Rural Emergency Departments Lag In E-Prescribing

Cloud computing could boost adoption of computerized physician order entry systems necessary for Meaningful Use, says consultant.
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Rural emergency departments were much less likely than those of urban hospitals to have computerized physician order entry (CPOE) systems, according to a study of EDs in four states that used 2008 data. But technological advances may have helped reduce the disparity since then, one health IT consultant said.

While CPOE was installed in 6% of rural EDs and 21% of EDs in rural areas close to cities, it was available in 40% of urban EDs. On average, 30% of the 290 responding non-federal EDs in Colorado, Georgia, Massachusetts, and Oregon had CPOE systems, said the study in the Annals of Emergency Medicine .

Of the four states, Massachusetts had the highest CPOE penetration in its EDs: 44%, compared to just 15% in 2005. (Massachusetts was the only state in which the researchers surveyed EDs in both years.) In Oregon, 34% of the EDs had CPOE in 2008; in Colorado the rate was 25%, and 24% in Georgia.

Doug Hires, a partner in health IT advisory firm Santa Rosa Consulting, noted that rural and critical access hospitals (CAHs) have long been behind in IT. Part of that has to do with a lower level of resources compared to their urban counterparts, which tend to be larger organizations.

In addition, he pointed out, it's harder for rural facilities to find or afford trained technical staff. Whereas a big urban or suburban hospital may have a sizeable IT department, a small critical access facility is lucky to have one or two technicians to maintain its billing and lab systems.

Because of this staffing barrier, the advent of remotely hosted applications could be a game changer, Hires told InformationWeek Healthcare. "The availability of Internet-hosted applications could take some of the operational cost away and make health IT more accessible to an organization that doesn't have the capital or the staff [to run the systems itself]."

Hires added, "I know of one vendor that does point solutions on ED systems, and they've done just that in rural areas. They've changed their licensing structure for critical access hospitals, and they've introduced a cloud-based computing solution."

CPOE is essential to showing Meaningful Use so that hospitals can qualify for federal health IT incentives. Including either all ED patients or only those admitted to a facility, a hospital must attest that its staff used CPOE in prescribing drugs for at least 30% of patients who received a medication. Since nearly half of patients in the average hospital are admitted from the ED, having CPOE in that department can give a big boost to a facility's efforts to achieve Meaningful Use.

The study also surveyed other aspects of ED computerization. Among other things, it found that "the majority of EDs in all states had electronic laboratory results, radiology images, hospital discharge summaries, patient tracking, and old ECGs. There was less consistent availability of electronic outpatient medication tracking, real-time clinical data collection, and computerized provider order entry."

It's notable that the health IT components most commonly found in these EDs had "passive" functionality that required little or no change in workflow. In contrast, computerized tasks such as data collection and CPOE alter workflow and require additional effort from staff and clinicians. As a result, physician buy-in is ever more critical in higher stages of health IT adoption.

Whether or not this is related to the low penetration rate of CPOE in rural areas and certain states is unclear. But Hires noted, "There is a shortage of physicians in rural health, and so there's a shortage of younger physicians. So there could be some cultural issues [involved in adoption]."

Meanwhile, the Obama Administration recently announced a new program that will help rural hospitals catch up on health IT by giving them access to existing capital loan programs so they can buy computer hardware and software.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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