According to our fourth annual Community Hospital Health IT Survey, MU is creating a new breed of unique challenges for small, rural hospitals — challenges that may require drastic changes to address.
Every year, Health IT Outcomes surveys more than 100 small community and critical access hospitals (300 beds or fewer) to gain an in-depth understanding of the health IT trends and challenges having the most significant impact on this key segment of the care continuum. Not surprisingly, every year the survey reveals that limited financial and human resources make it difficult for these smaller providers to meet their health IT demands. This year provided more of the same. However, some compelling new information did come to light as a result of this year’s survey. Namely, our respondents were outspoken in communicating how recent Meaningful Use (MU) program requirements are introducing a new set of unique challenges to community hospitals. These new challenges are widely viewed as shortsighted and unfair by community hospital leaders, but this contingent realizes that these requirements are unlikely to change. Addressing these new demands will require community hospitals to carefully assess their health IT strategy and often make drastic process and organizational changes. The following article outlines some of these new challenges and examines how some community hospitals are responding.
Meaningful Use Consumes Community Hospital Resources
One of the primary objectives of our Community Hospital Health IT survey is to determine the top IT priorities at these rural healthcare facilities. We asked respondents to name the single biggest health IT initiative currently under way at their organizations, and, not surprisingly, the vast majority (68.75 percent) identified EHR MU as the focus of their health IT efforts.
Achieving MU is likely the top health IT priority at most large health systems as well, but our survey was quick to point out some of the unique challenges community hospitals face in this regard. One of the biggest centered on the financial and human resource limitations of community hospitals. For example, we asked survey respondents to rank eight common health IT implementation challenges from 1 to 8 — with 1 representing the biggest challenge and 8 representing the smallest challenge. The initial costs associated with health IT implementations proved to be the biggest challenge overall for community hospitals, with 52.5 percent of respondents ranking this as the first or second biggest pain point. Workload/lack of IT resources followed close behind, with 32.5 percent of respondents ranking this as the first or second biggest challenge. Follow-up conversations with some of the survey respondents provided added color around this struggle.
“IT expenses currently consume nearly one-third of our capital budget,” says Maureen Kahn, RN, president and CEO at Blessing Hospital. “This is a significant expense and takes its toll on other hospital projects. Furthermore, while we have a large IT team for a community hospital, our rural location can make it hard to attract and retain top IT talent. Once we train folks on the systems we have in place here, they become highly marketable to other providers, hospitals, consultants, and vendors.”
Ismelda Garza, CIO at Comanche County Medical Center, has a much smaller IT staff than that of Blessing Hospital, and these limitations have negatively impacted the provider’s MU progress. “I only have two other IT FTEs besides myself,” she says. “Our limited staff and funding have hindered our ability to become meaningful users to date. Plus, MU is a catch-22. You need to spend money on IT investments in order to achieve MU and collect the incentive funds, but many community hospitals don’t have the money to invest up front.”
Stage 2 MU Introduces Patient Engagement, Direct Message Challenges
The healthcare industry’s quest for MU has placed even more pressure on community hospitals. For example, many EHR vendors are forced to scramble to meet the latest MU certification requirements released by CMS and ONC (Office of the National Coordinator). This rush to update products often has consequences for smaller hospitals.
“Our ongoing struggle is trying to manage the slew of software updates that we regularly receive from our inpatient and ambulatory EHR system vendors,” says Joe McHale, NextGen Manager for Copper Queen Community Hospital. “These updates are vital in our efforts to successfully attest for MU. However, with limited resources, we don’t always have the time to test these updates before we put them into production. This often comes back to bite us.”
Other significant challenges cited by community hospitals are related to some of the primary objectives outlined in Stage 2 of the MU program. According to many community hospital leaders, it is unrealistic and unfair to expect small rural hospitals to be able to meet some of the Stage 2 requirements, particularly those related to patient engagement and Direct messaging.
“The patient portal requirement in Stage 2 that states that greater than 5 percent of our patients have to visit a patient portal to view their health information online is outrageous and out of our control,” says Parhez Sattar, senior director of information technology at Grande Ronde Hospital. “Patients aren’t employees. We can’t force them to go to a patient portal. Moreover, as a rural hospital, more than 55 percent of our patient population are retired. This older demographic isn’t as tech-savvy as younger generations, which makes engagement even more challenging. In fact, many of our patients don’t even have Internet access either because they don’t use it, can’t afford it, or can’t receive good bandwidth where they live.”
Sattar explains that Grande Ronde has been providing all kinds of incentives in an effort to motivate patients to view health information online, so the hospital can fulfill this requirement and attest for Stage 2 incentive dollars. While these efforts have been successful to date, Sattar believes too much energy has been placed on this effort, and some focus has been diverted from patient care as a result. Moreover, Sattar is skeptical that Grande Ronde will be able to maintain a 5 percent or greater patient portal adherence rate over the long haul.
