Health Information Exchanges (HIEs) allow hospitals to share patient clinical data to deliver coordinated care as people move between providers and health systems. The data-sharing capacity of HIEs is key to giving providers access to up-to-date patient medical history, reducing redundant testing, and coordinating care for better outcomes when patients transfer between facilities—especially useful in emergencies like natural disasters or pandemics.
While many large, acute-care and urban-based hospitals participate in HIEs, there is a lag in connection when it comes to hospitals and providers in rural areas. A 2019 report by the Office of the National Coordinator for Health Information Technology (ONC) found that less than half of small rural hospitals and critical access hospitals (CAHs) participate in local, state, or national HIEs. Helping rural providers connect to HIEs could play a role in enhancing care coordination as their patients receive care from various providers, easing some of the unique challenges these healthcare facilities face.
Overburdened and Understaffed: The Struggles of Rural Hospitals
Among the many challenges facing rural healthcare providers today are staff shortages, lower population density, sicker patient populations than their urban counterparts, and a higher rate of underinsured and uninsured patients, leading to lower reimbursement rates. There is no doubt that these factors contribute to the unfortunate reality that many rural hospitals cannot afford to stay open. The Sheps Center for Health Services Research has tracked 138 rural hospital closures in the U.S. since 2010, and a study published in 2020 by the Chartis Center for Rural Health reported that of the 1,844 rural hospitals operating today, 453 of them are at risk—that’s nearly one in four.
These rural hospital closures can be devastating because those communities lose access to what may be their only healthcare provider, requiring patients to travel farther distances for medical attention. For people who have acute health conditions, lack access to personal transportation, cannot travel long distances, or have an emergency health crisis, the burden of travel can lead to worse health outcomes, especially if care is delayed. In addition to the burden placed on patients, rural hospitals are often a top employer in their communities, which means job and revenue loss that increases the hardships those populations must face.
How Connecting Rural Providers to Health Information Exchanges Can Help
The challenges rural hospitals face can make it difficult to cover operating expenses, much less turn a profit to reinvest in health information technology (IT) and the operating costs required to assist with the adoption and management of new technology. However, working to help rural providers connect to HIEs could be part of the solution to the rural hospital crisis.
Patients in rural areas tend to visit more healthcare providers in the course of their treatment since small, rural providers or CAHs may not have the prescription they need or the necessary specialist or medical equipment for their treatment. That means they may move more frequently between facilities and health systems, which is where Health Information Exchange benefits and health IT could come into play. Rural providers could connect to a state or local HIE to gain greater insights into patient behavior, treatment outcomes, and social determinants of health.
One example of the value comes from a Strategic Health Information Exchange Collaborative (SHIEC) case study that describes how an HIE helped the Winslow Indian Health Care Center in northern Arizona that serves a population of 60,000 Native Americans living in rural and remote areas. Winslow Indian Health Care created a list of high-needs patients in the HIE and set up alerts for admissions and discharges from emergency and inpatient facilities to provide better care coordination. One result was that they were able to improve medication management for epileptic patients.
Small, Rural Providers Banding Together for Health Information Exchange Benefits
If Health Information Exchange benefits can improve patient care coordination and health outcomes, then what can be done to connect more rural hospitals and CAHs to these networks? Collaboration between rural providers and larger health systems could be one answer to reduce costs, enhance care coordination, improve patient outcomes and boost performance.
However, as the Health Resources and Services Administration’s 2019 “Guide to Rural Health Care Collaboration and Coordination” points out, often these smaller rural providers tend to feel like they are competing for funding and resources that they’d be in a better position to share. By connecting, these rural providers—including rural hospitals, CAHs, Health Centers/Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and local public health departments—can access more opportunities to share resources. Resources could mean increasing the pool of health staff these providers can access, cutting costs by reducing duplication of services, allowing for participation in value-based models, and working with community-based organizations to address social determinants of health affecting these patient populations.
Primary Partners is one example of rural providers pulling together for the greater good of the populations they serve. Comprised of healthcare providers spread across both rural and urban areas of Central Florida, Primary Partners was one of the first Accountable Care Organizations (ACOs) in the country. An ACO is a network of healthcare providers who voluntarily join to coordinate care for Medicare patients. Primary Partners serves about 45,000 patients living in large rural pockets of the state, as well as urban areas. Before connecting to Florida HIE Services, the only way providers would know if a patient was admitted to or discharged from a hospital was if the patient called them. Primary Partners began receiving admit, discharge, transfer (ADT) data through the HIE, so providers could schedule follow-up visits after hospital admission. In the first year of the program, Primary Partners saw a 40% reduction in readmissions per quarter, resulting in $284,000 in savings.
In a similar example, when Aledade Delaware ACO implemented real-time ADT data, they were able to reduce readmissions by 9% to strengthen their Transitional Care Management (TCM) services, which are paid by Medicare. Aledade Delaware is comprised of 70 physicians spread across 22 independent primary care providers in both rural and urban parts of Delaware, serving close to 20,000 Medicare patients. When they began to receive these ADT notifications when patients were admitted, discharged, or transferred to hospitals, they increased their billable TCM opportunities by 26% and were able to capture 41% of those opportunities. This is another successful example of rural providers achieving cost savings, revenue gains, and improved care coordination for better patient outcomes—all through ACO participation and HIE connectivity.
Health Information Exchange Benefits Can Be Key to Protecting Rural Hospitals and the Populations They Serve
Increasing the participation of rural hospitals in HIEs could play a role in helping struggling providers enhance care coordination to improve performance. With access to clinical data, these providers can gain key insights to their patient populations and the unique problems they face, while simultaneously reducing the burdens on the providers who can make better decisions for their patients. Connecting rural hospitals to HIEs could also move the dial on nationwide interoperability efforts that aim to shift to value-based care models with the goal of improving patient outcomes.
While some may ask how these rural hospitals can afford to adopt HIE technology, the question should perhaps be, can they afford not to?
The first step to increasing participation in HIEs is to ensure that rural providers understand the benefits associated with this data exchange and then outlining strategies to help them access the technology needed. For help determining how an HIE could serve the needs of your organization, Audacious Inquiry has a team of dedicated experts ready to help you with road-mapping and advisory to find the path forward.
About the Author
Diana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs.