From natural disasters to underpopulated hospitals, rural providers are facing the challenges and getting the help they need from their local HIEs.
Health information exchanges (HIEs) are crucial for connecting communities and ensuring patient medical records are available at all times. However, for rural hospitals and providers, participating in an HIE is not always a reality.
As value-based care brings more focus to patient social needs, HIEs allow organizations such as first responders, blood banks, schools, and drug and alcohol treatment centers to connect and share patient information.
In a survey conducted by Strategic Health Information Exchange Collaborative (SHIEC), 92 percent of the US population is covered by HIEs.
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But according to the most recent ONC data brief in late 2018, small and rural hospitals were about half as likely to share records compared to their larger counterparts. In total, only 62 percent of small hospitals shared this information.
If larger agencies and organizations work together, then the smaller and more rural hospitals will benefit from both a technological and financial standpoint.
Health data exchange aids when natural disasters strike
It is unfortunate, yet very common, for rural areas to get hit with natural disasters, such as hurricanes or wildfires. When these natural disasters happen, a strong health data exchange is crucial.
The Patient Unified Lookup System for Emergencies (PULSE) platform grew out of the aftermath of Hurricane Katrina by the Office of the National Coordinator for Health IT (ONC) in 2014 to provide secure health data exchange during an emergency.
PULSE allows emergency responders to search for health information on disaster victims, such as medications, diagnoses, allergies, and lab results. It limits access to only authorized personnel and to a “view only” format for medical information.
When Hurricane Harvey hit in 2017, Texas did not have PULSE capability. In fact, only California had limited PULSE capabilities. Since Hurricane Harvey hit, Texas, Florida, and North Carolina have looked to add the platform.
In March 2019, Texas Health Services Authority (THSA) requested $300,000 from the Texas House Public Health Committee to deploy PULSE in the state of Texas in case of emergency.
Later in the year, Audacious Inquiry (Ai), a leader in connected care, and the Sequoia Project announced a partnership to support the PULSE platform.
“Just after Hurricane Katrina, we had a lot of people showing up to shelters with medications they had fished out of their flooded homes,” said THSA CEO, George Gooch. “They would say things like, ‘I think the pink pills are for my heart.’ That’s when Texas realized that we needed a secure electronic means to exchange patient health information.”
“Fast forward to Hurricane Harvey, we realized that health information exchange generally had advanced leaps and bounds, but as far as it pertained to natural disaster response, we hadn’t moved the needle very much,” he said.
Cutting costs and providing reimbursement
Rural hospitals and providers do not possess the same spending power as larger hospitals. In an effort to promote interoperability and remove cost barriers, funding from the government or organizations allows for rural hospitals to access the same benefits as the larger hospitals.
Most recently, participants in HASA, Texas’ multi-regional HIE, received a Texas Health Information Exchange Advanced Planning Document (HIE IAPD) contract that allows for reimbursement.
Officials say the maximum reimbursement is $25,000 per hospital and up to $10,000 per provider (up to three provider) or $30,000 per practice.
The goal of the HIE IAPD contract is to lower HIE integration costs, while also promoting interoperability between the healthcare providers.
“This contract provides an unprecedented opportunity for hospitals and physicians to embrace patient health data exchange in the most cost-effective way,” said Phil Beckett, CEO of HASA. “Ideal for smaller practices and rural hospitals, this initiative also allows us to expand our services throughout Texas – helping providers to reduce costs and enhance the overall quality of care.”
HASA recently re-negotiated its rates with rural hospitals by charging a monthly fee based on the area’s census, not per hospital bed. This tactic allowed rural, underpopulated facilities to save money.
HASA is also partnering with larger health systems in its jurisdiction to help connect local rural practices and hospitals to the HIE to share patient data.
“There’s a tremendous white space in Texas when it comes to bringing health information exchange to life for rural hospitals and providers,” continued Beckett. “In addition to the HIE IAPD funding, our recent pricing changes, and partnerships with anchor hospitals, we are making it possible for rural providers to share data at such a minimal cost.”
HASA also prioritizes cost efficiency. HIE leaders continually strategize ways to keep costs low so that small, rural, and community hospitals can utilize their services without breaking the bank.
“Cost is a real challenge in rural hospitals,” said Beckett. “How do you get a return on investment for a small practice? We can input really lightweight ways to connect to that physician’s system at a very low cost.”
“Some of that requires good, usable workflows for rural environments,” Beckett continued. “We can then integrate from those rural practices at a price point that they find they can afford.”
Upgrading HIE infrastructure to meet the needs of all kinds of hospitals and health systems is also key to ensuring HIEs stay relevant in an ever-evolving health IT landscape.
Providing funding to assist rural hospitals in annual costs
While Texas provided reimbursement to providers, Blue Cross and Blue Shield of Arkansas provided $817,000 in funding to Arkansas Rural Health Partnership to expand its HIE to rural areas of Arkansas.
This donation aims to help rural hospitals in the area upgrade equipment and pay the annual dues for the hospitals and clinics to fully participate in the state’s exchange, State Health Alliance for Records Exchange (SHARE), which is overseen by Arkansas’ Office of Health Information Technology.
The high cost of a full SHARE membership makes it difficult for smaller, more rural hospitals and clinics to afford a full membership. In fact, several hospitals that will now be covered by this partnership are involved with SHARE, but they cannot reap the full benefits.
“Making sure doctors and hospitals in all areas of the state have the information they need to treat their patients is critical to overall quality,” said Curtis Barnett, president and CEO of Arkansas Blue Cross. “And we believe that all stakeholders have a role to play in making the health care delivery system more effective and sustainable for the people we serve.”
“We also know that we produce better results when we work collaboratively,” continued Barnett. “To that end, Arkansas Blue Cross is embracing current and emerging technologies as a key strategy to use information more effectively to create a healthier Arkansas. We are confident this grant will bring us a step closer to that goal.”
This grant will allow the hospitals under this umbrella to fully participate in SHARE.
“They must be able to share and have access to patient data as well as have the support of a system that can assist them with compiling and collecting the data to use in treating their patients,” said Mellie Bridewell, the partnership’s CEO and a UAMS regional director of strategy, management, and administration. “Without this assistance, our small rural hospitals will not be able to financially survive the changes ahead.”
Extend interoperability and improve health data access
Overall, the main goal of funding and cutting costs for rural hospitals is to improve interoperability and to overcome patient matching issues.
This is particularly important because of the healthcare challenges patients living in rural areas face. Individuals in rural communities experience chronic illness at a higher rate than those in urban or suburban areas, and face care access issues due to geographic barriers. Enabling better HIE for the sake of improving patient care goes a long way in these communities.
In 2018, Alabama One Health Record, the state’s HIE, joined the Strategic Health Information Exchange Collaborative (SHIEC) to improve health data access for patients in rural areas.
The HIE provides health data exchange services to patients and providers across Alabama and works to promote patient participation in clinical decision-making for better health outcomes statewide.
“Our goal is to expand electronic health record (EHR) utilization, care access and telehealth capabilities so Alabama’s health care providers can deliver care coordination more quickly and cost-effectively,” said Gary Parker, Alabama Medicaid Agency Director of Health Information Technology at the time of the collaboration. “Joining SHIEC will help us achieve our vision by expanding our access to great partners, resources and ideas from across the country.”
Having an all hands-on deck approach from government agencies, to organizations, to key healthcare stakeholders will be crucial to aiding rural hospitals and providers in the future. When rural hospitals have the ability to improve interoperability, enhance data exchange, and cover up financial issues, it ensures patient care is put first.
Source: EHR Intelligence