Network Spotlight: Prairie Health Information Technology Network

May 2016
Prairie Health Information Technology Network

The Prairie Health IT Network was established in 2011 to assist its members with the meaningful use and adoption of health information technology. Since then, the Network has developed successful working relationships that support member needs in the areas of shared IT services and training.

Network Name Prairie Health Information Technology Network
Location Howard, SD
Key Contacts Lacey Finkbeiner, Network Director, and Scott Weatherill, CIO
Mission The mission of the network is to improve patient outcomes and the quality of care for the medically underserved, including the uninsured and underinsured patients of South Dakota through the meaningful use and adoption by both provider and patient of health information technology and the electronic health record.
Vision The vision of the network is to enhance patient safety, improve the quality of healthcare delivery, and reduce healthcare costs through efficient methods of health information exchange among all healthcare stakeholders in South Dakota.

Lacey Finkbeiner and Scott Weatherill of Prairie Health Information Technology Network were interviewed by NCHN’s director of member services to share information on the network’s characteristics, key learnings, accomplishments, and challenges.

Q: In a “nutshell,” how would you describe your network?

A: Originally our network formed due to where we’re located. Our rural location makes it hard to find electronic health record specialists. Our network was designed to train people in healthcare, to reach out to community health centers and FQHCs about sending their workers for training, and to help organizations with electronic record development. We started in 2011 with most of the FQHCs in South Dakota and some in North Dakota. The more rural ones continued to network.

Q: What benefits do network members receive?

A: Network members receive IT support services, training, and networking opportunities. The network is great, as the members have someone to bounce ideas off of. We also hold quarterly board meetings, involving all the CEOs from each network member and the network leadership team.

Q: What are the biggest challenges you face working in rural health care? 

A: Recruitment for sure. Trying to do more with less. It’s not easy recruiting IT staff for small rural communities. On the telemedicine side, a big barrier is reimbursement. When we connect to providers in metro areas, we are eligible for a $25 fee, but it doesn’t come close to covering the costs of connectivity, equipment, and staff time. The specialist on the far end gets to bill as they would a face-to-face, but we get very little. We’ve only been able to use telemedicine so far by securing grants to cover those costs.

Technology capabilities are also a challenge, such as working with the Health Information Exchange and EMR workflow design. We do not always have the staff to cover it. Technology and connectivity is not always there when you live in the rural communities. Adequate bandwidth is not always available to support the ever-changing technology.

Q: Contrarily, what are some advantages of working in your rural environment?

A: We are a truly rural frontier network. Our hub is located in a community of fewer than 100 people. So, we’ve been able to have a leg up on some grants due to population. We also have clinics on American Indian reservations, so we’ve been able to leverage funds for technology due to the chronic disease and behavioral health needs of those communities. In most cases, we’re the only shop in town.

On the patient care side of things, it’s more personalized. We know the patients better. We can offer services in their home town when it’s 120 miles to the nearest major hospital. In the future, we could see a huge advantage of telemedicine in our rural outreach communities.  

We like to think part of our success has been that we’ve known each other as organizations for years and have a history of collaboration and trust that may not exist in a lot of networks. Because we’re small, we’ve been doing economy of scales for quite a while. The relationships have helped as we pursue initiatives.

Q: What’s been a surprising insight or development as your network has grown?

A: The need for the staff with an EMR knowledge and skill base. You don’t always realize the need when you’re running the day-to-day operations until you see the advantages it has on your workflow. It really makes a difference and you can actually see the impact.

The inspiration for the earlier version of our network revolved around telemedicine. The industry shifted to electronic record, and now rural HIT is back again. I think HIT is going to be the direction of our network with our dialed-in focus being telemedicine.  

Q: Tell us about a challenge or challenges your network recently overcame.

A: Recruitment for students has been a challenge, especially on the clinical practitioner side. Our first initiative was helpdesk IT services. We’ve been able to sustain those services after the grant funds ended. We hired two IT staff with our first grant, and both are still on board.

Setting the goal of networking was key to our success (for instance, hosting presentations, having a presence on the web, word of mouth). After the first cohort of students finished, the network members and trainers from Dakota State University in Madison, SD, sat down and reviewed the student evaluations from the course. Changes were made to the curriculum, pre and post tests were added, and the number of training sessions were lowered to allow students to set achievable goals. 

Even though we have it figured out, sustainability has been difficult: continuing services without grant funds, knowing none of us have excess money, being able to find money to sustain our services. Another challenge is forming a separate legal entity. There’s a level of liability, so it’s a good idea, but we haven’t been as active on this lately. We’ve dealt with it through MOAs (Memorandum of Agreements) and Business Associate agreements.

Q: How do your challenges and advantages affect the network’s collaboration?

A: The healthcare needs keep growing. Being able to work together as a network helps our organizations meet those needs in a more skillful and efficient manner.

There are so many initiatives going on right now, from accountable care organizations (ACOs) to payment reform, that you can collaborate on. There’s no shortage of initiatives out there to work together on.  

If we continue to sustain these access points, we’re going to have to work together to meet those challenges and the needs of an industry that’s changing continually. There’s a lot we cannot do by ourselves. There will always be a place for our network.

Q: Based on your experiences, what advice would you give to developing a rural health network? 

A: Ensure that each member has equal say among the group. Also, it’s important that network members are willing to bring something to the table. It’s key to have that mindset and have it established among all members. It can be too easy for a certain organization to dominate.


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