The transformation of the nation’s healthcare system really begins with the advances that support the relationship between providers and their patients, which has been extended beyond the bedside and examination room.

Information technology has been at the vital center of this transformation, which has accelerated quickly over the last 10 years. However, widespread deployment of information technology has not eliminated the challenge. Health IT leaders at community and critical access hospitals face a range of problems that are often not appreciated.

These IT leaders typically fill more roles in their organizations, interact with a wider range of colleagues and handle more tasks. Recent interviews of these leaders by Galen Healthcare Solutions, identified these common responsibilities:

  • Act as broker between IT departments, administration and clinicians, convene multi-stakeholder steering groups, agree on a finite list of important projects, and obtain buy-in for the time, resources and scope necessary to deliver those projects.
  • Deploy data management and data governance strategies to increase trust in organizational data, improve quality of care and patient safety, maintain regulatory compliance, manage costs and succeed with new payment models..
  • Facilitate interoperability, data normalization, harmonization and care coordination across care settings.
  • Broaden and harden IT security to mitigate emerging and evolving threats.
  • Enable increased patient engagement capabilities, such as telehealth technology, to maintain competitiveness with regard to patient access.

The interviews indicated that these tasks are made more difficult because these hospitals are typically financially strapped and have depleted resources, and serve semi-isolated communities and rural areas.

In the interviews researchers heard these and other common themes, and how HIT executives aim to deal with them in some way particular to their own care setting, but generally compensating for the lack of financial resources, while seeking to implement the best possible tool for clinicians and their patients, balancing competing initiatives, and navigating the path from fee-for-service to value-based care.

Beyond fragmented databases to continuity of care
Brian Sterud, vice president and CIO at Faith Regional Health Services, Norfolk, Neb., a HIMSS EMRAM Stage 6 hospital that serves a population of 156,000, is juggling a number of EMRs--Soarian on the inpatient side, NextGen on the ambulatory side, a different EMR for home health and a different EMR in its nursing home.

A lot of organizations, with different applications across care settings, must normalize and harmonize their data, but, as Sterud admits, “it’s definitely not an ideal scenario. We are going through a process of evaluating a move forward to potentially centralize many of those on a new platform. This is difficult. There’s very little data that traverse across the systems, so it creates silos of data, which isn’t good for anyone. Not to mention the challenge it creates in terms of supporting multiple disparate systems. There are probably some inefficiencies from a cost perspective, but the biggest thing, again, are the fragmented databases, in terms of not having continuity of care driven by a centralized database. It’s as if the clinicians are presented with chunks of the chart rather than a complete picture.”

A significant portion of concern for Sterud and IT leaders for hospitals in similar circumstances is population health management and how it factors into a decision for a new EMR, or if by contrast, the EMR selection should be driven purely by the desire for a single database solution.

“It’s a huge part of what we’re doing, making sure that we can get data, and who we can collaborate with, to be able to analyze data in our region,” Sterud says. “We are exploring areas where we can exchange patients and methods with other facilities, and how easily we can do that in terms of interoperability. We need to get to that next level where we can get good at actionable data and things that we can do relative to population health management, in the time frame that we need to do it. We simply don’t have the data at the speed and the detail that we need it right now. When we move to another platform, that definitely needs to be a part of the package.”

Independence, platform migration and physician relations
David Parker is CIO/VP of IT for Magnolia Regional Medical Center, a HIMSS EMRAM Stage 6, 200-bed acute care hospital in Corinth, Miss., a city and county-owned hospital associated with no other health organizations.

“Our closest competitor is roughly an hour away. We’re fortunate we don’t have heavy competition in our neighborhood, although that’s starting to change,” Parker says. “We’re starting to see a little more encroachment in our community from other healthcare systems. We’re all being pressured from different angles and trying to find ways to grow our systems; we must adjust and adapt.”

With usability and productivity deficiencies driving replacement activity in the EMR market, Parker has thought long and hard about migrating platforms. “Last year, we implemented MEDITECH’s 6.1—their latest platform—on the acute side, and this year, we’re implementing MEDITECH’s web ambulatory product; we’re a MEDITECH customer across the board. We have almost every single module that MEDITECH offers as it’s a good fit for a hospital of our size.

“But during the vendor selection process, several of our physicians wanted us to look at Epic, as they had trained at much larger hospitals and knew the Epic platform and liked it,” Parker adds. “However, Epic doesn’t sell directly to community based hospitals like us, so the only option we had was to partner with another Epic hospital. We took that message back to our physician base. Here in our community we enjoy our autonomy and do not want to get into the hip pocket of another big healthcare organization, so we decided that was not an option.”

Nevertheless, over a period of time, a sentiment arose among the younger physicians that drove Parker to re-evaluate and consider a new platform. MRMC was running the MEDITECH Magic system on the acute side, but it had GE Centricity on the ambulatory side. “We had lab and radiology report interfaces, but aside from that, there was very little other integration between those systems,” he says. “As we moved forward, the doctors expressed the desire for one platform. When MEDITECH came on-site to do their demos, they also showed how this new product they were working on would be fully integrated. The doctors who saw it could see the benefit of it. Although physicians typically don’t want change, they recognized this is the way for us to progress forward.”

Small staff, tight budgets and medical records in the basement
Jeff Weil is CIO of the District Medical Group, a large physician practice whose revenue comes primarily from supplying doctors and mid-level providers to Maricopa Integrated Health System in Phoenix. Nevertheless, he says, “We still haven’t quite figured out how to optimize our electronic health record systems. We still have physicians struggling with utilization of these systems, yet now we’re being asked to add on new technologies whether it’s connected health or population health initiatives.”

One of the numerous challenges CIOs in community hospitals confront all the time is finding solutions to interoperating, such as between acute care and outpatient care. With tight budgets and doctors not yet comfortable using EHRs, Weil must get creative in working on integration strategies. His solution has been to invest in “our own integration engine, as well as bringing on staff to support that initiative. Every single time we do an interface, it may cost $15,000 and take 90 days to develop. Eventually the ROI is going to turn in our favor if we’re got staff in house to design and develop interfaces on our integration engine platform.”

Finding enough people to meet that requirement is not always easy for smaller medical groups. “We’re a fairly small shop. I’ve got 17 people in all of IT, and that’s both on the applications and technology side, supporting almost 1,100 employees. We’ve got quite a bit going on, so I do need people to wear multiple hats.”

Adding to the burdens these CIOs must lift are the frequent inquiries for records. The eDiscovery process requires that Weil “either take some sort of an export out and send it to file or print a whole bunch of stuff. We end up looking through all of our databases. And, because we also provide medical directorship to some nursing homes/long term care facilities and other facilities that don’t necessarily have EMR systems, many records are in boxes in basements or over at Iron Mountain. We have to go wherever they store their records and pull that information out. As you might imagine, it’s not an easy task.”

Maintaining competitiveness in the transition to value-based care
As the nation’s healthcare organizations gravitate toward value-based reimbursement, the role of the CIO is changing from managing the infrastructure and basic IT initiatives to a strategic position that demands maintenance of patient satisfaction and better quality of care. As such, the business model and the care model are becoming increasingly intertwined. In this environment, community and rural hospital CIOs must be nimble and innovative to balance numerous initiatives while trying to remain competitive in the transition from fee for service to value based care.

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