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Implementing HIT in Critical Access Hospitals

April 18, 2011
by Jennifer Prestigiacomo
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One Texas hospital faces financial, staffing challenges

The 13-bed Collingsworth General Hospital in Wellington, Texas, has had many unique challenges, not unlike the other 77 critical access hospitals (CAHs) in the state, and the 1,324 in the U.S. Not only do rural hospitals have limited staffs—Collingsworth has only two physicians—these organizations have limited funds for information technology implementations. To aid its transition to electronic medical records (EMRs), Collingsworth secured one of only 16 national grants from the federal Flex-HIT Program. The $1.2 million grant was administered by the Office of Rural Community Affairs’ Texas State Office of Rural Health, a state agency which oversees programs to increase rural communities’ access to healthcare.

CAHs are significantly less likely than other U.S. hospitals to have adopted key applications that are preconditions for meaningful use, according to a policy briefing from the Rural Health Research Centers at the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine (the Flex Monitoring Team), which were the recipients of a five-year cooperative agreement award from the Federal Office of Rural Health Policy to monitor and evaluate the Medicare Rural Hospital Flexibility Grant Program (Flex Program). Fewer than 14 percent of CAHs have an EMR with a clinical data repository and some clinical decision support capability, while the most frequently adopted technology applications are order communication systems, which have been adopted by almost two-thirds of CAHs, and radiology picture archiving communication systems (PACS), which have been adopted by over half of CAHs.

In 2008 Collingsworth General Hospital began implementing its EMR from the Horsham, Penn.-based NextGen Healthcare. The hospital currently has independent laboratory and pharmacy systems, and has implemented medication reconciliation and computerized physician order entry (CPOE). The hospital is now working towards creating an enterprise system through NextGen to help meet meaningful use requirements. Hospital Administrator Candy Powell spoke with HCI Associate Editor Jennifer Prestigiacomo about the challenges her hospital faces implementing health IT.

Can you tell me a little about your EMR implementation?

Essentially when we started out, they brought in a team of seven or eight from NextGen, and they went through our whole hospital and learned our [processes] and saw what processes were duplications, and showed us where we were spending a lot of time. They were mainly working with our 10 department heads at the time. Then we had to pull all of our data in, and that took a great amount of time getting everything pulled and ready to go into the system. Nextgen was very good about getting on the phone and working with our other vendors to help integrate. When the implementation process started, they probably brought about five or six [people] down and they would train our super-users. They were here probably a week before going live, and then a week and a half after go-live. At times, we were worried that our financials weren’t integrated, as we were integrating systems that we not all NextGen systems. Getting vendors to work with other vendors [was challenging].

Candy Powell

What were some other challenges your hospital faced?

Money is always an issue with small, rural hospitals. Another big challenge is IT staff. In small, rural towns you’re limited on who does your IT. We realized that was a huge hurdle to overcome. We ended up getting a guy in Austin, and he runs all of our IT now. He works for other facilities too. So we had to outsource it. I have one person here, and one we’re training to back her up.

What you have in small hospitals is so many people wear so many hats, where in urban hospitals they do one job usually. In urban hospitals you usually have a lot of hospitals to be super-users, they may have 20 to 30 people set up as super users when they put in a system. In our hospital we probably had four or five super-users and they still had to carry on all their tasks while they were doing this. We have a lot of remote staff like our social worker, and we have a contract pharmacist—you just don’t have everyone around all the time.

Is it challenging to have the head of your IT department work remotely?

You have to think of things in advance to be prepared for [things that come up]. We have to have backup servers. When you’re in a rural town you have to have more backup plans in place than in an urban community.

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