Almost one fifth of the US population lives in a rural area. Critical Access Hospitals (CAHs) and other small, rural hospitals provide vital services in rural areas and often serve as the foundations of rural health care delivery systems. Residents of rural areas face barriers to accessing health care services that include traveling long distances to seek care. Since rural hospitals are often the sole local source for patient care in rural communities, they are more likely to offer additional services that otherwise would not be accessible to residents. To improve care for patients residing in rural areas, rural hospitals are expected to:

• Improve access to services, including urgent care services, and meet unmet community health needs in isolated rural communities
• Engage rural communities in rural health care system development
• Develop collaborative delivery stems in rural communities as the hubs of rural health care
• Create transitions of care coordination with urban health care system alignment
• Be the subject matter experts and coordinators for the health care environment of providers, patients and staff

What is a Critical Access Hospital?

The Medicare Rural Hospital Flexibility Program (Flex Program), created by Congress in 1997, allows small hospitals to be licensed as CAHs and offers grants to States to help implement initiatives to strengthen the rural health care infrastructure. CAHs must be located in a rural area and be more than 35 miles from another hospital (15 miles by secondary roads or in mountain terrain) or have been certified before January 1, 2006 by the State as being a necessary provider of health care services. Additionally, to be considered a CAH, the hospital must have an emergency room that operates 24 hours a day and 7 days a week using either on-site or on-call staff. A CAH is normally limited to 25 inpatient beds used for either inpatient or swing bed services. CAHs are also subject to a 96-hour (4-day) limit on the average length of stay.

For more information on CAHs and other small, rural hospitals, see the following resources:

• Flex Monitoring Team: CAH Information
• Social Security Act, Title XVIII, Sections 1820
• National Rural Health Resource Center

Benefits of Health IT adoption among CAHs and other small, rural hospitals

The use of health IT holds much potential for rural America. Not only does health IT enable better care coordination, but instant access to patient information can improve health care quality and patient outcomes in rural communities.

The benefits of electronic health records are well documented, and rural providers are uniquely positioned to benefit from the use of EHRs. Health IT has the potential to transform how rural health care providers collect, manage, store, use and share health information. 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. 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. Many of these EHR mechanisms and enhancements can be used to improve rural health care gaps and deficiencies.

Health IT will be especially beneficial to rural America. In rural areas where distances between clinics are great and specialists are often few and far between, health IT can:

• Give health care providers instant access to information they need to make timely, vital decisions and save lives
• Decrease travel time for patients and their families
• Enable rural hospitals to utilize remote clinicians, pharmacists, and staff members to improve and extend access
• Facilitate efficient transfer to other facilities for vital services not offered locally
• Facilitate efficient local care after intense care in a tertiary hospital by enabling patients to get care near their families and primary care providers

Read about Cass County’s success story to upgrade their EHR: Focus on Improving Patient Care Motivates Hospital to Upgrade Electronic Health Record

Overcoming Barriers to Health IT Adoption and Implementation

Health care providers serving the approximately 60 million Americans who reside in rural communities face special challenges in their effort to improve health care quality and patient outcomes. The realities of distance, isolation, and constricted resources can complicate rural health care delivery. Health IT can help ameliorate some of these problems. See the following resources to learn more about overcoming rural barriers to health care delivery and improving health care quality and patient outcomes in rural settings.

• Hospital Leadership: Strong leadership is needed to prioritize and direct resources to health IT implementation and maintenance, including Boards of Directors, administrative teams, clinical leadership and department directors

• Funding: Financing to help pay for the cost of health IT adoption and implementation

• Health IT Workforce: Personnel and expertise that will enable health care providers to integrate EHRs into their standards of care and workflows

• Broadband: Access to affordable broadband connectivity sufficient to transmit relevant patient data in a reliable way