By Laurie Peters

Imagine a patient living in a rural community managing multiple chronic conditions— from Type 2 diabetes, kidney disease, and generalized anxiety disorder. Their primary care doctor is located within their community, but the patient makes a three-hour round-trip journey to the nearest city for specialized medical appointments several times a week. The patient has found the health system difficult to navigate, observed a lack of communication among their providers, and is constantly anxious due to lack of information about test results and next steps.

Access to adequate healthcare in rural communities has been a long-standing issue across the health industry. How can modern digital health technologies and tools help improve care?

The Challenges Faced by Rural Communities

When discussing how to improve care, it is important to first identify some of the key challenges impacting healthcare in rural communities.

Access to the Right People

When hiring healthcare professionals, rural communities are typically limited, as they don’t have the population to draw from, and it can be hard to attract necessary expertise. Sourcing the appropriate expertise and resources can be a challenge, as can be retaining these healthcare professionals for longer periods of time due to a competitive market. Due to these constraints, at times, the providers and healthcare workers in rural communities wear multiple hats. For example, a doctor may also serve as lab director, or a doctor working in the local emergency department may also run a family practice in town.

Limited Spending Power

Within rural communities, the small patient population base contributes to rural healthcare organizations not typically having the financial resources or capital that some of the larger organizations or states will have access to. Working under constrained budgets will impact what healthcare services are available to patients.

Access to the Right Technology

Due to the aforementioned financial limitations, rural healthcare organizations may not be able to keep up with the latest and greatest technology. When they do have the funds to buy technology, they often invest in clinical tools to address the more immediate needs of the patients.

Access to Care

Another key area is patient access to care and the ability to reach care when needed. In rural communities, distances between the home and hospitals, providers, or specialists can be significant. Due to resource shortages, there are often waitlists for family doctors resulting in increased use of emergency departments (EDs) for non-emergent healthcare needs.

Technologies to Tackle the Challenges

According to the National Rural Health Resource Center, an electronic health information exchange (HIE) involves the ability to move clinical information among different information systems to facilitate the timely access of accurate data in support of patient-centered care.

HIEs are poised to help serve rural communities and address the challenges by increasing interoperability through the secure exchange of data among providers and disparate systems, which ultimately broadens the information that providers have access to as well as the health system’s capabilities and reach.

The Value of HIEs in Rural Communities

HIEs provide a longitudinal patient record to aid in patient treatment, which offers a more complete picture of a patient and all of their healthcare interactions. In rural communities, patients may have a primary care provider, but for any specialists, they often have to go outside of the community and, in some instances, the primary care providers don’t receive the resulting report from the specialist, which can impact the continuity of care. The HIE would increase connectivity and allow those records to be securely exchanged among providers. This would lead to improved quality of care and care coordination while supporting team-based care models, which is particularly helpful in rural communities, as care may be coordinated among multiple providers and settings of care. It may also offer access to providers that patients in a rural community may not otherwise have access to and could help limit the need to travel long distances to reach other providers or specialists.

The HIE can automate required lab and immunization reporting to the state, improve patient safety by reducing medication and medical errors, and help save health-related costs such as reducing duplicate or unnecessary tests, hospital readmissions, or ED visits.

HIEs as a Participant in National Gateways

HIEs now participate in many national gateways that allow individual users (the providers) to access their patients’ information from almost anywhere in the US, including federal agencies such as the Veteran’s Administration (VA), Department of Defense, Social Security Administration, and Indian Health Service. Some examples of these national gateways are the eHealth Exchange, CareQuality, and the Patient Centered Data Home. These national gateways provide a single connection to exchange data nationwide. For example, the eHealth Exchange network includes four federal agencies, 77 percent of state and regional HIEs, 75 percent of hospitals, and 85 percent of dialysis centers. These national gateways are positioned to make connections and provide information, which can improve patient care and overall public health.

An example of a situation where the national gateway would prove beneficial may be a veteran living in a rural community. Veterans receive some care from their primary care provider, but they also receive access to free healthcare in some instances through VA medical centers, which may not be located in the same community. The HIE can act as the link to exchange the relevant encounter data so the primary care provider can stay involved and informed across all interactions for the patient.

Population Health Analysis

Traditionally, on their own, rural communities do not have strong data repositories or the ability to complete data analysis. HIEs contain higher volumes of data that can be leveraged for population health analysis. The HIE is well-positioned to aid smaller rural facilities in identifying important insights (i.e., here’s the majority of patients, and here is what they need). When rural organizations and providers are focusing their limited resources, these insights offer a view of the areas of most need. For example, if 60 percent of patients have a chronic disease, such as diabetes, a facility can focus their education, treatment, and resources on that particular disease and ultimately make a bigger impact in their community.

The HIE can also assist in exchanging and analyzing social determinants of health (SDOH) data, described by the Centers for Disease Control and Prevention (CDC) as conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks and outcomes. Access to SDOH data can offer insights to help address health disparities and inequities, which is particularly important in rural communities often more severely impacted by certain SDOH conditions.

HIEs are also beginning to include payer data that is clinically rich, which further aids in analytics to identify key trends in specific patient populations, helping in resource and response planning.

Assisting with Compliance

HIEs in any state can assist rural communities with compliance of federal or state-level regulations. Some examples include:

The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) final interoperability rules are designed to drive interoperability through data-sharing and to empower patients through increased access to data but can be complex for organizations to comply with, especially those with limited resources. Based on the existing capabilities, an HIE should be well-placed to help rural providers and hospitals to comply with these rules without having to utilize a large amount of time and resources.

Notably, under these rules, hospitals and providers need to be equipped to comply with the admission, discharge, and transfer (ADT) event notifications mandate, which requires all healthcare facilities to send direct electronic notifications to a patient’s provider once the patient is admitted, discharged, or transferred from another facility. The HIE would be equipped with the appropriate tools to facilitate sending these notifications.

The COVID-19 pandemic highlights the importance of interoperability and streamlining electronic processes for the collection and sharing of data. An HIE can help with public health reporting and the sharing of test results, vaccination data, hospitalization rates, etc. with other providers, patients, and public health organizations as needed. The North Dakota Health Information Network is a rural HIE that streamlined the process to boost their public health reporting and data exchange during the pandemic.

There are numerous ways connecting to an HIE can help improve care in rural communities.
HIEs increase interoperability, which broadens the information and resources available when treating patients. This is particularly beneficial in rural communities where there are significant resource and access constraints. The HIE can serve as a single source of patient information, saving clinicians and other staff time in obtaining the necessary information and giving a more complete picture of the patient to aid in better clinical decision-making.

If we can use digital health technologies such as HIEs to stay connected, stay compliant, and resource plan, while offering more complete care to patients, it will lead to improved outcomes and allow rural communities to maximize efficiency with the limited resources they have while keeping the patients at the center of care.

Laurie Peters is the HIE client director and global privacy officer at Orion Health.

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