EMRs In The Absence Of Broadband

Rolling out an electronic medical record system is fraught with difficulties, from workflow disruptions to physician resistance to patient anxiety to financing (at least until the government's stimulus program kicks in to help defray the cost).

And if there's no broadband Internet access, the list gets longer. That was the situation for Hot Springs Health Program when it rolled out an EMR system three years ago to its four medical centers. As the only healthcare provider in Madison County, N.C., Hot Springs Health's four medical centers play a key role in the lives of the county's 20,000 people who are spread over 457 square miles.

Broadband access in Madison County is spotty at best. "This is a very rural community," says Richard Ford, Hot Springs Health's executive director. "Every road is a dead end except the main roads. One generation back, some people had no running water or electricity," Because of the geography, DSL is only available if you live close to the center of town, Ford says, and most of the county's four townships don't have cable.

A few years ago, a local electricity provider, a co-op called the French Broad Electric Membership, received about $1 million in federal funding to install fiber in parts of the county, especially to reach schools. So when Hot Springs Health launched the EMR initiative, it was able to piggyback on the fiber available in some areas to provide broadband to its two largest medical centers: the Mashburn center, which handles about 17,000 patient visits a year, and the Mars Hill center, which handles about 20,000 patient visits a year, Ford says.

But the other two--the Hot Springs Medical Center and Laurel Medical Center, both of which handle as many as 4,000 patient visits a year--are served by different power companies that weren't yet providing fiber, so no broadband access was available. That's still the case for Hot Springs Medical Center. Laurel recently got broadband access after fiber was extended to Laurel schools.

Clinicians at the Hot Springs Medical Center remain dependent on systems that have to connect via T-1 lines to the IT hub at the Marshburn Medical Center.

Connecting through phone lines is difficult, Ford says. "T-1s are up and down," he says. "It's much slower, and reliability is much more problematic." Bandwidth quickly becomes an issue when you're dealing with large digital images so Hot Springs Health doesn't use the system to send diagnostic digital images, like X-rays, over the network. Primary care doctors at the Laurel Medical Center can look at X-rays themselves, but if they want a second opinion from a radiologist at another facility, they have to physically send the images to the other facility.

Doctors viewing images at the facilities without broadband initially had to deal with much slower screen flip when they clicked through patients' EMRs, Ford says. They complained that the system was "torturous," telling Ford it was so slow, it held up their work. The system has since been tweaked to speed doctor's access to electronic files. Nevertheless, there's still a significant difference between the broadband haves and have-nots in the county.

Ford plans eventually to have broadband access at the Hot Spring Medical Center, too. Perhaps, it will be able to piggyback on to fiber the county may provide to the schools in that township, he says.

In months and years ahead, fewer rural U.S. communities should face the sorts of difficulties that Hot Springs Health has had to deal with when it comes to broadband access. The $787 billion American Recovery and Reinvestment Act federal stimulus legislation signed into law earlier this year includes about $7.2 billion for expanding broadband access in underserved regions.

Meantime, those who work or live in places lacking broadband still face slow Internet access, or perhaps opt for none at all.

In fact, Ford's only option for accessing the Internet at his house is dial-up. "That's why I don't have a computer at home," he says.