In the U.S., patients in rural areas often face fragmented healthcare due to a lack of interoperability between hospitals and healthcare providers. Without access to a unified medical history, patients need to fill out new forms when navigating the network of healthcare providers, leading to wasted resources and administrative redundancies, including running unnecessary tests. These inefficiencies contribute to clinician burnout, patient disengagement and could compromise the overall care quality.
Efforts to create a more interconnected healthcare system and digital adoption in the U.S. healthcare system have been underway for nearly two decades. In 2004, President George W. Bush set the goal for most Americans to have electronic health records (EHRs) within 10 years. The 2009 HITECH Act further accelerated this goal by promoting the adoption of EHRs and aiming for a system that continuously improves healthcare delivery.
While urban hospitals have made significant strides toward interoperability, rural hospitals lag behind. According to a 2023 report from the Office of the National Coordinator for Health Information Technology (ONC), 47% of urban hospitals are actively engaging in all four domains of interoperable exchange – sending, receiving, finding and integrating patient information – compared to only 36% of rural hospitals. Independent hospitals fare even worse, with just 22% engaging in these practices, compared to 53% of system-affiliated hospitals.
Interoperability in rural hospitals
Rural hospitals face substantial challenges, from manual data entry to disconnected systems, which lead to uncoordinated care for patients and clinician burnout. While all hospitals and HCPs share the goal of delivering the best care and saving lives, it’s important to acknowledge that rural hospitals encounter unique infrastructure and operational barriers to achieving the same level of interoperability as their urban and system-affiliated counterparts. These challenges are harder to overcome due to the limited resources and lack of internal technology expertise amongst rural providers. They often rely on outdated technology that struggles to integrate with modern health record management systems to begin with. In addition, rural providers need to hire external specialists to develop and implement a transformation roadmap that meets the standards set by Trusted Exchange Framework and Common Agreement (TEFCA).
From a resource perspective, rural hospitals can explore federal and state IT project grants, such as Meaningful Use Incentives, the Rural Health Information Technology Network Development (RHITND) Program and the 21st Century Cures Act. These programs provide essential financial support for upgrading electronic health record (EHR) systems, enhancing data exchange capabilities, and bolstering cybersecurity measures. Funding can also help cover costs related to hardware purchases and staff training, ensuring hospitals can modernize without straining their budgets.
However, securing funding is only the first step. A strategic investment in interoperability also requires partnering with technology providers who are experienced in developing solutions that comply with federal interoperability standards – such as HL7 and FHIR (Fast Healthcare Interoperability Resources) – and data security protocols. By combining external financial support with the right technical expertise, rural hospitals can implement solutions that not only meet immediate needs but also position them for long-term success in delivering coordinated, high-quality care.
A strategic roadmap/checklist for an interoperability project
While digital transformation at any scale can be daunting, interoperability doesn’t need to be a massive, disruptive overhaul all at once. Scalable, cost-effective solutions can be tailored to fit the needs and budgets of mid-size clinics and hospitals. There can also be a staged approach based, for example, the four levels of interoperability from the Healthcare Information and Management Systems Society (HIMSS), and start small and gradually expand the scope as you begin to see benefits and secure further funding.
Here are our recommended initial steps:
- Assess needs: Begin by identifying inefficiencies in existing workflows, such as manual data entry or disconnected systems. Prioritize areas where immediate improvements are possible, focusing on enhancing system connectivity and streamlining data entry processes.
- Set long-term goals with phases milestones: Define the objectives for the project, starting with foundational interoperability and a phased roadmap. Initial goals may include improving internal communication and reducing administrative burdens, while long-term goals should focus on expanding data exchanges with external providers, achieving full interoperability across the care continuum and integrating telehealth and remote monitoring as the system scales.
- Choose cloud-based solutions with data privacy and security: Select a cloud-based, modular solution that supports scalable integration and ensures robust data privacy and security. The solution should comply with regulations like HIPAA, offer encryption for data transfers and provide ongoing security measures. When selecting technology vendors, prioritize those with experience in healthcare interoperability, strong security protocols and a proven track record of successful implementations.
- Begin with internal data sharing: Focus on improving the internal flow of information within the hospital. Start by integrating systems that handle lab results, diagnostic imaging and patient records to reduce manual processes and improve care coordination internally.
- Ongoing training & governance: Establish a strong governance structure to oversee the project’s implementation. Ensure all relevant staff members understand how to access and use the new integrated data. This is critical for reducing resistance to change and ensuring quick adoption of the new system.
After streamlining internal operations and making sure clinicians and administrative staff are now comfortable using the data, you can establish secure exchanges with external partners such as labs, diagnostic centers and surrounding providers. This will facilitate real-time access to patient data and enhance collaboration across the care network in your area.
Once the initial phase of interoperability is successfully implemented, consider connecting your hospital to regional or statewide HIEs, where available. This will allow for the exchange of comprehensive patient records with other healthcare providers and facilities, enhancing the coordination of care. Gradually, widen the scope of your integration to include additional areas such as chronic disease management, telehealth or remote monitoring, further improving patient care and giving providers access to the full care continuum.
Working with Star
We understand that the interoperability journey for rural hospitals and clinics in the U.S. is not a straight path, and the needs will evolve over time. That’s why we tailor our services to your specific needs, starting with workshops to identify pain points and assess your current systems. From there, we help you build a customized roadmap that aligns with your available resources, offering scalable solutions designed to create a seamless healthcare experience for both providers and patients.
