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Q&A: HIT's Critical Role in Rural Hospital of the Future

 |  By gshaw@healthleadersmedia.com  
   August 09, 2011

In last week's column, I wrote about how small hospitals can prepare for future technology demands . This week I thought I'd share some comments about the future of rural organizations and health information technology from Tim Size, executive director of the Rural Wisconsin Health Cooperative (RWHC) in Sauk City, Wisconsin. RWHC has been pursuing its mission, to help keep quality care available, cost-effective, and accessible in rural communities through an array of shared services and advocacy agendas driven by a cooperative model, for 30 years. It has 35 member hospitals.

I interviewed Size for the HealthLeaders magazine cover story, The Hospital of the Future. As often happens with a source who's passionate about a particular topic, much of our long conversation didn't make it into the story. Here's some of what ended up on the cutting room floor:

Gienna Shaw: How can rural hospitals prepare for the future -- not just for the most pressing, immediate issues but to position themselves for long-term success?

Tim Size:The best advice I ever got was to “choose your parents carefully.” The second best, and only slightly more easily implemented, is to choose well the leaders you get to work with. I am fortunate to work in a state that is frequently ahead of the curve, solving tomorrow’s problems more often than reliving past complaints. Wisconsin has a business and non-profit culture that is particularly fertile for strategic alliances, both formal and informal.

GS: What are some of the ways rural hospitals in your state are doing that?

TS:  Rural Wisconsin hospitals on their own and through RWHC have been actively engaged in the development of many statewide initiatives, including most recently what will become our state’s health information and health insurance exchanges. RWHC is developing a rural portal with the Wisconsin Health Information Organization, a data repository, in order to access one of our country’s most comprehensive sources of health claims information.

This will allow us to better understand physician performance and where there are opportunities for systemic improvement. RWHC and rural hospitals are at the table with the Wisconsin Payment Reform Initiative in order to help develop the next generation of payment models so that they will work for both urban and rural hospitals.

GS: How are the 35 RWHC member hospitals preparing for the increasing emphasis on health information technology and electronic health records?

TS:  RWHC’s work in health information technology is just one example of what a rural network with strong member support can accomplish. Long before there was such a thing as meaningful use, RWHC was involved in developing telecommunication networks and facilitating electronic health record adoption.

Our main technology project has been the establishment of the RWHC Information Technology Network (ITN). This is collaboration between five of our member hospitals in which participants pool their HIT resources and access a common EHR system from our two data center locations. RWHC provides the shared staff that supports the hardware, software, and infrastructure.

We started this project a couple of years before meaningful use hit the stage, which was good timing. All five ITN members are well positioned to receive incentive payments this year.

GS: In what ways is your organization reaching out beyond the Wisconsin borders?

TS: The ITN helps a number of Wisconsin hospitals with hands-on HIT assistance, but we’re also working hard to ensure that other rural hospitals aren’t left behind in the HIT revolution that meaningful use represents.

We’re doing this both by advocating for regulations that take rural-specific circumstances and challenges into account and also by developing tools and resources to help all rural hospitals achieve meaningful use.

As part of the above work, RWHC’s QI program has just received ONC ATCB certification for meaningful use. It’s now one of only a handful of “modular” products nationwide that meets the QI submission requirements. The point is that we are focusing heavily on the intersection between information technology and quality, something that will be critical to all providers’ future success.

GS: And how can rural hospitals across the nation help themselves prepare for the future—especially in terms of government regulations, such as meaningful use?

The long-term strategy for rural hospitals must include becoming much more active as advocates for the people they serve–to assure that major federal policy initiatives have been thoroughly vetted for their potential impact on rural communities. In particular, CMS leadership and rural health leaders need to sit down and discuss how we can work more collaboratively in pursuit of many common goals. 

We need to address the engrained attitudes on both sides that appear to have fueled too many initiatives from the current and prior Administration. Too many proposed regulations or comments have been seen as outright attacks on the very existence of small rural hospitals.

Do you think it's possible for small hospitals to remain independent in the long run? Or is it inevitable that the for-profits and large systems will take over?

TS:  I don’t think any one corporate model is inevitable in our country given the value we place on independence, inventiveness, and the underdog. But it isn’t my place to say what a rural hospital should or will do with such a sensitive issue. There are many examples of both “independent” and “system” hospitals excelling at serving their local communities. We clearly are in a time of significant uncertainty. During such times, we see a spike in mergers and acquisitions in any sector.

GS: What are some of the specific trends that will help rural organizations find their place in the healthcare market landscape of the future? 

TS:  In the long run, there are at least four trends that I believe will continue to support locally based organizations as part of the mix.

First, all providers are increasingly incented to work collaboratively so the distinction is fading between independent and system.

Second, advances in telehealth and electronic support services will give local hospitals more choices in where and how they gain assistance in maintaining local care.

Third, the imperative and benefits of hospitals working with their communities to create health will definitely favor those with the strongest local connections.

And last but not least, health reform will tend to level the playing field between primary care and specialists (and their related hospitals). The overpayment of specialty services will be less available to fuel the corporate acquisition and subsidization of rural hospitals. I believe it is likely that we will see a healthier balance between the power of capital and the power of place.

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