"It is about money," she says.
"They don't have the same resources as large academic medical centers or urban facilities, partly because of their size, but also because they have a smaller population. They do struggle to be able to afford the workers needed to support EHR. That is not just technical staff, but clinical staff that can bridge the technical and clinical. Of course attracting people to an area that doesn't have all the urban amenities makes it a challenge as well."
Tehachapi (CA) Valley Healthcare District recently became one of those critical access hospitals to achieve meaningful use attestation. CEO Alan J. Burgess says going through the process made it clear that rural hospitals were an afterthought when the federal government devised the criteria.
"I don't think ONC really understands rural health. The rules clearly were written for large municipal hospitals with all the different services," he says. "The standards weren't very flexible in light of small and rural facilities. Sometimes you have to keep patients longer because there is no step-down available within 100 miles. Those are issues that I have to deal with every day that most big city hospitals don't have to deal with."
Brock Slabach, senior vice president for the National Rural Health Association, says rural providers also have been slower to implement meaningful use because of continued uncertainty about what is actually covered under the reimbursement.