Though critical access hospitals are making substantial strides in adopting health IT and increasing their telehealth and health information exchange capabilities, they face significant challenges in implementing electronic health records due to a lack of resources and workflow and staffing barriers.

Found in every region of the U.S., CAHs represent roughly 30 percent of hospitals nationwide, often providing critical healthcare services in underserved rural areas of the country. The good news is that as of last year 89 percent of CAHs had an EHR in place, and 62 percent of CAHs with an EHR had a fully electronic health record system, while 27 percent had a health record system that was part electronic and part paper.

Nevertheless, as of late 2013, they were less likely than other hospitals to have demonstrated meaningful use in the EHR incentive program. In addition, determining payments for participating in the Medicare and Medicaid EHR Incentive Program is not as straightforward for CAHs as it is for other types of acute care hospitals

Despite the central role these medical facilities play in their communities, these “smallest of the small rural hospitals”--some with a census of fewer than 10 patients--are struggling with financing and workforce-related obstacles to EHR implementation. Limited access to capital, in particular, is a major problem for CAHs. An article in this month’s Health Affairs, authored by several officials in the Office of the National Coordinator for Health IT, finds that CAHs that have certain types of technical assistance and resources available to support health IT are more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals.

According to ONC, CAHs that pool resources with other hospitals are more likely to have EHR and capabilities related to health information exchange and care coordination, compared to those that do not pool resources or engage in group purchasing. ONC and other federal agencies are partnering with non-governmental organizations to help CAHs identify and apply to financial assistance programs.

“It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system,” states the ONC article.

As of September 30, 2013, ONC and the U.S. Department of Agriculture piloted a public-private collaborative funding initiative that successfully generated over $32 Million in funding to critical access and rural hospitals across four states. Still, in a 2013 survey, 60 percent of CAHs reported having at least one significant financial challenge to EHR implementation and use—more than any other potential roadblock. At the same time, ONC’s findings indicate that CAHs receiving technical assistance from outside parties are less likely to report significant workflow and staffing challenges, compared to hospitals without outside assistance.

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