Electronic health records (EHR) systems are a major issue in medical IT and the industry is grappling with the pros and cons of the technology. On the pro side, EHR offers the advantage of electronic records that can be easily shared (and easily read, compared with the illegible handwriting that doctors are famous for). On the con side, there is cost, training time (especially for medical professionals without a computer background), and the standard document management problem of converting the backlog.

Medical organizations are in the process of switching over to EHR, using both carrots and sticks: Carrots are grants and incentives, and sticks are penalties. Under the Health Information Technology for Economic and Clinical Health Act (HITECH), which was put in place under the American Recovery and Reinvestment Act (ARRA) of 2009, providers and hospitals are required to adopt the second stage of EHR technology by this year, writes Alex Rudansky in Information Week.

This is all particularly important in the rural areas of the U.S., which comprise about 20 percent of the population and about 2,000 hospitals, most of them with 25 beds or fewer. EHR offers a great deal of promise to rural residents and medical providers, because it helps smaller practices track patients more efficiently and makes it easier to share data if the patient needs to visit another facility.

At the same time, the rural medical facility has fewer staff, less money, and may be less likely to have computer experience, both for IT staff and the medical personnel. “Smaller hospitals devote fewer financial resources to IT, are less confident that their IT staff can successfully implement new technologies, and are less likely to have a written IT strategic plan or a full-time Chief Information Officer,” found one study.

Consequently, rural adoption of EHR is behind that of urban hospitals—14.2 percent behind as of 2012.

But it’s beneficial for rural hospitals to implement EHR, insists the White House on its HealthIT.gov website. “Health IT also helps rural communities access and coordinate care, improve disease surveillance, target health education, and compile regional data—all activities aimed at improving health care quality and patient outcomes,” notes the site. “An EHR also creates an improved mechanism to complete specialty referrals which is valuable when access to specialists is often limited in rural communities. Additionally, EHR software provides easy access to up-to-date lab result information, new medication information, and medication interaction and allergy safeguards that would not be readily available otherwise. Because many rural areas typically have a lower per capita income, additional EHR efficiencies may help to control health care costs to help offset lower than average levels of reimbursement.”

In addition, rural medical professionals need EHR for competitive reasons, according to the government’s Health Resources and Services Administration. “Rural providers also risk losing business and revenue if they do not have the same level of technological sophistication as other institutions,” notes the organization’s website. “Competition from neighboring hospitals or clinics can draw business away if patients perceive that quality of care might be greater at these other organizations.”

There’s one area, though, where rural medical professionals are adopting EHR more quickly than other regions of the country—pediatricians. In Use of Electronic Health Record Systems by Office-Based Pediatricians, a random survey conducted by the American Academy of Pediatrics found that rural practices were more likely (87 percent) to adopt EHRs than their suburban counterparts (72 percent). Moreover, pediatricians practicing in rural areas were more likely to report meeting the first stage EHR criteria than other regions—72 percent compared with 46 percent.

The report didn’t offer a rationale for the disparity. It did, however, note that younger clinicians were more likely to adopt EHR. In addition, solo or two-physician practices were the least likely to have adopted the new technology, which seems odd considering the expectation that rural practices would be more likely to be small. Still, though the percentage of pediatricians using EHR increased from 58 percent in 2009 to 79 percent in 2012, the time of the survey, only 14 percent of pediatricians use a fully functional EHR that includes both billing and clinical information, the survey found.

Meanwhile, although the second and sometimes even the first stages are not yet complete, the Department of Health and Human Services is already working on the next stage of EHR implementation, scheduled to take place in 2017.

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