Health Care Technology Divide Grows for Critical-Access Hospitals
Although the Journal of the American Medical Informatics Association finds that 81 percent of hospitals have adopted a basic electronic health record (EHR) system, only 37.5 percent are using at least eight out of 10 performance measurement functions, and only 42 percent are offering at least eight patient engagement functions. This health care technology use gap seems to disproportionately affect critical-access hospitals, which serve rural areas and are at least 35 miles away from the next available hospital.
Hospitals that use performance measurement and patient engagement functions tend to report better hospital performance metrics. As the Harvard School of Public Health explains, EHRs help health care organizations get a better picture of their performance. By linking large-group outpatient and inpatient data instead of looking only at individual encounters, hospitals can identify outcome trends in different layers of the organization — from practice to program to system. Hospitals that don’t take advantage of this functionality can miss out on those health care insights. Critical-access hospitals, which tend to serve poor communities with significant health challenges, seem to be falling further behind.
Rural Patients, Big Challenges
Patients served by CAHs tend to have health care challenges that exceed those experienced by the population at large. Overall, these patients are older and sicker than their urban-area counterparts. According to the Centers for Disease Control, patients from rural regions are at higher risk for developing conditions that are the leading causes of death in the United States, including heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke.
The opioid crisis has also hit rural areas hard, according to NPR Illinois. Jobs in industries that are prevalent in rural areas, such as manufacturing, mining and farming, put workers at higher risk of on-the-job injuries from both acute and repetitive strain. Plus, job availability has declined in these areas, people may be at higher risk of self-medicating because of depression, anxiety and the financial and family pressures that come with unemployment. And the problems don’t just affect those addicted to opioids; babies born with opiate withdrawal symptoms are rising much faster in rural areas than in urban populations.
Lacking Health Care Technology Funding
To qualify for the additional financial support given to critical-access hospitals, these facilities must meet guidelines established by the Centers for Medicare and Medicaid Services. They must provide 24/7 emergency services, house no more than 25 inpatient beds and discharge or transfer patients after 96 hours for acute care. These hospitals are members of State Flex programs, which makes them eligible for additional grants. In addition to receiving reimbursement for inpatient and outpatient services, they also receive reimbursement for providing ambulance services when they’re the only available facilities in the area.
Despite the additional support provided by critical-access hospital status, rural hospitals often face personnel shortages. According to Stanford University, although 20 percent of Americans live in rural areas, only 10 percent of America’s physicians practice in rural hospitals. Because of the thin concentration of health care providers across these rural areas, hospitals struggle to provide timely ambulance services, and paramedics work mostly on a volunteer basis.
In addition to heavy workloads and tough operational constraints, many rural hospitals are strapped for the cash and expertise required to implement advanced EHR functions. Although big data and analytics could help them find ways to do more with limited resources, implementing those technologies and correctly interpreting analysis costs money, locking these facilities in a tragic catch-22. When basic patient care needs can’t be met, health care technology seems low on the priority list — and yet, it could be the perfect tool to do more with what they have.