CHIME Time: Patient empowerment as a strategy for engagement in rural facilities

Getting patients more involved in taking responsibility for their health is the current quandary for providers. In most healthcare reform scenarios, patient engagement is seen as the key to success. How to achieve it seems mysterious, and most believe that the “unknown” can be solved by applying some kind of universal solutions to all healthcare organizations.

The road to patient engagement will be paved differently in rural healthcare settings. Small provider organizations in rural areas serve as vital healthcare links to residents in their areas. Reaching and engaging these residents will be fundamentally different than in more populated areas of the country.

To give a sense of this differentiation, I want to briefly describe my facility, the scope of services it provides and the residents it serves. There is rural and then there is rural, and Chadron Community Hospital and Health Services is as rural as it gets. It's a 25-bed not-for-profit critical-access hospital. It's a basic trauma facility in the panhandle of Nebraska, 350 miles away from Lincoln, 100 miles away from the nearest referral hospital and more than 50 miles from the nearest critical access hospital.

However, you can't define Chadron Community based on isolation or the small number of inpatient beds. It provides 67 services, including dialysis, hospice and home health (nurses travel as much as 75 miles to treat patients in the several counties that we serve). Twenty of those 67 services are community health programs, such as family planning, WIC and Ryan White just to name a few. Chadron Community provides many specialty clinics to allow better access to specialists, and it uses teletrauma, teledialysis and telehealth for mental health care, saving patients and providers time and travel.

In rural areas, these services and nearby access to care are critical to residents, who count on rural facilities to provide important basic care and stabilize patients who need transfers to referral facilities. It's this access that is crucial, and the issue is not whether we continue to provide care, but how we provide it with the greatest impact. Rural hospitals battle sparse resources and shrinking populations while still providing primary health care for patients who often are elderly, poor or uninsured.

In this context, reaching and impacting patients is not a new challenge for rural hospitals, but it will represent a challenge that's different than that faced by larger healthcare organizations.

Some aspects of patient engagement strategies at rural facilities may be similar to those employed elsewhere. These strategies can range from providing patients with personal health records or giving them access to patient portals. Other strategies can include offering smartphone apps or using text messaging to communicate with patients about their healthcare needs. Social media may provide endless possibilities and potential to reach patients as well.

But because of limited resources, rural facilities will have to choose wisely. There is not much room for a not-for-profit rural critical access hospital to select the wrong technology or pick the wrong patient engagement approach. Therefore, we need to be clear on the goal of implementing technology to fit our goals. The risk of error grows when rural facilities get it backward by creating goals that match up with existing or popular technology.

Most importantly, technology aside, rural providers need to make sure they are addressing the rural patient in the technology equation. Any other focus is a recipe for failure, if not disaster.

Rural organizations have moved forward with technology by identifying provider champions and clinical champions. The next challenge is identifying patient champions who can help us with technology and speak to our communities about the benefits. Strong patient champions will be the key to influence other patients' involvement in managing their care, and help us with spanning any potential gaps that exist in patient buy-in.

We can gain adoption, and engage patients, by doing what rural organizations do best—emphasizing the type of communication that exemplifies small communities. Rural organizations want patients to have a positive experience in accessing their records and becoming engaged in their care—ultimately, they need to experience improved outcomes as a result of becoming engaged and more directly managing their health.

It's our patients—not the latest and greatest technology—that needs to be the focus of our efforts to engage them with healthcare IT. We need to capitalize on patients by empowering them.

Anna Turman

CIO and COOChadron (Neb.) Community Hospital and Health Services