The Promise of EHR Interoperability to Rural Communities
By Rene S. Cabral-Daniels, JD, MPH, CEO of Community Care Network of Virginia, Inc., with contributions from Isaiah Dolcee and Eliza Singleton, interns at Community Care Network of Virginia
The impact of health information technology (IT) on the healthcare industry is irrefutable. According to the Department of Health and Human Services’ Office of the National Coordinator (ONC), nearly 90% of office-based physicians have adopted an Electronic Health Record (EHR). Moreover, the percentage of hospitals that provide patients the ability to view, download, and transmit their health records online accelerated from 10% in 2013 to 69% in 2015. Patients are likewise availing themselves of this resource in greater numbers. The ONC reports patient use of information technology to interact with their health care provider, view their personal health information, and track their health and wellness grew significantly between 2013 and 2014. Patient use of one or more of the selected types of IT significantly grew between 2013 and 2014, from 39% to 48%.
The growth in EHR utilization by patients and providers alike likely reflects the many benefits of this technology. Providers value the ability to make medical decisions based on the most current information. As patients may receive care in a variety of healthcare settings, the ability to coordinate the most recent medical information in deciding future treatment is an imperative for providers. EHRs also enhance patient safety, particularly by assuring greater reliability in prescribing pharmaceuticals. Patients requesting their medical records through an EHR can expect to receive complete documentation free from handwritten notes that often prove difficult to read.
The significance of interoperability within health care performance
All of these benefits, as well as the benefit of cost reduction, help communities realize health system performance Triple Aim goals:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of health care 
While the increase in provider EHR usage is commendable, an EHR’s greatest promise is commensurate with its ability to achieve interoperability. Interoperability refers to the ability of disparate information technology systems and software applications to communicate, to exchange data with accuracy, efficiency and consistency as well as to use the information that has been exchanged.
Interoperability of EHRs has the ability to enhance each of the Triple Aim benefits. The American Hospital Association asserts interoperability progress will support all three Triple Aim goals, each of which has a positive impact on rural communities.
Enhancing the rural patient experience
The challenge each Triple Aim criterion seeks to address is greater in rural communities; interoperability of electronic health records therefore has a greater advantage in rural communities. The first Triple Aim criterion, patient experience of care, may have a geographic correlation. A study of health center patients found urban patients were more satisfied with their physicians than rural patients. This finding is likely influenced by the challenges faced by rural health providers. Rural American communities face substantial healthcare disadvantages compared to urban and suburban communities. The 40 to 45 percent of people who reside in these areas (approximately 150 million people) report higher levels of chronic conditions and a lower per capita income. These factors, combined with the lack of specialists in rural communities, force many patients to travel to more populated areas to find certain providers. Patient care is often solely provided in the few hospitals in these areas, causing most to be overextended and under supplied.
EHR interoperability can play an important role in enhancing patient satisfaction. The Rural Health IT Corporation asserts improving customer satisfaction in healthcare depends on complete data interoperability. The Bipartisan Policy Center report on the role of health IT in transforming healthcare stated studies indicate high levels of patient satisfaction with online consumer tools. Clearly, patient satisfaction can be positively influenced by EHR interoperability. This finding is particularly relevant to rural communities, as rural patients tend to be less satisfied with their care than their urban counterparts.
Improving the health of rural populations
Improving the health of populations is the second goal of the Triple Aim. Population health management includes the methodologies for providers and payers to contain and lower costs, thereby increasing operational efficiencies such as the ability of providers to streamline care and improve treatment outcomes. One of the main benefits of EHRs is increased access to information. Interoperability of EHRs escalates that benefit by assuring the information is comprehensive and not site-specific, a necessary element in improving population health.
This advantage of comprehensive data review by providers is imperative for rural communities, as residents need to travel greater distances to access different points of the health care delivery system. Healthcare facilities in these areas are small and often provide limited services, thereby requiring rural residents to travel to seek care, particularly tertiary care. Often, due to geographic distance, extreme weather conditions, environmental and climatic barriers, lack of public transportation, and challenging roads, rural residents may be limited/ prohibited from accessing healthcare services in their communities.
Utilizing health IT has benefits for rural providers and patients alike. For example, patients can exchange secure messages, have “e-visits” with their physicians and decrease the hassle of traveling to a specialist. Specialty referrals are also made easier, which is valuable since access to them is often limited.
Reducing costs by increasing interoperability
The third criterion of the Triple Aim involves reducing the per capita cost of healthcare. Every year, providers lose millions of dollars due to the amount of time spent searching for paper medical records. In the past, knowledge of a patient’s medical history relied on physical records held by a primary physician and the memory of a patient, both of which were not completely reliable. These inherent discrepancies in health data are even more prevalent in patients from rural areas since most tend to see multiple physicians. By increasing interoperability, time is used more effectively to solve a patient’s concerns and therefore save money for both the practice and the patient. The Office of the National Coordinator’s Connecting Health and Care for the Nation: A Shared Nation Interoperability Roadmap stated interoperability can help reduce care delivery redundancy and cost by allowing test results to be reused while supporting analyses to pinpoint waste.
The per capita cost of healthcare is significantly reduced with the implementation of interoperable EHRs. This is because patients no longer have to pay for both the cost of administering care as well as complex IT systems that are necessary to access health data in siloed information systems to administer effective care. The West Health Institute calculated the aggregate financial benefit to be projected at $30B saved in the healthcare industry per year. Efforts to lower costs will therefore positively benefit rural communities as their local providers will have access to a full panoply of tests if interoperability of EHRs is complete.
The nation as a whole benefits from true interoperability of electronic health records. When these benefits are viewed through the lens of the Triple Aim, the benefit to rural communities is even greater.
Community Care Network of Virginia, Inc. (CCNV), a community health center-owned and governed provider network, was legally incorporated as a statewide network organization in. CCNV has a long, successful history of providing integrated, network-based services and programs to Virginia’s health centers, including the acquisition and implementation of a centralized practice management system, help desk, and support infrastructure commencing in 1999.
With over two decades of experience as a leader in health policy, finance, and law, Rene Cabral-Daniels has been the CEO of CCNV since 2013. She currently serves on the Healthcare Information and Management Systems Society (HIMSS) North America Board of Directors as well as the National Cooperative of Health Networks (NCHN) Board of Directors.
Isaiah Dolcee is a rising senior at Princeton University, and Eliza Singleton is a rising junior at Elon University.