Small providers present health IT implementation concerns to Policy Committee
Although meaningful use standards for EHRs should help improve patient care within community health centers (CHCs), many barriers remain in place for smaller providers to adopt the technology, according to representatives of these facilities who spoke at yesterday's meeting of the HIT Policy Committee.

Michael Lardiere, of the National Association of Community Health Centers, a national membership organization for federally qualified health centers (FQHC), said that meaningful use standards of EHRs could improve patient care within smaller health centers. This is because they have the potential to improve quality, safety, efficiency, reduce healthcare disparities, improve care coordination, improve population and public health and ensure adequate privacy and security protections for personal health information.

However, Lardiere cited funding as an obstacle to incorporating EHRs into FQHCs. “We would recommend that meaningful use funds be provided to FQHCs in the first year, as soon as an FQHC informs the state of its intent to sign an agreement with an EHR vendor, and the funds be available to the FQHC within 30 days of the notice to the state. This would allow the FQHC to move forward with adoption and be on their way to meaningful use. Unless these funds are available, the adoption of EHRs may be stalled,” he said.

Marty Fattig, CEO of Nemaha County Hospital in Auburn, Neb., explained how EHRs were implemented at his 20-bed critical access hospital six years ago.  Although Fattig was proud of the EHR progress at Nemaha County Hospital, he stated that the proposed meaningful use standards surpass the capability of its current system, and by extension, would surpass the capacity of many similar small hospitals and CHCs who have yet to implement EHR technologies.

Fattig’s primary concern for small hospitals and health centers was the accessibility of technical resources in their service area.

“Smaller communities do not enjoy the large pool of technical expertise found in more urban areas," Fattig said. "Talent is difficult to attract and retain, especially once a higher level of proficiency has been reached. It is therefore imperative that scarce resources focus on implementing technology that supports the hospital mission of providing care."

Bonnie Britton, chief nursing officer of Roanoke Chowan CHC in Ahoskie, N.C., addressed individuals who would be affected by the proposed meaningful use measures. She noted that high levels of uninsured/underinsured patients, patients who are not fluent in English, along with the fact that the majority of CHC patients live below the Federal Poverty Level, create obstacles in engaging patients in their healthcare. 

Britton noted that most of these patients do not have computers or Internet access, and in some cases, patients cannot read.

“Most patients have to decide whether to pay their electricity bill or buy their medications," Britton said. "Indigent patients will not benefit from the proposed objectives because they cannot access care or afford the care they need. Special consideration needs to be given to creating objectives and measures that address solutions to these barriers.”

Remote monitoring was the solution proposed by Britton in order to successfully work with the meaningful use objectives for EHRs. Britton suggested that patients who record their own blood sugar levels, weight and blood pressure on a daily basis, and report the information back to their CHC, will become successfully engaged in their personal care cycle.

“Patients learn behavioral 'cause and effect' resulting in an increased compliance to their medical and nutritional regimen,” said Britton.

Willarda V. Edwards, MD, president of the National Medical Association, spoke on healthcare providers to minority communities and the challenges these facilities face in conforming to the meaningful use criteria. She acknowledged the “digital divide,” as well as affordability and patient mix as the main issues with meeting the meaningful use measures for these providers. 

“Often through no fault of their own, many patients are unable to comply with a doctor’s instructions," Edwards said. "Reasons include health illiteracy, or any other social determinant of health [including] lack of adequate housing, lack of access to nutritious food, limited access to safe outlets for recreation, environmental hazards, etc., all contribute to the success of our prescribed therapies, which would in turn impact our meaningful use outcomes.”

Solutions that were suggested by Edwards for deploying health IT with these providers were to “spread the word, set the example [and] encourage minority vendors to get involved in [health IT] design and implementation.”