As health care systems move toward more and more electronic record keeping, the labor it takes to manage that data threatens to cripple rural hospitals, according to industry insiders.
The data transfer between hospitals and other entities can negatively affect rural hospitals. The problem centers around the digital divide where rural healthcare facilities struggle to securely share or receive electronic health records, Jordan Bazinsky, CEO of Intelerad, wrote in MedCity News recently.
It’s called the “interoperability crisis.” In a rapidly changing and technological world, rural hospitals and older clinics may rely on older electronic health record (EHR) platforms that don’t communicate with modern application programming or advanced data-sharing capabilities.
A 2023 study from the University of Nebraska College of Medicine found that rural hospitals were less likely to adopt electronic health records or to manage the interoperability of different platforms communicating with one another. The study found that EHR adoption was significantly higher in urban hospitals at 74%, compared to rural hospitals at 64%.
“Significant disparities exist in EHR adoption and interoperability between rural and urban physicians. These disparities highlight the need for targeted interventions to enhance EHR adoption and interoperability in rural settings to ensure equitable access to healthcare technologies and improved patient outcomes across all communities,” the study found.
The lack of communication between platforms can put rural healthcare facilities at a disadvantage, leading to fragmented care when patient information can’t move from rural hospitals to larger urban medical centers or vice versa, or lead to increased costs when physicians have to repeat tests and scans because they can’t access prior diagnostic images or results, Angela Chubb, senior manager of quality and regulatory advisory services with Nordic, a global health and technology consulting company, said.
To compound the problem, technology departments in rural hospitals and clinics often only consist of one or two people already stretched thin trying to manage basic maintenance. Some rural hospitals may also lack reliable broadband infrastructure, or the financing to handle continuous system upgrades.
Meanwhile, hospitals across the country are moving to increasingly data-driven reimbursement and care coordination programs. Those systems require hospitals to provide numerous reports to several different state and national organizations; reports that are tied to how much the hospital is reimbursed for services. Rural hospitals are struggling to keep up, Chubb said.
“We have this ongoing burden that is put upon our rural communities — from the regulatory standpoint, from a resourcing standpoint …. People are processing technology. And if you look at the upcoming regulations … these communities are dealing with that ongoing administrative burden,” Chubb said in an interview with The Daily Yonder.
“They’re trying to figure out how to manage their costs, they’re trying to figure out how to manage their resources, and it becomes very overwhelming. They’re doing a great job in those communities because they’ve had to adapt over time and evolve. But at some point, they’re going to get to this shift that they may not be able to manage effectively and practically.”
But some data managers in rural hospitals said providing those reports takes more labor than they have to spare. Smaller systems are forced to manage creating and delivering that data without the staffing, structures, or technology resources that larger systems have, according to Phillip Mues, chief informatics officer with Cherry County Hospital in Valentine, Nebraska.
“When you think of all of these different places that we’re sending data, then think about the fact that their data requirements are all different,” Mues said in an interview with the Daily Yonder.
“What does that do to our team? Well, that requires our team to make multiple calls, over multiple weeks, to get the data formatted correctly. That’s a huge lift. That’s weekly calls sometimes for up to two years to get the data formatted the right way… And that takes time, that takes knowledgeable staffing, that costs money.”
For instance, Mues said he and his staff have to send the same information to multiple agencies at federal and state levels. But none of the agencies want the same information in the same way. That means those same forms have to be re-formatted multiple times to ensure the agencies all get the information they need in the format they want it in. Tied to that information is reimbursement for the hospital, patient information, and metrics for quality and service. Managing that data can cut into the time his staff has to do the day-to-day operations of the hospital.
“A lot of the times, they [reporting agencies] don’t realize that little hospitals like us, we don’t have an unlimited amount of staff to do just that,” he said. “We have people that are taking care of our day-to-day tasks, and now they have to step aside from some of those, put those on hold and do that to get that right.”
It’s enough to interfere with managing other important tasks, he said. It’s also enough to make keeping highly skilled information management personnel on staff an issue.
More than just billing records and data transfers, basic patient care is impacted by data, Chubb said.
“If you think back to that time when we needed a medical record, we had to call and get that physical copy, or maybe have somebody fax it to us,” she said. “But now, we now have a much smoother flow of patient data, so when you are at a hospital and you’re at an ER and you go visit family in the next town when you go to see a doctor, now there’s better exchange of that data …. Whether it’s medication, or it’s a diagnosis that was forgotten that may impact the care and treatment of that patient in the moment, those standards are meant to decrease some of that burden.”
But those advances in data management aren’t good for the patient if they over-burden the hospital. And fixing the issue is going to be different for every rural hospital, Chubb said.
“The solution is not a one-size-fits-all solution,” she said. “All rural communities, the only thing they have in common is that they’re all different. They all function based on their needs, based on their community needs, based on their provider needs, their demographics, their locations. It’s really how can these organizations structure the process that makes sense for them.”
Chubb said policymakers and others need to reach out to smaller communities and smaller hospitals to ensure they are able to keep up with the demands of an increasingly complex data environment, with ever-changing requirements.
So far, Mues said, no one seems to be coming to the hospitals to ask how they need help or how interoperability is affecting them. More than anything, he said, rural hospitals just need the funding to keep up with the changes.
“I think that’s probably the biggest thing is being conscious that rural facilities don’t have the staff available all the time to just make deadlines, especially if they’re short-notice deadlines,” he said.
“Just having the funding available is very important. We can use consultants, which is really helpful, but having the funding is where it ends and begins because if you don’t have the funding, then you can’t even get the consultants.”
The post Study: Rural Hospitals Struggle with Increased Data Demands appeared first on The Daily Yonder.
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