Rural EDs tend to lag behind their urban counterparts when it comes to computerized provider order entry, research finds. More financial help must be needed, right? That's probably true, but the cause may run deeper than simply a lack of funds.
Imagine this: I'm going to give you $500,000 to help you build a LEED-certified, environmentally friendly home. Although that offer might sound great, it might also be very overwhelming. What are the requirements? Who are the best environmentally certified contractors in the area? Are some solar panels better than others? What does LEED even mean, exactly? And what happens if this lack of knowledge leads to some poor investments?
Instead of just getting a lump sum, you might be better off if I included with those dollars a little bit of practical guidance to teach you things such as what to ask when interviewing a contractor or how to choose the highest-performing materials.
The same kind of logic applies to doling out federal resources for helping hospitals adopt health IT, concluded researchers in a study appearing in the August Annals of Emergency Medicine.
"Federal resources might be more effective if they helped providers select health information technology tools, improve health information technology design, and evaluate its influence on care delivery, versus simply calling for 'more,'" the authors wrote.
The study surveyed all nonfederal EDs in Massachusetts, Colorado, Georgia, and Oregon. It assessed health IT prevalence in 2008, with a focus on computerized provider order entry.
Of the respondents, 30% had adopted computerized provider order entry, with urban EDs more likely to have it than their rural counterparts. Oregon EDs had a higher likelihood of computerized provider order entry adoption than ones in Georgia, which ranked at the bottom of the study results.
The study also compared the data on Massachusetts with 2005 data from a similar survey and found that ED computerized provider order entry adoption nearly tripled from 2005 to 2008. And that was before any financial incentives for adoption were established, the authors noted.
One can't help but conclude that although financial incentives certainly provide a leg up—especially to organizations that struggle just to keep their doors open—they aren't enough. According to Aric Sharp, CEO of Quincy, IL-based Quincy Medical Group, although there are incentives in place now, they need to be well organized in order to be truly helpful.
"The data from the emergency department study seems to acknowledge that rural communities are struggling to keep pace with their urban counterparts in information technology implementation," he said in an e-mail to HealthLeaders. "This is not surprising as the current incentives in rural settings lack coordination and in some cases even fall short of congressional intent."
"For example, physicians practicing in rural health clinics have no effective way to participate in 'meaningful use' incentives under Medicare," he said, pointing to the "legal oversight" that prevents certified rural health clinics from participating in incentive programs simply because of the CMS form on which they're required to bill.
"If we want rural patients to experience the benefits of promising EHR technology, it is important that we better address some of these basic issues," he said.
Alexandra Wilson Pecci is an editor for HealthLeaders.
