Health Information Technology Initiative

Arizona Rural HIT Users Group

The most recent conference call was from 2:00-3:00 p.m., Monday, January 29, 2007.

The next call will be scheduled for mid-April. To join the Users Group, please contact Jim Laukes, 520-626-0721 o jlaukes@u.arizona.edu for details.

The United States movement is currently in full swing to bring electronic health records into physician offices, clinics and hospitals.  It is believed by national and state policy makers that the interoperable exchange of electronic patient record systems will result in higher quality, safer health care delivery at lower costs.  President Bush has outlined a 10-year plan to ensure most Americans have electronic health records, and Arizona’s Governor Napolitano has launched a Health-e Roadmap to bring the state into alignment with the national goals within a five-year time frame.

The Institute of Medicine has estimated that between 44,000 to 98,000 Americans die from medical errors. Studies have shown as much as $300 billion is spent each year on health care that does not improve patient outcomes – treatment that is unnecessary, inappropriate, inefficient, or ineffective. Gathering a patient’s important medical information into a single electronic record, accessible throughout the health care system, will allow more efficient diagnosis and treatment.  The patient’s medication and treatment histories will be readily accessible and available at all points of entry in the health care system, and more effectively utilized within a continuum of care.

For small rural hospitals, like the critical access hospitals served by the Arizona Rural Hospital Flexibility (Flex) Program, the costs of planning and implementing full access to an interoperable electronic health record system seems prohibitive. Many of these hospitals also lack the expertise in the information technology infrastructure systems that are necessary for implementing the new systems. Some lack the fiscal resources required to get started.  For this reason, the Flex Program has started to serve as an information clearinghouse about health information technology issues, and to provide mini-grants to support planning and implementation of electronic health record systems among the state’s critical access hospitals. 

In the summer of 2005, the Flex Program contracted with the Cerner Corporation to implement a preliminary assessment of the extent to which the state’s small rural hospitals were considering electronic health record systems. The Cerner consultants did not receive many responses from the hospitals, probably because at that time, the national and state publicity regarding health information technology initiatives had not yet reached the ears of the CAH leadership. The consultants made personal visits to three critical access hospitals (those in Benson, Wickenburg, and Willcox). Each of the hospitals visited were provided with a Cerner analysis of their readiness for E.H.R. implementation.

The first gathering in the State of Arizona for rural health providers to learn about health information technology took place in fall 2005 and was generated by the Arizona Rural Health Association in collaboration with the Rural Health Office.  In spring of 2006, the Flex Program sponsored a second seminar on electronic health records, directed specifically to critical access hospitals. By June, 2006, the Flex Program had awarded four small grants to critical access hospitals eager to move quickly to plan and implement E.H.R systems. Simultaneously, the state legislature approved a line item in the Governor’s budget for a $1.5 million initiative to help rural health care providers to move forward with electronic health records.  The grant guidance for disseminating these funds was in the process of being developed at the time this publication went to print.  At the national level, programs such as those administered by the Office for the Advancement of Telehealth and the Office of Rural Health Policy (both in the Health Resources and Service Administration-HRSA), are supporting applications that pilot electronic health record systems in rural areas.   

While the field of health information technology is not new (the U.S. military has had a sophisticated electronic health record system in place for over a decade), harnessing the technical and financial resources to make it happen is a major challenge for rural Arizona. The Flex Program is committed to helping our critical access hospitals as much as possible to ensure that health information technology is within their reach.

Arizona’s critical access hospitals vary in their stages of electronic health record implementation.  The three Indian Health Service critical access hospitals (located in Hopi, Parker, and Ft. Yuma respectively) along with HuHuKam Memorial Hospital in Sacaton are implementing the VistA electronic health record system that is used throughout the Veterans Administration hospitals and clinics around the country. Other critical access hospitals that are managed by large health systems (e.g., Page Hospital is managed by the Banner health system), are implementing the E.H.R. system being administered by the larger system.

Most CAHs, however, are in the early planning stages and are performing a work flow analyses necessary to systematically and incrementally get the job done.  Three of the hospitals funded by the Flex Program (those in Benson, Ganado, and Winslow), have formed a network to plan together, using the same consultant, with the hope that they can ultimately save money through joint vendor negotiations for compatible systems. A fourth critical access hospital (in Bisbee) was funded with Flex funds to enable its E.H.R. vendor to train hospital front line staff members in how to use the system that was installed with the benefit of federal funding obtained through the Community Access Program (CAP).

If you have any questions about the Health Information Technology Initiative, call Alison Hughes at (520) 626-6253 or e-mail her at ahughes@email.arizona.edu.

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