Rural provider shows size no barrier to EHRs

("Rural provider shows size no barrier to EHRs" is the first of a four-part series on healthcare IT and EHR adoption in rural regions.)

Some small, rural healthcare organizations have become health information technology front-runners and their leaders techno mavens, despite the digital divide that separates the larger, urban health IT have-nows from the smaller, rural IT have-not-yets.

Few states are more country than West Virginia, where 51% of its people live in rural areas. (Only Maine and Vermont have higher percentages.)

In 2000, 20 of the state's community health centers banded together as the Community Health Network of West Virginia, in part to create economies of scale for healthcare IT projects. The network first offered a remote-hosted practice management system, then, in 2008, through a pilot program funded by the Health Resources and Services Administration, it added an electronic health record, the Resource and Patient Management System developed by the Indian Health Service from the Veterans Affairs Department's VistA EHR.

“We really wanted to do population health,” says David Campbell, the network's CEO. “We knew that's where healthcare was going, and in our rural communities we had to look at a very diverse population. We wanted a public utility that you could plug into with a subscription model. For what we were trying to accomplish at the time, RPMS was the best system available.”

One network EHR user is Pendleton Community Care in Franklin, population 720. Pendleton County, on the eastern edge of the Alleghenies, is hemmed in by four major mountains and “lots of hollers, as we call them,” says native West Virginian Michael Judy, the clinic's CEO. The only other healthcare provider in the county of about 7,700 residents is an office staffed by a part-time physician assistant.

The clinic is staffed by three family practitioners, a pediatrician, three physician assistants and a nurse practitioner. It has a satellite office elsewhere in the county. Coming soon is a preventive, primary-care program in four public schools. Its clinicians handle 18,000 patient encounters a year, including those from about 300 veterans, whom the clinic treats under a contract with the VA.

RPMS is piped to the clinic from the Community Health Network's data center in Barboursville, 240 miles away. VistA is fed to the clinic, too, from a VA hospital in Martinsburg, 133 miles north.

Dr. Laura Nulph, a family physician at the clinic since 2008, leads its quality-improvement committee, using RPMS to gather and perform data analysis on a host of measures, a task that would have been so labor-intensive as to have been almost impossible with paper records.

Over the past year, clinicians have increased the percentage of patients getting Pap tests from 42% to 47%; colorectal cancer tests from 42% to 48%; diabetic eye exams from 39% to 49%; and diabetic foot exams from 52% to 57%.

“We're seeing small gains, but it's better than standing still or going backwards,” Nulph says.

Follow Joseph Conn on Twitter: @MHJConn