Quality Through Collaboration The Future of Rural Health (2005) / Chapter Skim
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6 Rural Health Care in the Digital Age
6 Rural Health Care in the Digital Age
Pages 147-190
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From page 147... ...
Hilty entitled "Rural Health in the Digital Age: The Role of Information and Telecommunicatioon Technologies in the Future of Rural Health" (March 18, 2004)
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From page 148... ...
In the current health care delivery system, however, most critical patient information is recorded in handwritten medical records dispersed across various settings, including ambulatory practices, hospitals, nursing homes, and others. Clinical information does not travel with the patient, nor is it readily accessible by clinicians or the patient.
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Finally, access to de-identified patient data can enhance health services research and population health surveillance systems. Central to this process is the need to maintain an electronic health record (EHR)
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ICT APPLICATIONS IN RURAL SETTINGS The development of an ICT infrastructure opens up many opportunities to improve health and health care in rural areas. Changes in health care delivery at all levels will result (BCG, 2003; Liederman and Morefield, 2003)
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Applications at Home and in the Community ICT offers many new opportunities for rural residents to access health information, communicate with the health system from home for clinical and administrative purposes, and manage their chronic conditions more effectively. Likewise, rural individuals residing in community-based long-term care and assisted living facilities and the providers who care for them can greatly benefit from the ICT applications that will enable them to better coordinate care and health information across settings.
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From page 152... ...
that can facilitate care coordination and management of health information as the patient moves through the care continuum (e.g., acute, hospital, assisted/long-term) or consults with physicians located in urban areas.
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Following is a brief discussion of applications in the areas of eencounters, remote language and cultural interpretation, knowledge and decision support, storage and retrieval of diagnostic and health information, distance consultations and patient monitoring, and emergency care.
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Remote Language and Cultural Interpretation Providing professional language and cultural interpreting services presents a significant problem for rural providers, particularly in small clinics that serve patients from diverse ethnic and cultural backgrounds who may speak several different languages. Telecommunications technology has been used to address language barriers through the use of voice-only services that are available through a number of commercial telecommunications companies.
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From page 155... ...
. Projects that involve rural public librarians and medical librarians bring quality health information and expertise to rural areas, with the goal of enabling health professionals to make more evidencebased decisions about their patient care practices and allowing the public to make informed decisions about their health.
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Storage and Retrieval of Diagnostic and Health Information Store-and-forward applications are the methods by which still-frame images, voice or sound recordings, and medical data such as patient history, physical examination findings, and test results are captured, stored, and transmitted by e-mail or Internet posting. Alaska's telemedicine network, for example, uses store-and-forward e-mail protocols to transmit electrocardiograms to cardiologists in regional centers (Patricoski and Ferguson, 2003)
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From page 157... ...
The use of telemedicine in inpatient settings will allow rural hospitals to keep more patients in the community and to raise the quality of care provided. For example, intensive care unit patients in rural hospitals can benefit from monitoring by intensivists located in urban areas through the use of videoconferencing and remote monitoring, resulting in reduced mortality, morbidity, and costs (Breslow, 2000; Celi et al., 2001; Marcin et al., 2004; Rosenfeld et al., 2000)
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From page 158... ...
. The Robert Wood Johnson Foundation is supporting the project Turning Point: Collaborating for a New Century of Public Health Initiatives to transform the population health system into a model that is more effective, more community-based, and more collaborative.
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and the President's Information Technology Advisory Committee (2001) have called for the development of a National Health Information Infrastructure (NHII)
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that include a spectrum of clinical and patient data, such as demographic data, diagnostic and treatment data, ancillary test results, progress notes, and insurance and billing data. · PHRs -- computer-based patient records maintained by patients and informal caregivers that include such information as preventive health information, health education material, medication and other treatment plans for chronic conditions, and tracking of health behaviors and key indicators.
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From page 161... ...
. In a survey by the Pew Internet and American Life Project, 61 percent of respondents said the Internet had improved the way they took care of themselves either "a lot" or "some." And while some are concerned about the quality of online health information, the ability to contribute to a more informed patient population is embraced by many health professionals.
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From page 162... ...
Web-based commercial PHRs, whereby one's health information is stored on a secure webpage; (3) functional/purpose-based PHRs, which are Web-based records related to a specific service, such as emergency care; (4)
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From page 163... ...
Telemedicine As discussed earlier, telemedicine has a number of applications in patient care, education, research, administration, and population health (Wakefield, 2002) and has the potential to be an important means of equalizing the differential availability of resources in rural and urban areas (Hartley et al., 2002; Wholey et al., 2003)
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Technical Requirements ICT applications depend on the exchange of data among providers, patients, and vendors. For the most part, exchanging data requires access to digital lines, along with national data standards to facilitate meaningful communication and protect confidentiality.
