Implementing Clinical Systems in Rural Areas (Part 1)
The 2009 Health Information Technology for Economic & Clinical Health Act enacted by the U.S. government aided in progressing the implementation, adoption, and meaningful use of the core clinical system comprising electronic hospital records and electronic medical records in urban and rural regions of the United States. However, the implementation of this core clinical system in rural areas mainly depended on three different themes including 1) Establishing incentives and standards, 2) Starting the process with vendors, teams, and committees and training, and 3) Surmounting difficulties faced by rural hospitals during the implementation process.
IMPLEMENTING ELECTRONIC MEDICAL RECORDS (EMR) IN RURAL UNITED STATES
The efficient step-by-step implementation of the aggregated clinical core system incorporating electronic medical records (EMRs) and electronic hospital records (EHRs) in rural areas of the United States was contingent on three separate themes, which included:
- Setting incentives and standards
- Commencing implementation with vendors, committees, and teams and training
- Conquering challenges faced by hospitals in rural areas
Additionally, the implementation process was primarily on a site-by-site basis since many rural hospitals initiated their own application schemes.
1) ESTABLISHING NATIONWIDE STANDARDS AND INCENTIVES
Executing the core clinical system with electronic hospital records (EHRs) and electronic medical records (EMRs) in rural regions of the United States, which has scattered rural establishments, began with the nation administering federal policies to expedite the process. The country established the American Recovery & Reinvestment Act (ARRA) in 2009 to build a national IT infrastructure. Afterward, the United States passed the Health Information Technology for Economic & Clinical Health (HITECH) Act, which organized the Health Information Exchange (HIE) across the nation to encourage healthcare CAHs, providers, and facilities to apply EHRs in significant ways.
The HITECH Act's main initiative supplied incentive funding through Medicaid and Medicare to advance the adoption of EMR and EHR in rural regions by helping them surmount any financial limitations. Nevertheless, the final goal was to achieve the acceptance of EMR and EHR nationwide. Additionally, the HITECH incentive disbursement authorized grants to associations, educational institutions, and states to intensify the adoption and implementation of HIE, along with extending the security and confidentiality demands of the Health Insurance Portability & Accountability Act (HIPPAA). Some alterations to the HIPAA Act by the HITECH Act involved the security of patients' electronic health information, as well as electronic protection and access. Through these federal policies, the United States government's intention was to create transformative propositions that facilitated superior methods of handling the health data of patients throughout the country (urban and rural settlements).
The Center for Medicare & Medicaid Services (CMS) directed the essential management guidelines for putting the EMR and EHR core clinical system into action in the country's rural regions. These particular guidelines concentrated on enhancing the quality of patient care and teaching the certification process of electronic health records. They also contributed additional guidance for clinical decision-making in sectors embracing HITECH to implement EMRs and EHRs. The CMS also maintained and coordinated monetary payments for rural hospitals and healthcare providers using EHR and EMR to satisfy the standard placed by the federal government. The criterion by the CMS required them to present their EMRs and EHRs to local and state health departments.
FINANCIAL INCENTIVES FOR RURAL IMPLEMENTATION OF EMR SYSTEMS IN THE UNITED STATES
The United States' 2009 Recovery Act allocated more than $20 billion in federal incentive payments for doctors and hospitals in the country using EHR and EMR core clinical systems to progress the safety, effectiveness, and quality of care. Also, the HITECH Act granted billions of dollars in direct funding to clinicians and hospitals in urban and rural regions to assist their leaders and administrators in installing EMRs. Furthermore, the ARRA awarded billions of dollars to small physician practices in the nation to promote the use of EHRs. Rural areas collected around $2.5 billion to develop broadband services to permit the adoption of electronic medical record systems. Finally, the U.S. Congress instituted broadband projects by funding up to $7.2 billion for both the National Telecommunications & Information Administration (NTIA) and the Rural Utilities Service (RUS).
2) BEGINNING IMPLEMENTATION WITH TEAMS, COMMITTEES, VENDORS, AND TRAINING
Based on authorized national measures by the federal government, hospitals in rural areas launched the process of implementing the core clinical system, including EHR and EMR, by building vendors, committees, and teams. These groups adhered to a distinct hospital's stated criteria. Rural hospitals recognized that the implementation process (EMRs and EHRs) primarily relied upon clinicians and providers utilizing and pointedly employing technology. Therefore, they started by developing and training staff using IT best practices.
Thus, the effective implementation of the EHR and EMR core clinical system in rural regions had two crucial components. One was staff engagement that included establishing essential committees and teams, along with securing stakeholder buy-in. The other was training staff before implementation to guarantee there was a stable shift to brand-new IT-enhanced systems. Hence, the implementation process, following proper consideration of nationally-instituted standards, involved rural hospitals collaborating with staff members to establish committees and provide training, as well as partnering with vendors and consultants to manage the process and produce the required IT tools.
A rural hospital in the country appointed a Chief Information Officer that took part in the EHR and EMR transition at another establishment to supervise its implementation process. As mentioned in a study submitted to the Walden University, the CIO "established a clinical informatics team, permit team, as well as informatics financial team." The individual also conducted organizational training to introduce cooperation IT best practices to help apply EHR and EMR effectively. While selecting vendors to assist in implementing EHR and EMR in rural hospitals, meaningful criteria included cost, ease of use, scope and cultural fit, and how the latest systems interfaced with existing ones.
3) CHALLENGES FACED WHEN IMPLEMENTING EMR AND EHR IN RURAL AREAS OF THE UNITED STATES
Some challenges rural hospitals encountered concerning the implementation of the EHR and EMR core clinical system included the following:
- Technical issues
- Cost difficulties
- Resistance from medical professionals
- Frontline workforce not persuaded about sensible returns
Meanwhile, the operational concerns that impacted the implementation of electronic medical record systems in rural regions were cultural circumstances related to:
- Users' inexperience utilizing IT
- Reduced system integration
- Staff opposition to change
- Absence of sufficient funds to train staff and expedite the overall implementation process
SUCCESS METRICS FOR IMPLEMENTING EMR IN RURAL AREAS OF THE UNITED STATES
Throughout urban and rural regions in the United States, the employment of the core clinical system (EMR and EHR) grew by about 46% with the intent of tackling over 98,000 deaths in the country, as of 2013, caused by the scarcity of data documentation along with exchanges between urban and rural clinics.
Also, there has been expanded utilization of the core clinical system (EHR and EMR) in various areas of the United States because of the series of funding possibilities and federally-established standards, which revealed the significance of e-health. Around 87% of hospitals in the nation, including rural ones, used the EHR and EMR core clinical system, as of 2015, to link their patients to e-health systems nationwide. This percentage rose to 94% in the year 2017.
Between the years 2015 and 2017, the average usage of electronic medical records data by rural hospitals to notify clinical practices grew from 5.1 to 5.5 because of the employment of the EHR and EMR core clinical system. Nonetheless, when compared to those in urban regions, this growth symbolized the smallest application of EMR data in the same time frame. The increase still signified the constant adoption of the core clinical system in the United States.