Doctor KeyOvercoming Challenges to Health IT Adoption in Small Rural Hospitals

Altarum Institute completed an economic case study of health information technology (IT) adoption in rural hospitals for Office of the National Coordinator for Health IT (ONC).  This in-depth case study was designed to explore in detail the challenges and facilitators of successful health IT adoption in rural U.S. hospitals.

The case studies used a set of semi-structured qualitative interviews with key leaders and staff members at each hospital as well as quantitative financial evaluations.  The financial evaluations included a detailed analysis of hospital IT investment costs, financial viability and sustainability, and financing models in the context of local and national reimbursement and incentive programs. 

Improving Care Coordination through Health IT Adoption

The drive to modernize health care through the adoption of electronic health records (EHR) and the exchange of health information has been a challenging one. It is impressive to see the progress that we have made so far, yet in many ways, the work has just begun.

In 2010, Altarum Institute’s Michigan Center for Effective Information Technology Adoption (M-CEITA) was established to help priority primary care physicians select, adopt, and implement new EHRs. M-CEITA has specifically focused on providers in settings such as small independent practices and underserved communities, as these providers are typically less likely to have information technology resources to support implementing such a system. To date, M-CEITA has exceeded its goal, reaching more than 4,000 providers with health information technology (IT) integration, advancing the rate of physician adoption from 42% when the program began to more than 66% today. This milestone is significant because adoption and meaningful use of an EHR translates into clinical quality improvements for practices and lays a foundation for better care coordination throughout the state.

The Kresge Foundation contributed to this success through a generous contribution of $1 million at the start of the project. Kresge’s support supplemented a federally funded grant from the Office of the National Coordinator for Health Information Technology to make our work possible.

M-CEITA’s technical assistance in EHR technology adoption has been especially important to providers treating underserved populations in rural practices and critical access hospitals. For example, Sheridan Community Hospital, a Michigan-based critical access hospital, reached out to M-CEITA for assistance with implementation and guidance in using their new technology to improve quality of care. Kevin Perdue, Client Services Manager at Altarum, described the important operational improvements made through the program: “Providers working within Sheridan’s hospital and clinics are now able to send and receive orders, results, and other clinical information electronically. Leveraging their EHR has saved time, improved care coordination, and greatly enhanced their understanding of their patient population’s health through advanced reporting analytics.”

Working with funding through the state of Michigan, M-CEITA continues to assist providers that serve the Medicaid population. Focusing on these providers is essential, because Michigan Medicaid provides health care coverage to more than two million individuals, and often the physicians do not have the resources to invest in technology. M-CEITA is working to ensure that Medicaid and other underserved patients will have better coordinated and documented care. What does this mean to Michigan? More comprehensive documentation of patient’s health information and treatment, helping providers avoid mistakes and waste while improving the delivery of care, and, ultimately, health outcomes. Additionally, the ability to capture this electronic clinical information in public health registries vastly improves our ability to manage population health in real time. All of this leads to better care for patients who need it most.

Although M-CEITA has achieved its initial goal of assisting with the implementation of EHR systems, the real value of the program lies in leveraging this new information to redesign care delivery. The program’s team sees many opportunities to positively affect the long-term health of Michiganders through practice redesign, quality improvement, and patient engagement.

To that end, M-CEITA is assisting providers with tools to apply best practices. The following initiatives are snapshots of how a redesigned process can change the patient experience and affect community health outcomes:

  • Practice redesign focused on quality. With new technology, practices need to rethink their operational processes. Using Lean Six Sigma principles, M-CEITA helps providers capture information, reduce risk, and improve clinical quality through a practice process redesign. The new process often saves the practice time and money while increasing quality. It allows for patient data to be quantified and used as a benchmark to improve community health.
  • Engaging patients. Recent studies show that engaged patients are less costly and have better health outcomes. Additionally, payment reform has raised the bar on getting providers focused on patient engagement due to published pricing and patient satisfaction scores. M-CEITA assists providers with utilizing best practices and EHR tools to engage their patients to be true partners in their health care decisions. These best practices range from providing patients with their health information to shared decision-making for personalized treatments to providing self-managed medication tools.
  • Facilitating population health management. Providers are in the midst of transforming from a reactive model, where they manage the patient in the exam room; to a proactive model of population health management, where they look at the whole picture as it relates to health within the community. This transition requires new information and approaches. M-CEITA works with providers to leverage their EHRs in monitoring quality metrics for their whole population of patients. For example, implementing clinical decision support tools helps providers continuously improve the health of their population.

As M-CEITA grows into its next phase, the goal remains bringing better health care to Michigan and improving patient outcomes, particularly for the most needy and vulnerable within the community.

Health Information Exchange Planning

Since 2005, Altarum Institute served as lead agent for multiple health information exchange (HIE) planning initiatives in Michigan, one of which is now an Office of the National Coordinator for Health Information Technology (ONC)-funded Beacon Community. 

Activities ranged from stakeholder interviews, creating technical asset inventories, discovering stakeholder expectations of information exchange, navigating competitive tendencies among local health systems and constructing roadmaps, to HIE development in the state, which leveraged existing assets and most effectively met regional goals.

Application of Usability and Information Design Principles to EHRs

Supporting efforts of the U.S. Agency for Health Research and Quality (AHRQ), Altarum Institute applied meta-analysis and the facilitation of expert panel discussions to analyze information design principles, and their potential applicability, to the future of electronic health records (EHR) design. 

Multiple perspectives of EHR design and performance were explored, including that of caregivers, their environment and workflow, human cognition, and human computer interaction.  This process resulted in multiple publications that can be found on AHRQ’s website.

Cognitive Task Analysis of HIT Implementations

Altarum Institute has supported multiple efforts to successfully integrate health IT into organizational workflows employing expertise oriented cognitive engineering methods. 

Through in-depth Cognitive Task Analysis (CTA), interviews and subsequent qualitative analysis, our team was able to uncover hidden barriers to health IT use and ease the burden of implementing health IT in complex and cognitively demanding primary care environments. 

A National Network for Health Care Transformation

The Regional Extension Center (REC) program was created to provide direct technical assistance to accelerate electronic health record (EHR) adoption. The RECs are a national learning network that provides on-the-ground assistance to help providers incorporate technology into care delivery. 

EHR adoption and incentive payments alone are not enough to improve quality of care. Physicians need sustained support to use technology effectively. Through technical assistance, highly trained REC staff work directly with health care providers to implement change. The Michigan Center for Effective IT Adoption (M-CEITA), led by Altarum Institute, is Michigan’s REC and part of this nationwide network, sharing best practices and raising the bar for all.

Funded by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, one-third of the $700 million invested in RECs went toward capacity building. This capacity can be reused to further our health system improvement objectives. RECs stand ready to provide direct technical assistance for health care transformation in several key areas, including work to advance health information exchange and clinical decision support, promote cost savings, curb fraud and abuse, and manage population health.

Download M-CEITA Infographic (pdf)