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. When the sending and receiving systems use the same data standards, health information can flow more easily from one system to another.
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. One key component of this initiative was the establishment of the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services (DHHS)
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. Designation of the National Center on Vital and Health Statistics as the preeminent health information policy advisory group of the federal government, the development of its vision statement for the NHII, the CHI collaboration, and the recent promulgation of some data standards have established a policy process and generated a widespread expectation that the federal government will continue to address this important issue in a thoughtful, coordinated, and strategic manner.
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. In fiscal year 2005, an additional $50 million will be made available to communities to plan and implement local/regional health information infrastructures (AHRQ, 2004b)
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A Rural Focus in the NHII Plan With the establishment of the Office of the National Coordinator for Health Information Technology, the federal government has assumed a leadership role in the development of the NHII over the next 10 years. To achieve this goal, the NHII Coordinator must implement a comprehensive strategy, operational plan, and budget.
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· The NHII strategic plan should include a component that is specific to rural and frontier areas, and this component should pro vide the programmatic and financial resources necessary for rural areas to participate fully in the NHII. · The Office of Rural Health Policy should be designated as the lead agency for coordination of rural health input to the Office of the National Coordinator for Health Information Technology.
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From page 171... ...
Additional resources should be made available as needed for the expansion of wired and wireless broadband networks to ensure that all rural communities have access to such networks by 2007. Where needed, programs should provide assistance for the internal wiring of health care provider facilities and for connection to the telecommunications infrastructure.
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Congress should take appropriate steps to en sure that rural communities are able to access and use the Internet for the full range of health-related applications. Specifically, consider ation should be given to: · Expanding and coordinating the efforts of federal agencies to extend broadband networks into rural areas.
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Some changes in government regulatory processes and health insurance programs may be desirable, but a detailed analysis of current practices for purposes of identifying barriers to telehealth has yet to be conducted. The Office of the National Coordinator for Health Information Technology might pro vide leadership and coordination for such work.
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From page 174... ...
. AAFP's initiative includes both the Open EHR Pilot Project, a small-scale phase 1 project to study and promote the transition to a paperless office and the use of EHRs, and the Doctors Office Quality Information Technology project, designed to assist physicians' offices in migrating from paper to EHRs, storing health information electronically, and using computer-generated decision support tools (AAFP, 2003)
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However, the NHII will likely be built community by community, with local or regional health information infrastructures adhering to national data standards. Rural communities should be actively engaged in this developmental work to establish local networks for the exchange of data.
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In addition, the federal government should provide financial support to a limited number of rural communities for the establishment of communitywide health information infrastructures. Efforts to this end are already under way.
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The Agency for Healthcare Research and Quality's Health Information Technology Program should be ex panded. Adequate resources should be provided to allow the agency to sponsor developmental programs for information and communica tions technology in five rural areas.
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. Chapter 2 recommended a set of demonstration projects in those communities to test alternative approaches to restructuring the health systems in rural communities to address both population and personal health care needs in a more integrated fashion, and to redesign finance and delivery system to achieve those objectives.
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This point is particularly applicable to rural communities. Networking8 among rural providers and with urban organizations has been central to building more stable rural health care delivery systems and addressing some of the workforce supply issues faced by rural areas.
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The National Library of Medicine, in collabora tion with the Office of the National Coordinator for Health Informa tion Technology and the Agency for Healthcare Research and Quality, should establish regional information and communications technol ogy/telehealth resource centers that are interconnected with the National Network of Libraries of Medicine. These resource centers should provide a full spectrum of services, including the following: · Information resources for health professionals and consumers, including access to online information sources and technical assis tance with online applications, such as distance monitoring.
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2004b. HHS Awards $139 Million to Drive Adoption of Health Information Technology.
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Commissioned paper for the IOM Committee on Data Standards for Patient Safety. Washington, DC.
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Journal of Health Information Management 17(4)
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Journal of the American Medical Informatics Association 4(1)
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2004. Health Information Technology Adoption in Rural Family Practice.
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Bulletin of the Medical Library Association 80(2)
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2001. Information for Health: A Strategy for Building the National Health Information Infrastructure.
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Bulletin of the Medical Library Association 88(4)
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2000. Providing consumer health information in the rural setting: Planetree health resources center's approach.
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2003. Tribal connections health information outreach: Results, evaluation, and challenges.
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