Question

Rural Hospital is a 15-bed critical access hospital that has had a hospital information system (HIS) that provides typical administrative information systems services for a number of years. It also has had an LIS system from a different vendor. It does not have a full time pharmacist, so it has not had a pharmacy information system. Except for basic radiology procedures, it refers patients to a tertiary facility about 60 miles away and does not have a radiology information system. Broadband has not been financially accessible to the community. There are three primary care providers within a 30- mile radius of the hospital and none use an EHR. These physicians are predominantly those working off student loans or are on temporary visas for foreign physicians. Turnover is high. The hospital decided to acquire an EHR system when the MU program started. Believing its options were limited, it contracted with a vendor who catered to critical access hospitals. The vendor implemented a stage 1 certified EHR.

The hospital subsequently found that because of its old and incompatible HIS, manual entry or re-entry of data was often required to register a patient into the EHR, to post discharges to the HIS, and such. Without a pharmacy information system, the physicians’ orders for medications had to be printed for the traveling pharmacist to use in stocking the medication cabinet for the nurses. The lack of other physician and nurse documentation not required in stage 1 resulted in the hospital printing all contents of the EHR to paper and continuing to file a paper chart. The result was significantly more time required to use the EHR system than with the paper chart alone. Finally, when stage 2 criteria for certification were released, the vendor struggled to respond and ultimately was sold to another company with no experience servicing small hospitals.

Since incentives in the MU program were front loaded (the majority of the incentives were delivered for demonstrating meaningful use of stage 1) and the critical access hospital is presently reimbursed on a cost rather than fee-for-service basis (HealthIT.gov 2015), it made the decision to delay further deployment of health information systems. It wants to hire a health information management professional, contract for more comprehensive IT support, and engage physicians and community leaders in more thoroughly evaluating both health IT options and the state of reimbursement for critical access hospitals. It recognizes that whatever the future holds, it will need to move to a best-of-fit health IT environment, probably utilizing a SaaS provider through cloud computing, requiring affordable and reliable broadband services.

HealthIT.gov. 2015. Benefits for Critical Access Hospitals and Other Small Rural Hospitals. http://www.healthit.gov/providers-professionals/benefits-critical-access-hospitals-and-other-small-rural-hospitals.

What are some of the considerations this hospital must make when deciding on acquiring an EHR?

Answer 1

Some of the considerations this hospital must make when deciding on acquiring an EHR;

It should have a reliable broadband connection

It should have a comprehensive IT support

Should have a best-of-fit health IT environment, probably utilizing a SaaS provider through cloud computing

The cost should be affordable.