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Guide: Telemedicine benefits held back by lack of reimbursements

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EHR adoption, telemedicine feasible for Colorado's rural providers

Collaboration between Colorado’s health information exchange and the state's telehealth network brings EHR adoption and telemedicine services to rural providers and hospitals.

Rural health care -- despite numerous grants from the federal government -- generally gets the short end of the health IT stick when it comes to deploying a serviceable Internet connection. It is no different in Colorado, where laying fiber is a difficult and expensive process, and satellite reception is hard to come by in the mountainous and farmland regions.

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However, thanks to a collaboration between the Colorado Regional Health Information Organization (CORHIO) -- the state's official HIE -- and the Colorado Telehealth Network (CTN), rural providers are not on the outside looking in for electronic health record (EHR) adoption and, eventually, telemedicine services via broadband Internet.

CORHIO-CTN collaboration followed a 'culture of leadership'

In order for CORHIO and CTN's collaboration to come to fruition, C-level executives  and leaders from physician practices, state hospitals, health systems and the public sector across Colorado assembled to create an initiative that would improve the state's overall care delivery. The initiative required a "culture of leadership," said Janice Whittleton, director of business development and outreach at CORHIO, adding that the biggest barrier was not technology-- it was getting leaders together to hammer out a plan where CORHIO would operate on CTN's network and, also, so CTN could leverage the technical assets of the HIE.

The plan, which began in the mid-2000s, focused on interoperability, HIE technology and policies to benefit all of Colorado's providers. Instead of brushing rural providers under the rug, leaders decided to make them a focal point. Both entities recognized that the only way for rural providers to reap the benefits of information sharing and new technologies would be to deploy a secure broadband connection statewide, said Whittleton.

Broadband enables EHR adoption, care initiatives, meaningful use

The broadband services supported and maintained by CTN serve as the "toll road," said Toria Thompson, strategic consultant at CTN, meaning once a provider or practice pays to join the network they can connect with any other organization on its network. The broadband connection has the capacity to support EHR systems and telemedicine services, both of which were goals from the beginning.

CTN's broadband is vital for Colorado's rural providers, who previously relied on dial-up service that was not effective for IT adoption. Prior to CTN's intervention, many rural providers faced two challenges: There was not enough bandwidth to support EHR uptime and functionality, and the price tag was steep.

Not only will the images be viewable from the secure image cloud on CTN, the images will also be more easily read by disparate PACS systems.

Toria Thompson, strategic consultant, Colorado Telehealth Network (CTN)

Whittleton said rural organizations have since deployed cloud-based systems not only to enhance care delivery, but to curb costs when adopting EHR technology. Cloud-based EHRs are a common option among rural providers who don't wish to maintain in-house systems, which can be expensive. As a bonus, cloud-based EHRs generally cost less to connect to HIEs, said Whittleton.

Hospitals and physicians are not only adopting EHR systems, but they are using them to advance care in locations that are medically underserved and up to two hours away from any larger hospitals. That is the case with San Luis Valley Regional Medical Center (SLVRMC), an acute care hospital in Alamosa, Colo., with nearly 60 beds.

SLVRMC adopted a McKesson-based EHR system nearly 15 years ago that is hosted on-site but includes cloud elements. SLVRMC operates cloud services on CTN's broadband connection, which is "a miracle for rural areas," said the medical center's CEO, Russ Johnson.

SLVRMC uses their EHR system for a number of care initiatives, such as connecting with a remote group of radiologists in Colorado Springs that reads the hospital's images. The Alamosa facility is also connected to SLVRMC's other facilities in the area and a "number of their remote physicians," said Johnson. These initiatives, added Johnson, are increasing care quality for patients who do not have access to city-based hospitals.

In addition to care initiatives, achieving meaningful use is also on Johnson's plate. "We are attesting San Luis Valley Regional Medical Center in 2013 and CTN is helping us get there," said Johnson, adding that physicians and mid-level providers in the San Luis Valley Regional Medical Center Physician Services branch -- also in Alamosa -- are currently attesting for meaningful use stage 1.

Rural providers get help with EHR adoption

Rural caregivers are not facing EHR adoption and implementation alone, either. CORHIO serves as the state's regional extension center (REC) as well, receiving a $12.475 million grant in 2010 to assist eligible professionals and rural hospitals in the selection, implementation and use of certified EHR systems to meet meaningful use mandates and access incentive payments. CORHIO has an agreement with six partner organizations to "facilitate electronic health record adoption by at least 2,295 primary care providers working in small practices and safety net providers," said Whittleton. Many of these providers will eventually connect to the health information exchange as well.

Rural providers lag in EHR adoption

Two studies published in the journal Health Affairs suggest that electronic health record (EHR) adoption among rural practices lags behind larger hospitals and physician groups.

The first study found that rural providers trailed urban practices by 34.2% in EHR adoption while the second study revealed that by 2011, 19.4% of rural hospitals will only have basic EHR functions compared to 29.1% of urban hospitals.

While these reports shed light on EHR adoption obstacles rural providers ultimately face, initiatives such as the collaboration between CORHIO and CTN demonstrate that these obstacles can be overcome.

For example, Summit Community Care Clinic in Frisco, CO -- a non-profit community funded clinic for the uninsured and underinsured -- is working with the Colorado Rural Health Center (CRHC), which is one of the partner organizations. The clinic is advised by CRHC on how to achieve meaningful use  and has already begun connecting to CORHIO’s HIE to receive lab and pathology results, image reports and physicians reports into their EHR system.

Telemedicine services to aid providers, patients alike

Harmonizing care between rural patients and providers with city-based physicians remains a challenge for health systems across the U.S. Telemedicine services -- such as teleconferences for provider-to-provider meetings, provider-patient consultations and virtual video rooms -- will be available in the near future for hospitals and physician practices on CTN's network, said Thompson.

Telemedicine services are expected to help radiology imaging services as well. For example, Denver Health -- a teaching hospital with more than 450 beds providing care to approximately 25% of the city's residents -- does business with many hospitals in the state. When the hospital's providers share images with organizations outside CTN, they "have to set up a private connection between themselves and the facility they're exchanging data with," said CTN's Thompson. However, using CTN's broadband connection, Denver Health is able to connect with one pipe to any facility on CTN, as the secure connection is already established.

To help facilitate the exchange of images, CTN seeks to translate images from disparate picture archiving and communication systems (PACS) for end users through the Colorado Image Sharing project, which could be operational as early as 2013. This project will make it easier to collaborate and coordinate care between providers.

The project involves implementing "vendor neutral archive software on CTN where each hospital can more easily exchange images with one another and with providers," said Thompson.  "Not only will the images be viewable from the secure image cloud on CTN, the images will also be more easily read by disparate PACS systems.  For example, a Fuji PACS system can be read by a McKesson PACS in a way that enables the additional information from the Fuji system to make its way into the McKesson PACS so that it is usable by the receiving system."

Through these telemedicine services, patients are engaged, too, receiving care in the communities in which they live, without having to travel to urban areas. Thompson pointed out that telemedicine services allow rural hospitals to deliver, for example, follow up care with a dermatologist via televideo rather than sending that patient hundreds of miles away to an in-person appointment. 

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Guide: Telemedicine benefits held back by lack of reimbursements

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