPhillips. A rural hospital or CAH could partner with a well-established healthcare enterprise in a metropolitan area, for example. “You can directly serve your community and the patients in your community in a very efficient way with a mature telemedicine clinical workflow,” he added. “So you would have some of the great subject matter experts — the best clinicians in the region — directly supporting and assisting patients who have very specialized and acute needs.”
That type of collaboration is coming to fruition in Hancock County, Georgia (cited above). A telemedicine program equips ambulances with computers, cameras and cardiology monitors so that EMTs can share real-time patient information with emergency room doctors at hospitals in neighboring counties, reports AJC.com. The program launched this summer with a $105,000 grant from the Georgia Department of Community Health. A subcontractor supplies the ambulances and the EMTs are reimbursed for their consultations with ER doctors.
McPhillips concluded, “Having a good technological footprint and infrastructure is so important. Making the technology capital investment will be crucial if the future state is going to be able to support these communities. The community will be dependent on a successful deployment of something like telemedicine in partnership with major healthcare institutions. Those two legs together will be essential for rural communities.”
Photo credit: NRDC.org