By Baha Zeidan
As 2020 focuses a spotlight on the social inequity entrenched in many US institutions, disparities in healthcare are receiving increased attention. Smaller hospitals in underserved communities have far fewer resources to meet the needs of their patients than larger hospitals, and the gap may widen. Of the roughly 1,800 rural hospitals in the US, 25 percent are at risk of closing due to financial pressure, and that was before the pandemic.
As CMS continues to shift to value-based reimbursement models, smaller hospitals will need to understand their data to properly assess performance-based contracts and protect their revenue. Without the technology to manage this critical analysis, underserved hospitals find themselves on the less fortunate side of the “digital divide,” ultimately impacting the quality and delivery of care. So what will it take for the little guys to level the playing field?
The Hospital Digital Divide
Healthcare IT is driving advancements that are making care coordination, communication, and disease prevention more effective. Most notably, there have been significant developments in technologies that improve patient engagement and data exchange.
From 2012 to 2015 U.S. hospitals accelerated online access to health information and enabled online communication. According to the latest data provided by the Office of the National Coordinator (ONC) for Health Information Technology, 64 percent of providers had an electronic health record (EHR) that could exchange secure messages with patients. Nearly 70 percent of physicians reported having the capability for patients to view their record on-line. Forty-one percent provided the capability to download a patient record, and close to 20 percent had the functionality that allowed patients to send their medical records to a third party.
These advances are helping drive transparency in patient care and they are critical enablers of provider engagement—engagement with patients, engagement with other providers, and engagement with documentation that leads to better data. But gaps remain, especially for smaller and traditionally underserved providers.
In another ONC study, researchers found that small, rural, and critical access hospitals (CAHs) use electronic methods to exchange summary-of-care records at significantly lower rates than their larger peers. These hospitals are three times as likely to send care records using only paper methods, and about twice as likely to receive summary-of-care records using only non-electronic methods.
So what? Does it matter if a patient record is received electronically or as a paper chart? With lower patient volumes, does the lack of technology really impact patient care?
As it turns out, a lack of access to IT advancement has a real impact on patient care and quality outcomes.
Technology Barriers Exacerbate Health Disparities
In a recent study, researchers found that there is a correlation between EHR optimization and clinical care quality. The kind of rapid EHR optimization and health IT advancement needed to help drive improvements in care quality, especially in times of crisis like Covid-19, requires significant financial investment. Smaller hospitals, who have always been at a disadvantage when it comes to technology access, find themselves far behind their larger peers simply because they lack funding and access to the right clinical talent.
This same study examined the association between a provider’s meaningful use attestation and certain clinical quality measures. Meaningful use stage 2 builds on the core pillars of the policy by “expanding and advancing EHRs for clinical decision support, health information exchange, electronic prescribing, direct messaging, health and disease management tools, health education materials, and monitoring of clinical quality metrics.”
Researchers found a high correlation between higher state meaningful use attestation and improvements in clinical quality measures. Attainment of meaningful use stage 2 or above, “was a significant predictor of performance on cancer prevention, obesity prevention, tobacco screening and cessation counseling, childhood immunization, and diabetes control measures.”
But the kind of advancements brought about by meaningful use require considerable resources to optimize the electronic health record. As a result, larger systems are more likely to have achieved these kinds of patient-centered transformations while smaller hospitals are handicapped by a lack of financial and human capital needed to implement and maintain advanced EHR capabilities.
Gaps in care extend beyond meaningful use. In another report, the ONC found that nearly 30 percent of individuals who visited the doctor over the past year experienced a gap in how their information was shared across care settings and providers. About five percent reported having to redo a test or procedure because their prior data was unavailable. And about 20 percent reported having to bring prior test results to an appointment.
These technology barriers intersect with socioeconomic determinants that drive the rural-urban gap in mortality and life expectancy rates. Generally, rural Americans are older, sicker, and have access to fewer resources. Approximately 16 percent of the rural population lives below the poverty line and death rates for ischemic heart disease and COPD are both higher in rural areas. While higher mortality rates and lower quality of life are driven by multiple factors, the lack of technology infrastructure and access at the provider level intensify barriers to care and increased risk.
Bridging the Divide
While technology has in many ways exacerbated the digital divide across providers, it also holds the keys to bridging the gap. The deepest challenges are rooted in technology that is resource intensive, billing focused, and prescriptive. In the recent Gartner report The EHR Megasuite Oligopoly Will Result in Less Differentiation and Innovation — and Higher Total Cost of Ownership, analysts explain how the EHR market has become an oligopoly dominated by a few firms. These “megasuites” are slowing innovation and standing in the way of interoperability and data transparency—core tenets that align to meaningful use measures and care quality outcomes.
But even in the shadow of these few industry giants, there are new EHR solutions coming online that are designed specifically to ensure access, agility, and autonomy so that providers can deploy technology that will enhance care through a simplified, lower resource-dependent approach. These solutions fill a gap in the current EHR market by delivering a provider-centric solution. Dominant EHR vendors prioritized regulatory compliance and billing over clinical experience and quality in solution design and implementation. In contrast, the emergent competitors are offering new solutions that change the entire focus of the EHR and how we measure its effectiveness.
What Does It Mean to be the Provider’s EHR?
An EHR designed for the provider offers several key attributes:
- It minimizes the intrusion of technology so that the provider can focus on the patient instead of a screen.
- It is malleable to different workflows so that data fields and information can be designed around the provider and the patient population.
- It frees IT to focus on the business rather than maintenance and infrastructure.
- It enables data flow and communication across stakeholders and care settings.
Cloud-based, provider-focused EHRs are offering a path to greater technology and data access for all hospitals, and they can help small and underserved providers achieve the technological parity with their better-funded counterparts that leads to better clinical care quality. By minimizing, if not fully eliminating, the investment required for on-premise and hybrid solutions, these platforms offer a light and easy-to-maintain option.
They are building on what it means to be a provider-focused EHR and delivering access to functionality such as telehealth, a patient portal, and messaging. And they are designed to enable a “configuration over coding” approach to lower change requests, increase the autonomy of the provider, and create a clinically flexible system that can adjust to different workflows, departments, care levels, and patient populations.
These provider-focused EHR platforms stand in stark contrast to the behemoth solutions that have dominated healthcare at the expense of the small and underserved providers. But the market power of the “big box” solutions is waning as more agile EHRs that are tuned to the provider and aligned to care outcomes continue to gain footholds with the hospitals that have historically been left behind.
Baha is the Co-founder and CEO of Azalea Health, a leading healthcare IT company whose mission it is to help underserved healthcare providers improve patient care and profitability. Under Baha’s leadership, Azalea has established itself as a high-growth innovator and leader, developing a comprehensive, cloud-based health IT platform for ambulatory practices and hospitals — including introducing the industry’s first fully-integrated proprietary telehealth solution with its EHR.
Azalea Health has achieved Inc. 5000 rank of fastest-growing companies in the U.S for three consecutive years, and has been named a Top 40 Innovative Technology Company by The Technology Association of Georgia (TAG).
Baha has been recognized in the industry with a number of awards including the Phoenix Award by the Metro Atlanta Chamber Bioscience-Health IT Leadership Council in conjunction with the Health IT Leadership Summit for his outstanding contribution to the growth of the health IT industry in Georgia. He is also a 2018 recipient of the Atlanta Business Chronicle’s 40 Under Forty Award and a 2019 recipient of their Most Admired CEOs Award.