“The demand (for HIT professionals) just exploded when the electronic record stuff took hold,” said Mark Sonneborn, vice president of information services at the Minnesota Hospital Association. From February 2009 to February 2012, the number of online job postings in the field almost tripled from 4,850 to 14,512, according to a data brief from HHS' Office of the National Coordinator for Health Information Technology. The ONC does not break out urban and rural job listings.
Brock Slabach, senior vice president for member services at the National Rural Health Association, said the looming end of the EHR incentive payments could hurt HIT efforts at rural hospitals and clinics. “The question will be, can these facilities, with these declining reimbursements, and the incentives ending with the American Recovery and Reinvestment Act, continue to operate these information systems efficiently and effectively?” he asked.
In addition to the stimulus program, the Patient Protection and Affordable Care Act drove the need for IT development and staffing through its focus on population-health initiatives, quality-of-care measures, and preventable readmissions. Another factor is the looming implementation of the ICD-10 coding system.
Implementing EHRs is the heavier lift for Milly Prachar's hospital, however. “It's so far-reaching and really touches all users within the organization,” said Prachar, director of health-information management at Roseau LifeCare Medical Center, a 25-bed critical-access hospital in Roseau, Minn., a town of 2,600 near the Canadian border.
Tight deadlines and finances are one side of the problem, and finding qualified IT workers is the other. Prachar's hospital opted to train one of its nurses in clinical IT rather than recruit an IT specialist. That's a strategy a number of other rural-health facilities are using for their IT needs. “Because of our location—we're pretty remote—we didn't think it would be likely that there would be someone with the knowledge of the organization as well as EHR knowledge that could step into that role,” she said.
But that does not solve the problem of how to deal with the increasing number and scope of IT projects on top of the hospital's usual workload. The result for small town and rural providers is a backlog of work and delays in implementing meaningful use of EHR systems and cost-saving quality measures. It also holds them back from participating in alternative payment and delivery models such as accountable care organizations and bundled payment, which require sophisticated data systems.