Experience from Front Line:
Rural Provider Perspective
California State Legislature Rural Caucus
Health Information Technology Informational Hearing
June 9, 2010Earl W. Ferguson, M.D., Ph.D.President-elect, California State Rural Health Association;
Director, Southern Sierra Telehealth Network;Director, Telemedicine and Rural Health Development
Ridgecrest Regional Hospital, Ridgecrest, CA
Advanced HIT Implementation in Rural Areas
• Electronic Health Records (EHRs)• Health Information Exchange (HIE)• Telemedicine/Telehealth• Integration of these technologies• What does future look like?
Electronic Health Records (EHRs)
• Southern Sierra Medical Clinic (SSMC)– Selection of EHR (1996-2000)– Work flow redesign for EHRs (2000-2001)
• Automation of front office– Scheduling, Registration, Coding, Billing, Collections
• Back office/Nurses station redesign– Patient assessment, vital signs
• Implementation of computer systems at all work stations, provider offices and examining rooms
• Workforce training
Electronic Health Records (EHRs)
• Southern Sierra Medical Clinic – Implementation of Comprehensive
EHR System (2002)• Provider training and mentoring• Transition from paper charts• “Paperless” EHR System by end of 2002
– “e-Prescribing” (2003)– ELINCS (EHR-Lab Interoperability and
Connectivity Specification) HIE (2004)
Health Information Exchange (HIE)
• ELINCS (EHR-Lab Interoperability and Connectivity Specification) HIE (2004)
– Ridgecrest Regional Hospital (RRH)– Southern Sierra Medical Clinic– Other investigators
• Lab reports automatically sent from RRH into SSMC EMRs
• Labs, PACS (radiology) images, RRH EHRs (since 2009) and other information available via secure RRH websites.
Telemedicine/Telehealth
• Southern Sierra Telehealth Network (SSTN)– Telemedicine Consults from RRH to
Southern Inyo Healthcare District, Lone Pine and to RRH from consultants outside our region (2001) .
– Telehealth educational programs• Nursing educations (LVN to RN, RN to BSN)• Staff and patient education
Integration of Health Information Technologies
• Telemedicine visits with interactive video on one screen, EHR on another, and PACS images on a third demonstrated in 2006 using combination of SSTN telemedicine system, SSMC EHR system, and RRH PACS system.
What does future look like?
• Broadband enabled integration of all these systems into systems that will provide information whenever and wherever it is needed to support health and healthcare decision-making.
• Marked improvements in the quality, efficiency, cost-effectiveness and accessibility of healthcare in rural areas.
What does future look like?
• Chronic disease management of patients at home– Monitoring patients and alerting
providers of problems– Marked decrease in need for
hospitalization and emergency visits– Increased efficiency and decreased
healthcare costs
Summary of Major Issues• Broadband connectivity is essential• Purchasing advanced HIT and telehealth
hardware, software and services• Cost-effective telemedicine systems can be
implemented• Costs of other advanced HIT systems are high, but
incentives and funding encourage adoption
• Staffing/Workforce must be developed• Reimbursement must support services• Advanced HIT systems will be integrated
• PHRs/EHRs/HIE/telemedicine/telehealth systems
Conclusions• Reimbursement for services, particularly in rural and remote areas, must be adequate to sustain healthcare systems • Reimbursement should be focused on addressing community needs and overcoming barriers to healthcare access• Biggest issues for success are regulatory policies and funding, not technologies• Keeping decision-makers informed must remain a high priority
