I sometimes enjoy the sympathetic nods I get at industry conferences. When I tell people where I work—a small hospital in rural Nebraska—I get that look like, “Oh, honey. I'm so sorry for you. That must be rough.”
Well, it is and it isn't. It isn't always like slogging uphill. If I can use a skiing analogy, it's sometimes like plummeting off a double black diamond slope. You learn quickly to be vigilant, assess the environment quickly and never descend by yourself.
One of the risks in the rural
arena is that small hospitals can't sit idly by waiting for the change to happen. We have to work with the limited resources that are a fact of life in critical-access facilities.
One way many of us approach this lack of resources is to limit the number of vendors we engage. As a result, we are not likely to opt for using a “best of breed” approach, in which we might choose individual applications that we'd deem to be the best for different purposes. When an organization has to deal with a variety of change initiatives—the transition to ICD-10
, data exchange, analytics and much more—having a short list of vendors helps significantly.
Don't get me wrong—fully integrated systems have deficits that a best-of-breed approach might address. But coping with multiple vendors would have represented a constant battle for resources that we don't have.
For all the challenges of small size and limited resources, there are times where rural healthcare works to our advantage. I'm crossing my fingers that implementation of ICD-10 will be one such case.
Transitioning to ICD-10-based systems is a huge undertaking, involving many departments within most hospitals. That can make ownership of the ultimate responsibility for the transition difficult. At my facility, I've come to realize that I might be best equipped to lead the transition effort. It's a project within a project, and it brings us a step closer to some of the data initiatives that we need to be able to accomplish, such as the exchange of patient data and data analytics
As a small organization, we were able to anticipate some of the challenges of ICD-10 and make plans as senior executives. For example, we set goals to decrease days in accounts receivable to provide financial padding that we've never seen before, and we have already surpassed our goal.
Having a small community with a predictable patient and provider base makes it easier to focus on our priorities and practice patterns. We have studied the past two years of documentation and codes, which led us to focus on approximately 140 ICD-9 codes that account for 80% of our coding. We have been communicating monthly with non-employed physicians on the importance of documentation, emphasizing the top 30 primary diagnosis codes for more than a year. We provided refresher courses on terminology, physiology and anatomy. And there have been countless ICD-10-CM and PCS training sessions and coding workshops.
On the IT side, we're very confident in our coding software and our EHR
product—that will mitigate querying times and cut the learning curve by months. We face several unknown variables, to be sure—such as payer processing times and liability insurance provisions that are unpredictable.
Small providers can't face the challenges of IT and IT-related change alone. Networking and learning from our competitors, partners and other communities is essential for rural CIOs. We will have to learn to cope with our shortcomings by maximizing our strengths. A good baseline strength would be grit.Anna Turman is chief operating officer and chief information officer at Chadron (Neb.) Community Hospital and Health Services.