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Surgeon general: EHR systems at rural health clinics are vulnerable

The Massachusetts governor’s HIT conference focused on the highest of high tech. Surgeon General Regina Benjamin reminded attendees that EHR systems must serve low-tech areas, too.

BOSTON -- Bayou La Batre, Ala., isn’t as well known as New Orleans, but it was battered by Hurricane Katrina in 2005 just the same. Katrina's surge left shrimp boats and even an oil tanker lodged in trees. At the time, future U.S. Surgeon General Dr. Regina Benjamin was a practicing family physician at a clinic in Bayou La Batre, less than 50 miles from where she grew up.

The rural health clinic's staff members had to dig paper patient charts out of flooded file cabinets and dry them in the sun on the sidewalks. “It wasn’t very good for HIPAA,” Benjamin wryly joked in her keynote address last week to attendees of Massachusetts Gov. Deval Patrick’s two-day health IT seminar.

Unfortunately, a fire destroyed the newly renovated clinic -- and the paper charts -- soon after. A combination of local, state and national contributors are helping rebuild the office at a new location, but the clinic was forced to start from scratch with its records system. Groups from Bentley College in Waltham, Mass., chipped in with the rebuilding effort. One class at the business school had been studying electronic health record (EHR) systems and offered to get a system up and running at the clinic. The students also convinced Westborough, Mass.-based eClinicalWorks LLC to donate the software.

“My office staff had been saying, ‘We want an electronic record, we’re not going to dry any more charts, ever, in the sun,’” Benjamin said, delivering her message via live video feed from the University at Buffalo, where she delivered a commencement address later that day. “Usually, you have to convince your staff to go to the [electronic health] record. They were telling me, ‘When are we going to get [them]?’”

Benjamin reminded the physicians, IT leaders and vendor representatives in attendance that the current wave of health IT initiatives might grab a lot of headlines for its cutting-edge merits. But for it to benefit all patients, they will have to reach rural health clinics, patients and other traditionally underserved populations as well.

One such group is the working poor -- those too poor to afford health care, but too rich to qualify for Medicaid. The reading skills among people in this group vary from none to high levels of comprehension. Their levels of Internet connectivity vary as well. Some patients of facilities like rural health clinics might not have telephones but can be reached via Web mail accounts accessed through a computer at, for instance, a public library.

We have to build our [EHR] systems around people who, often times, don’t have strong reading skills.

Dr. Regina Benjamin, U.S. Surgeon General

“When we talk about IT, these are some of the patients that we will have to interact with, and we have to build our [EHR] systems around people who, oftentimes, don’t have strong reading skills, and we have to make sure we keep them in mind,” Benjamin said.

She said EHR systems can help reach underserved populations and streamline health care in those communities, too. While some practitioners might be apprehensive about using a new technology, Benjamin insinuated that, at least at her facility, those fears might be unfounded. Her octogenarian nurse,  who had so little computer experience that she had to start with learning how to use a mouse, was able to plug into a newly installed EHR system and get up to speed within a few days.

From her point of view as America’s top doctor, Benjamin listed three main concerns for the present HIT build-out, all of them patient-oriented:

  • That providers, payers and vendors keep patient data private and protected.
  • That those organizations keep patient portals simple and therefore accessible to more patients from varied walks of life.
  • That those groups keep wellness and disease prevention in mind when designing EHR systems, by giving doctors the aggregated patient data and appointment reminders they need to act in a quick, straightforward way.

If these goals are met, Benjamin said she’s convinced EHR systems cannot just improve health care quality, but also “make a big difference.”

She also pointed out a less-publicized, but very real benefit of electronic medical records she understands well through her experiences in Bayou La Batre: When backed up properly, they make disaster recovery possible in cases where paper can’t.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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