7 Ways Community and Rural Hospitals Can Achieve Meaningful Use

Although many hospitals are rapidly making a move toward deploying healthcare information technology in order to qualify for incentive payments through the American Recovery and Reinvestment Act, there is widespread concern that healthcare providers in smaller communities will not be able to keep up with this swift movement toward electronic health records. Community and rural hospitals, lacking financial strength and IT expertise, often cannot afford the big investment in healthcare IT larger health systems are able to make. Here are seven ways community and rural hospitals can achieve meaningful use despite lack of funding and resources.

1. Understand and stay educated on meaningful use. The federal government released an estimated 800-page document that outlines and details the definition, requirements and goals behind meaningful use. Eric Geis, managing director of CommunityWorks at Cerner, says because the information is so complex, it is critical for community and rural hospitals to work diligently to parse out the information and truly understand the measures, criteria and requirements tied to Stage 1 of meaningful use, as well as understand what criteria might be required in later stages.

Looking ahead is critically important, as the requirements around meaningful use will only become more stringent and demanding with the finalization of Stages 2 and 3. Mr. Geis suggests community and rural hospitals establish a committee whose sole responsibility is to monitor the climate around healthcare IT and meaningful use on Capitol Hill.

"Step one is getting organized," says Mr. Geis. "Rural and community hospitals can start to overcome [the challenges of meeting meaningful use] by first figuring out who within the organization is tagged to learn and keep track of everything."

2. Consult other resources. Hospitals should consult federal- and state-level organizations created to offer healthcare providers the services and tools needed to achieve meaningful use. State Offices of Rural Health, regional extension centers, the National Rural Health Association and industry experts can serve supporting roles for rural and community hospitals. Mr. Geis says reaching out to other small healthcare organizations on how they succeeded in deploying EHRs can prove beneficial.

"The Office of the National Coordinator recently hosted a meeting to discuss where smaller hospitals fit into meaningful use," says Janet Kiburz, program manager at Cerner. "It's important to get the 'small hospital' perspective because most have the same questions: How are small hospitals managing healthcare IT? What do meaningful use rules mean for small hospitals, especially in the critical access space?"

3. Gain buy-in and support of EHR deployment. Successful EHR deployment and qualification for incentive payments directly depend on whether community and rural hospitals successfully obtain buy-in and support. This includes the hospital board, physicians, other medical staff and the surrounding community. If there are no clinicians on-board to use the system and no patients willing to take advantage of a personal electronic record, rural and community hospitals will struggle to achieve meaningful use and reap the benefits healthcare information technology can provide.

"Many community and rural hospitals may not have done much strategic planning around health IT initiatives," Mr. Geis says. "Getting the community involved is going to be very important."

4. Research alternative financial arrangements. Because rural and community hospitals generally don't experience as much of a cash flow as some other larger hospitals and health systems, it will be incumbent upon them to research alternative and creative financial arrangements with their supplier of choice. Mr. Geis says some suppliers understand not all healthcare organizations are capable of putting down as much capital on the front-end, so they will sometimes work with smaller hospitals to design a payment plan that is more feasible.

"There are definitely companies that are trying harder to be creative with their financing and payment terms," Mr. Geis says. "For example, many suppliers have varying approaches to hosting, application management and upgrades, whether those services are included or will have to be paid for separately."

5. Deploy a system that fits your organization's needs. Because the healthcare IT industry has exploded in the past couple of years, rural and community hospitals should take advantage and choose a vendor whose system fits the hospital's needs. Contracts and relationships with healthcare IT vendors should also be treated like marriages: for the long-term and through thick and thin. Clinician adoption is a big part of the meaningful use measurement criteria, so choosing a system that gets good adoption scores is also very important.  

"If [a community or rural hospital] is going to make a purchase of an EHR system, the organization needs to make sure they are going with a supplier they are confident will meet Stage 1-3 of meaningful use and the goals the organization wants to achieve such as patient safety and improved quality of care," Mr. Geis says. "This really ties back to the timelines of meaningful use and the reimbursement methodology. [Community and rural hospitals] should not go with the cheapest product."

6. Consider how to become interoperable. Meaningful use has a theme around exchange of information, whether at the patient, provider or even state level. Examples are vaccinations, lab results and continuity of care documents. These capabilities and strategies need to be taken into consideration when looking at suppliers and implementation strategies. Outside resources can also give guidance around state initiatives. The next stages of meaningful use will most likely include more requirements around interoperability and exchange of information.  

"Sharing patient information with other agencies is huge, so [rural and community hospitals] will have to establish some different processes in order to achieve that interoperability," Mr. Geis says.

7. Address your organization's key ongoing concerns. Hospitals across the country are faced with a multitude of challenges, but some challenges are more specific to the rural and community healthcare arena where staffing and capital are limited. Mr. Geis says small hospitals should remain mindful of considerations related to support, training and interfacing. All these issues require a good strategy with the supplier.

"There are some issues [rural and community hospitals] will have to spend some time trying to address," he says. "One to note is the change in technology. Many physicians in smaller hospitals may not have a computer at home or older nurses aren't as familiar with computers. To address this, [rural and community hospitals] will have to implement a comprehensive training plan to ensure good adoption of the system."

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