Over the past month or so, 14 critical access hospitals have joined the Nebraska Health Information Initiative (NeHII), the statewide health information exchange. But even with mega-incentives on the table, getting those CAHs to sign on to the exchange has taken lots of convincing.
"You're talking to the person that had to do all of that," Deb Bass, executive director of NeHII, tells HealthLeaders. She's spent the past several years working with the state's hospitals and health systems in an effort to get them onboard with the exchange. But if getting big health systems onboard is hard, getting CAHs to participate is even harder.
For most CAHs, Bass says, the average daily census is less than five, but they still have to offer a lot of services. Plus, some of them only have a half-time IT employee. So how do you communicate the value of getting connected in the face of their extreme money, time, and personnel constraints? Bass starts the conversation with CEOs, and says, "I know I'm getting success if they let me talk to their CIOs."
"You just have to help them understand why it makes sense," Bass says. "And then [you're] looking at putting together a deal that makes it so attractive they couldn't say no."
And the deal is a pretty attractive one. According to Bass, NeHII is charging no implementation fees. "We're absorbing all of those," she says, using ONC HIE Cooperative grant funding. In addition, by joining the HIX, hospitals also connect to Nebraska's state immunization records system to do their public health and disease reporting.
"For many of these small hospitals that are looking to connect their hospital with a clinic, we deliver that master patient index functionality using NeHII, so they don't have to go out and buy that as well when they're already spending money for EMRs," Bass says.
Now, Bass is coming up with timeline for when each of the hospitals will get connected, since they're in different stages of readiness. Bass says one hospital is still in the process of implementing an EMR, while others have had them for years.
"We're working on figuring out who's most ready, so they will go first," Bass says.
One of the 14 CAHs that's among the most ready is Antelope Memorial Hospital, a 25-bed hospital in Neligh, Nebraska. Administrator Jack Green says his hospital is close to achieving stage one meaningful use. He believes that connectivity makes sense for healthcare.
"You can go to Europe and you can go up to an ATM and get money out of your bank account," he tells HealthLeaders. "But you can't go five miles from here and get information on yourself. I think that's the good thing about it."
He acknowledges, however, that no matter how much connectivity will improve patient care, some facilities just won't be able to participate because of a lack of resources, "whether it be manpower, whether it be money. You get some very small critical access hospitals and they just don't have the money."
Indeed, even though 14 CAHs signed onto the exchange, there are 65 CAHs in Nebraska, which means many didn't sign on.
"They were torn about passing it up because they knew it was a good deal," says Bass. "But for those still that are going through an EMR selection," they couldn't commit to the 12-month timeframe that NeHII offered for getting up and running.
Still, Bass is optimistic about getting other CAHs signed on in the coming months, especially since NeHII has encouragement to do so from their project officer at the ONC.
"It really was intended from the very first discussion in 2005 to be a statewide health information exchange," Bass says. And that includes CAHs. "It's really a clear message to those critical access hospitals that we'll make every attempt to help you with this."
Alexandra Wilson Pecci is an editor for HealthLeaders.
