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Critical Access: The Need to Connect

July 20, 2010
by Daphne Lawrence
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Connecting midsize hospitals to rural critical access hospitals is important to the growth of both-but there are things larger hospitals need to know


Many small, rural critical access hospitals are reaching out to each other and to larger hospitals as a way of setting up affordable health information technology systems that will meet meaningful use requirements. CIOs who have followed this strategy weigh in on its benefits and potential pitfalls.

Todd reynolds

It's hard for hospitals to go it alone today. That is especially true for small, rural critical access hospitals, which are just as responsible as their larger siblings for meeting meaningful use requirements of the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.

According to the Office of the National Coordinator for Health Information Technology (ONC) of the Department of Health and Human Services in Washington, D.C., there are about 2,073 hospitals with fewer than 50 beds, 1,305 of which are critical access hospitals. That is no small number. Recognizing the unique needs of these small hospitals and the potential difficulties they face in terms of support, the ONC allocated an additional $25 million in April for regional extension centers to help these small hospitals set up health information technology (HIT) systems. But as many critical access hospitals have already found out, working with nearby tertiary care hospitals-as well as each other-can be the best place to start.

Bill drozda

“The key for everybody to understand is that we cannot survive being independent islands on our own,” says Jim Rieber, CIO at Perham Memorial Hospital and Home, a 25-bed critical care hospital with a six-bed long-term-care facility in Perham, Minn. “Technology is moving fast and patients' expectations are growing,” he says. Rieber believes that small hospitals can maintain their independence, but they are going to have to form partnerships or alliances-especially around IT needs.

Perham Memorial, for example, is part of a technology group of 15 hospitals whose IT directors get together via video conferencing to pursue group purchasing and share ideas, education, and training. “Independently it's hard to get those resources available to you,” Rieber says.

Bill Drozda, vice president of rural market strategy for Irving, Texas-based VHA Inc. agrees. VHA Inc. works with more than 1,400 hospitals across the nation, including more than 320 critical access hospitals. One of the association's primary business activities, Drozda says, is helping its members form regional collaborative networks for the purpose of sharing information. “Most of the small members are concerned about the mandate for EMRs [electronic medical records] because they don't know how they are going to be able to afford it,” he says. “Many are working through state organizations and networks.”

In addition to the state and regional initiatives, even an alliance of two critical access hospitals wields more power than a single entity. Memorial Medical Center, based in Ashland, Wis., is one example. It's comprised of two 25-bed critical access hospitals, one in Ashland and the other in Hayward, Wis. Todd Reynolds, IT director, says his office in Ashland acts as the data center for both hospitals. “Small hospitals cannot afford the technology that is available without some form of a relationship,” he says. “With two hospitals we have a little buying power.”

Though the two hospitals operate autonomously, they share software supplied by Reston, Va.-based QuadraMed Corp. for revenue-cycle management and clinical applications, and plan to upgrade the clinical package to QuadraMed's Computerized Patient Record, a component of the vendor's Care-Based Revenue Cycle solution. Fiber-optic cable connects the two hospitals, which are 60 miles apart. In addition, Reynolds recognizes the need to work with his fellow critical access hospitals. “The state of Wisconsin is in the process of creating a health information exchange, and we've been participating in that,” he says.

I've seen several of our larger hospitals try and put their EMRs into a small hospital, and it has not worked out well.-Bill Drozda

In addition to linking to each other, top-of-mind for many critical access hospitals is the information-sharing link with their local tertiary hospitals. That presents its own set of problems. Many CIOs agree that piggybacking onto a larger electronic health record (EHR) system is usually not a good solution. “Larger systems may not be able to adapt their big EHRs for a critical access hospital; and it may be inappropriate, overkill, and cumbersome,” says Drozda. “I've seen several of our larger hospitals try and put their EMRs into a small hospital and it has not worked out well.”