MedCity Influencers, Health IT

What rural hospitals can teach their urban counterparts about patient engagement

Rural hospitals are grappling with high rates of chronic disease, lack of broadband access, and workforce shortages that are exacerbated by the low pay and professional isolation that are characteristic of rural settings. It is from within this digital divide that rural hospitals have learned so much they can pass along to their urban peers.

For rural hospitals, financial pressure and widespread staffing shortages have heightened the demand for nimble, cost-effective and straightforward technology platforms that enable practices to meet patient needs without adding to their administrative burden.

Even before the Covid-19 era, rural and small hospitals faced unprecedented fiscal difficulties; of the roughly 1,800 rural hospitals in the US, 1 in 4 were at risk of closure. The current pandemic has only increased these pressures, and with the cessation of many revenue-generating activities as a hallmark of the pandemic response, no hospital — small, large, rural, urban — is immune to the revenue threat.

For all hospitals, healthcare IT (HIT) must figure prominently in their route to recovery.

For rural hospitals, necessity is the mother of invention when it comes to improving patient engagement and outcomes while protecting revenue. Rather than wrangling multiple disconnected HIT platforms, the most innovative rural providers have adapted by deploying unified, interconnected cloud-HIT platforms that combine electronic health records (EHR), revenue cycle management (RCM), health information exchange (HIE) and telehealth solutions. In other words, one patient, one record.

But having access to a first-class HIT platform is the ultimate prize for more than just rural hospitals; it’s critical for all providers in any setting. In fact, larger, urban hospitals are taking a page from the rural hospital playbook, modernizing their EHR systems with solutions that are focused on interoperability to maintain a complete picture of their patients’ healthcare history and needs.

How Barriers to Access Have Shaped the Rural Hospital
We often think of barriers to access as a problem faced by individuals. Institutions, however, also face socioeconomic and structural hurdles that limit their ability to deliver goods and services, attract and retain talent, and drive revenue growth. This reality is one that hits rural hospitals especially hard. Limited access to advanced telecommunications capabilities and resources have plagued rural hospitals and have left them hamstrung and behind their urban peers in achieving value-based care goals.

This isn’t a small problem. Thirty percent of hospitals are located in rural communities. According to the Federal Communications Commission (FCC), most counties with the worst access to clinicians are also the least connected. It’s recognized that digital isolation compounds health disparities though that divide in broadband access is narrowing.

Public hospitals in rural areas tend to have more patients per nurse, a lower percentage of registered nurses among licensed nurses and more patients diagnosed with high illness severity. These “double burdened” regions are grappling with high rates of chronic disease, lack of broadband access, and workforce shortages that are exacerbated by the low pay and professional isolation that are characteristic of rural settings.

It is from within this digital divide that rural hospitals have learned so much they can pass along to their urban peers.

Lessons Learned by Rural Hospitals in Difficult Circumstances
EHR adoption within the rural setting is challenging but absolutely necessary. The most successful rural hospitals have determined that the key to ensuring EHR access is in the solution’s lightness. A software-as-a-service (SaaS) solution, available through a browser and delivered in a way that reduces bandwidth requirements, is the most effective deployment option within the rural setting. Even with the lowest levels of internet access, a lightweight EHR will load and function to support patient care and documentation.

Rural hospitals have also learned to place configuration over coding. This approach is predicated on the ability to configure and customize the core EHR functionality through a workflow platform that local IT teams can stand up and maintain quickly and easily. With this model, the hospital’s IT team can support localization and workflow customizations without development and coding updates. This puts more control in the hospital’s hands and reduces dependence on vendor experts and high-cost IT service resources.

Even before the pandemic, rural hospitals could foresee the inevitability of remote care. But when Covid-19 hit, telehealth suddenly became critical to both continuity of care for patients and the survival of rural practices themselves. Regulatory roadblocks that impeded broad adoption of telehealth in the past have finally given way. There has been a recent surge in telehealth with the number of beneficiaries receiving telemedicine services jumping from 13,000 per week before April to nearly 1.7 million per week as of the first week of June.

Rural hospitals have quickly embraced this new care delivery model, which has enabled them to extend their reach to new patients and augment their practice with specialists and clinical resources that they lacked before. And this trend is likely to continue well past the current pandemic as many experts predict that regulatory changes in place to today will remain as telehealth becomes a core workflow across the healthcare landscape.

Leveraging the Ingenuity and Lessons from Rural Hospitals
Urban hospitals, while generally better resourced, still face many challenges. Forty percent of physician burnout is attributable to poorly performing EHRs, according to a group of researchers from the University of New Mexico (UNM). And now, as Covid-19 continues to rage, deficiencies and restrictions inherent to current EHR systems have become more apparent and more intolerable, and clinicians are burning out faster and with more dire outcomes.

Urban hospitals are beginning to look beyond the “big box” EHR solutions that have dominated the market, turning to more agile tools built with interoperability in mind to counter vendor lock-in while fostering better integrated care. As they do so, they can draw on the lessons learned by their rural peers. At the top of the list of must-haves is a lightweight system that is easy to deploy and maintain. It must provide the necessary capabilities that allow the hospital to extend the reach of their care teams into the community. And it must reduce dependence on expensive IT resources to manage customized integrations and coding changes.

By strategically investing in HIT solutions, urban and rural hospitals alike can tap into the benefits of technology-enabled clinical intelligence that reduce administrative burdens while improving efficiency. Rural hospitals have quickly learned what is and isn’t important when it comes to HIT. For an EHR solution to work effectively, it must circumvent the technical and resource-related hurdles that are inherent to the healthcare industry. Rural hospitals have found that such solutions exist and are immediately available. And as larger, urban hospitals come to understand that the rural approach can bring them the same benefits, the healthcare system overall will have found the keys to future HIT success, better fiscal stability, and improved patient outcomes.

Photo: Pongasn68, Getty Images

Baha is the Co-founder and CEO of Azalea Health, a leading healthcare IT company whose mission it is to help underserved healthcare providers improve patient care and profitability. Under Baha’s leadership, Azalea has established itself as a high-growth innovator and leader, developing a comprehensive, cloud-based health IT platform for ambulatory practices and hospitals -- including introducing the industry’s first fully-integrated proprietary telehealth solution with its EHR.

Azalea Health has achieved Inc. 5000 rank of fastest-growing companies in the U.S for three consecutive years and has been named a Top 40 Innovative Technology Company by The Technology Association of Georgia (TAG).

Baha has been recognized in the industry with a number of awards including the Phoenix Award by the Metro Atlanta Chamber Bioscience-Health IT Leadership Council in conjunction with the Health IT Leadership Summit for his outstanding contribution to the growth of the health IT industry in Georgia. He is also a 2018 recipient of the Atlanta Business Chronicle’s 40 Under Forty Award and a 2019 recipient of their Most Admired CEOs Award.

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