Health IT Boosts Patient Care, Safety

Critical access hospitals (CAHs) that serve approximately 20% of the U.S. population living in rural communities, have fewer clinical capabilities, a lower quality of care, worse patient outcomes, and are less equipped with health information technology to support clinical workflows, a national study by researchers at the Harvard School of Public Health (HSPH) has found.

The report, entitled: Quality of Care and Patient Outcomes in Critical Access Rural Hospitals, was published earlier this month in the Journal of the American Medical Association. The study's findings were based on analyzing the records of more than two million Medicare fee-for-service beneficiaries at 4,738 hospitals (27% of which were CAHs) diagnosed with acute myocardial infarction (heart attack), congestive heart failure, and pneumonia in 2008-2009. Compared with other hospitals, CAHs were less likely to have intensive care facilities, advanced cardiac care capabilities, or even basic electronic health records (EHRs).

With regard to EHRs, researchers concluded that federal government efforts to encourage CAHs to adopt EHRs could be improved. Under the Medicare and Medicaid EHR Incentive Programs, eligible CAHs that implement EHRs and meet Meaningful Use guidelines can qualify for incentive payments. However, many CAHs lack the financial resources and the personnel to implement and maintain health IT systems, researchers found.

"The federal effort to promote EHR adoption among CAHs has focused on technical assistance by the Regional Extension Centers. However, some Regional Extension Centers have elected not to work with CAHs and others are charging fees that may be unaffordable for CAHs. Policy makers may need to consider additional strategies to avoid exacerbating an already emerging digital divide," the report states.

According to Ashish Jha, senior author on the study and an associate professor in HSPH's Department of Health Policy and Management, it is troubling that CAHs are deficient in the use of technology.

"With regard to technology, the most surprising finding was the degree to which CAHs lagged behind on technologies that have become commonplace in many hospitals across the country--for example, only 66% of CAHs have electronic viewing of laboratory test results, compared with 91.3% of non-CAHs, and only 22% of CAHs use electronic clinical reminders, compared with 44% of non-CAHs," Jha said. "These findings were surprising because they highlight the degree to which these hospitals are at risk of falling even further behind as medicine becomes increasingly complex and technological."

Jha also said CAHs run the risk of being left behind in the healthcare system if they are unable to overcome the barriers standing between them and the effective adoption and use of health IT. With regard to developing systems that support evidence-based medicine and quality reporting measures, Jha said the omission of CAHs from most innovations such as pay-for-performance, public reporting, and value-based purchasing is a concern.

To overcome these challenges, policy efforts are needed to bring additional healthcare practitioners to underserved areas to ensure that CAHs have key clinical resources. And the increased use of telemedicine and clinical data exchange also has the potential to improve the quality of care, the report said.

Jha said telemedicine could help CAHs, which often have difficulty recruiting specialists, provide specialty care. He also said that while these systems could assist clinicians to make clinical decisions at the point of care when they are faced with complex clinical situations, telemedicine is not a panacea.

"For example, a tertiary care center could provide assistance with electrocardiogram (ECG) interpretation for a patient suspected of having a heart attack, and help the on-site clinician with the decision of whether to give the patient lytic therapy or transfer him or her for cardiac catheterization," Jha said. "However, any telemedicine system that functions in isolation is likely to be less effective than one in which it functions as part of a fully integrated health information system."

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