Small, rural and critical access hospitals lag in interoperability

Despite progress in EHR adoption, small facilities struggle with data exchange, says Vaishali Patel.

While rural, small and critical access hospitals are closing the gap in electronic health record adoption relative to their larger urban counterparts, they are lagging behind in achieving interoperability, according to the Office of the National Coordinator for Health IT.

At Wednesday’s joint meeting of the Health IT Policy and Standards Committees, ONC presented an update on EHR adoption and interoperability based on an analysis of 2015 American Hospital Association Annual Survey–IT Supplement data.

The data show that small facilities are struggling when it comes to the interoperable exchange and use of electronic health information.

According to the brief, rural hospitals have less than half the rate of engaging in all four domains of interoperability—electronically finding, sending, receiving and integrating information—compared with suburban and urban hospitals (15 percent vs. 34 percent, respectively).

Small hospitals also lag behind medium and large hospitals in achieving these capabilities (18 percent vs. 34 percent, respectively). In addition, CAHs had significantly lower rates of engaging in the four domains of interoperability, compared with facilities that are not CAHs (17 percent vs. 30 percent, respectively).

“Among smaller, rural and critical access hospitals, we found that they had significantly lower rates of electronically sending, receiving, finding or querying, and integrating information,” Vaishali Patel, a senior ONC advisor, told the committees.

At the same time, while the percentage of hospitals electronically sending, receiving and finding key clinical information grew significantly nationwide between 2014 and 2015, Patel reported that the electronic availability of outside information at the point of care and usage of that information for clinical decisions was lower among rural/small hospitals and CAHs.

According to Patel, from 35 percent to 39 percent of rural or small hospitals and CAHs had electronic information available from outside providers/sources vs. 46 percent for all federal non-acute care hospitals. She also said from 41 percent to 46 percent of rural or small hospitals and CAHs actually used electronic information received from outside providers or sources, compared with 53 percent of all federal non-acute care hospitals.

Nonetheless, Patel added that rural or small hospitals and CAHs are closing the gap in EHR adoption. “There have been significant increases in EHR adoption amongst these hospitals,” she said. “For example, critical access hospitals’ basic EHR adoption rate has increased four-fold from 2011. As it relates to gaps in interoperability, it may be that we’ll have to track this over time to see how this evolves. And, it may be that as EHR adoption increases some of these gaps may narrow over time. But, that’s something that remains to be seen.”

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