The need to use Information Technology in health care has increased over recent years due to its potential to improve the quality and efficiency of health care services. This kind of technology is not any less important in rural communities. The use of IT in rural health care providers is important in helping rural communities to overcome health care challenges such as distance to healthcare facilities and lack of adequate personnel.
However, there has been low adoption of such health information technologies (HIT) in rural areas due to lack of finances and inadequate workforce (Agency for Healthcare Research and Quality, 2005, para. 5). This paper will look into the financial and expertise constraints for rural health care providers in HIT adoption. It will also evaluate the current intervention measures for overcoming these constraints and increasing the adoption of HIT in rural communities.
Financing small and rural health care HIT needs
Financial constrain is the major reason highlighted for the poor adoption of HIT by rural health care facilities. This is according to the May 2006 report from the Flex Monitoring Team, a group of rural research centers. The findings of their research showed that though 95 percent of critical access hospitals had computerized their administrative functions (such as accounting, payroll, and patient registration) only 21 percent used some form of Electronic Health Record.
One of the intervention measures for financing rural health care providers to establish health information technology is through grants and loans from federal state agencies (Agency for Healthcare Research and Quality, 2005, para. 4). Rural health service providers are expected to come up with projects that can attract funding from such agencies. I find this challenging to such providers because they do not have the human resource in information technology to come up with feasible projects that can attract funding. For example, a rural hospital with no HIT administrator would not be able to come up with a proposal on HIT option because they do not know such technology.
The Agency for Healthcare Research and Quality (AHRQ) is one of the federal agencies that have been involved in funding Health Information Technology (HIT) projects for rural communities (Agency for Healthcare Research and Quality, 1996, para. 6). In 2004, AHRQ provided funding for HIT planning and in 2005 selected grantees were given funds to implement their HIT plans. 11 out of the 16 grantees were rural communities. This was a step forward towards increasing the IT capacity of rural communities.
However, the grant award criteria were very competitive for most of the rural communities. Though AHRQ emphasizes promoting rural capacity, very few of the rural service providers are capable of coming up with such HIT plans. This grant program puts the rural communities at the same level as their urban counterparts who have the human resources to develop such plans.
Another source of grant opportunities for small rural communities for HIT is the Office of Rural Health Policy (ORHP) within the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services. ORHP provides grants to rural hospitals through the Medicare Rural Hospital Flexibility Grant (Flex). However the focus of such grants is not specifically on the implementation of HIT, therefore the percentage of such grants that goes to developing HIT for rural communities is not significant. Also, there are other basic needs (such as health care equipment and medicine) of small rural health providers which are given priority over HIT development.
Financial assistance for HIT can also be obtained from the Rural Health Care Program of the Universal Fund. It offers grants to suitable rural health care providers for the provision of telecommunications services (Federal Communication Commission, 2010, para. 2). However, very few hospitals and clinics in rural areas, benefit from this grant program. This is because it focuses on providing discounts for the purchase of telecommunication services. Only a few rural health care providers can afford even the discounted services since the telecommunication rates for rural areas are higher than the urban ones, and discounting only brings these two rates to the same level.
An additional source of funding is also anticipated from the American Recovery and Reinvestment Act of 2009 (ARRA). The Act has provisions that will have a direct impact on the funding of HIT for rural health providers. As of 2011, non-hospital-based providers registered in the Medicare program who implement the use of Electronic Health Records (EHRs), can be given incentive payments of $18,000 to $44,000 (Health and Human Services, 2008, para.. 5)
This will be a good initiative but the biggest challenge for the health care providers will be the actual implementation of the EHR. This is because, they will be required to use their resources to plan and implement the EHRs first, and only after successful and meaningful use of the EHRs, will they be eligible for the incentives. This is not feasible because most rural health providers would not afford to meet the costs of implementing and using such electronic health records.
Health Information Technology workforce creation for rural health care
In small and rural communities, health care providers face difficulty in obtaining and retaining the expertise to implement and maintain a health IT system. This is documented as one of the main reasons for the low adoption of HIT in such communities. These health care providers have very limited financial resources to attract HIT experts and those who afford to hire such staff lack attractive enumeration packages to retain them.
One of the proposed approaches for rural health care organizations is to enhance the expertise of the existing clinical staff. This can be achieved through providing for the staff opportunities for additional training in health HIT. As sound as this proposal looks, it is not practical without external help since such training will require additional funds which small and rural health care facilities cannot generate. Another approach is to acquire new staff specialized in HIT to provide the rural communities with information technology education. The biggest challenge here again will be funding for such education programs and also hiring of the expertise. The rural communities cannot afford the programs on their own and will therefore have to rely on grants, which may not be readily available.
Efforts have been made to some extent, to train personnel for HIT in rural areas. One of them is the Massachusetts (MA) State Office of Rural Health (SORH), which has created forums for rural hospitals to study HIT initiatives of the Massachusetts Technology Collaborative (Health and Human Services, 2008, para.3). These initiatives include computerized provider order entry, e-prescribing, and broadband access. Though this is a good initiative, it is just a single state’s project and does not apply anywhere else, consequently, the results of the program are regional and not so significant.
The state office also facilitates the Massachusetts Rural Health Forum together with the Massachusetts Health Data Consortium, a group mainly composed of western Massachusetts healthcare organizations. The group is exploring joint options for making online HIT training accessible for rural health care providers. Availing undergraduate and graduate-level HIT programs to rural organizations is also part of the group’s plans, to further create HIT expertise among clinical staff. However, this has not been implemented and at the planning stage does not assure the implementation of any project.
There are funding opportunities for HIT training programs in The American Recovery and Reinvestment Act (ARRA). These include academic institutions’ grants for developing and expanding medical informatics training programs. The Act also provides for the integration of health information technology into the clinical program’s curriculum, to increase the HIT workforce. Still, this does not automatically guarantee an increase in rural health care HIT expertise.
Small and rural communities require Health Information Technology in their health care facilities to improve the quality of health care service provision. However, the adoption of such technology has been low due to financial constraints and lack of expertise. The proposed and current intervention measures discussed above are inadequate to produce the desired result. Therefore, this calls for an integrated approach to HIT adoption mechanisms by small and rural communities. The government should involve the communities and their health care providers’ directly in formulating policies and projects for HIT adoption and allocate more funds to such programs.
Reference List
Agency for Healthcare Research and Quality. (1996). Improving Health Care for Rural Populations. Web.
Agency for Healthcare Research and Quality (2005). AHRQ Awards Over $22.3 Million in Health Information Technology Implementation Grants. Web.
Federal Communication Commission. (2010). Rural Health Care Pilot Program. Web.
Health and Human Services Press Release. (2005). AHRQ Award in Health.
Health and Human Services. (2008). Rural Health Care Workforce Activities. Web.