“In a small community like ours, you tend to encounter the same patients over and over again,” he says. “You can only motivate them to access their health data online so many times. This makes it more difficult for us to achieve the 5 percent portal access objectives outlined in Stage 2 on an ongoing basis.”
The Direct messaging requirements outlined in Stage 2 MU pose an altogether different problem for community hospitals – a problem that lies not so much with the patients, but with neighboring providers. The root of the problem is that the current language pertaining to Direct messaging in Stage 2 focuses only on sending patient medical information via the platform (i.e., 10 percent of the patient information a provider sends to another provider must be sent electronically via the Direct platform). Nowhere does the Stage 2 criteria outline requirements for receiving Direct messages. As a result, community hospitals are finding themselves equipped to send and receive Direct messages, but with no one to exchange this information with.
“Grande Ronde Hospital adopted Direct messaging in 2013, but only two other hospitals (out of more than 20) that we regularly work with have a Direct messaging address,” says Sattar. “How are we supposed to meet the 10 percent Direct messaging requirement if there are no other facilities in our region to Direct message to?”
Cloud Technologies Offer Some Community Hospital Relief
While a community hospital may not be able to influence change in government policy, many can (and do) implement process and organizational changes in an effort to overcome their most pressing health IT challenges. According to our survey, most community hospitals are trying to address their pain points by increasing their IT budgets (51.25 percent*) or hiring outsourced IT support or consultants (51.25 percent*).
Simply throwing money at a problem won’t solve it. The key is to be strategic in your health IT spending so that it helps offset your weaknesses and supports your overall objectives. Comanche County Medical Center provides an excellent example of this.
As mentioned earlier, Comanche County Medical Center has just three FTEs to oversee all of the hospital’s health IT initiatives. Until recently, these responsibilities included ongoing maintenance and troubleshooting of all the on-site servers, routers, and storage devices that served as the backbone for Comanche’s MEDITECH EHR platform. In an effort to free up employee time, Comanche County Medical Center decided to switch to Dell’s cloud-based service offering.
“Now Dell maintains all of the servers, storage devices, and other hardware that support MEDITECH,” says Garza. “By delegating this responsibility to a trusted partner, my employees now have more time to dedicate to MU strategy and execution. This is incredibly valuable, especially when our internal resources are so limited.”
Some community hospitals are even finding ways to cope with the challenges associated with patient engagement. For example, like most providers striving to attest for Stage 2 MU, Blessing Hospital has been consumed with trying to motivate patients to use its patient portal. Historically, hospital employees attempted to sign up patients for the portal during the admissions process. They quickly realized that trying to register a patient for an online portal when they are acutely ill was an exercise in futility. In response, the hospital began using student nurses to engage admitted patients about the online portal at more convenient times (e.g., in the evenings in the patient’s room, often when surrounded by family members who play an active role in their health management). The impact of this slight process change has been dramatic.
“Having our nursing students visit the patient’s bedside to discuss and demonstrate our online portal has quickly doubled our sign-up rate,” says Kahn.
Despite Challenges, Health IT Is Helping
Government and industry pressure for increased health IT adoption has undoubtedly created daunting challenges for community hospitals, but the leaders I spoke with are quick to point out that these efforts are already paying off. For many, the most immediate benefits of health IT are a result of the wealth and accuracy of patient data that is now being collected in a standardized and discrete format that can be easily analyzed.
“With EHR technology, we are now generating health records that provide clinicians with a complete picture of patients,” says Kahn. “Moreover, we’re gaining a level of visibility into this data that we’ve never had before. There’s really no way to capture this data and compare it across different patient populations without technology. Once you have the data, you can parse it and analyze it in ways you can act upon. We’ve been working with our EHR vendor, Allscripts, to generate reports that allow us to isolate and analyze data that is helping us reduce readmissions and improve quality measures.”
The positive impact of telehealth and telemedicine deployments were also referenced by all of the community hospitals interviewed for this article. For example, Sattar explained how Grande Ronde Hospital has leveraged telemedicine to provide its rural patients with access to international specialists.
“We have deployed remote presence telemedicine robots from InTouch Health throughout our facility to allow physicians from all over the world to assess our patients,” says Sattar. “Not only has this telepresence technology been instrumental in providing our patients with access to quality care remotely, so has our EHR. Our Web-based physician portal from McKesson Paragon allows remote specialists to not only access and view everything in the patient record, but also complete orders using CPOE (computerized physician order entry), access a patient’s medical images, and more.”
Finally, it’s important to note that large-scale EHR and telemedicine implementations aren’t the only way to experience the benefits technology can deliver to community hospitals. In fact, oftentimes, the most modest IT deployments can have a lasting impact on efficiency, productivity, and patient care. Copper Queen Community Hospital and its associated clinics have witnessed this firsthand with its investment in an automated phone messaging system from PhoneTree.
“We use the automated phone system to send out appointment reminders to our patients,” says McHale. “The system automatically calls a patient 48 hours prior to their appointment. It’s a simple solution, but using it has drastically reduced our no-show rate.”