The Government Accountability Office (GAO) report reveals that small and rural hospitals are lagging in adopting electronic health information exchange (HIE) technology when compared to their larger counterparts. The report suggests that these providers have fewer financial and technological resources and use fax and mail more often to exchange patient health information. While initiatives such as the Trusted Exchange Framework and Common Agreement (TEFCA) could help, stakeholders have called for expanding broadband access and developing training programs for healthcare IT staff to support HIE among small and rural hospitals.
Electronic health information exchange (HIE) has grown in popularity in recent years as a way to increase communication and collaboration among healthcare providers. However, a new report from the Government Accountability Office (GAO) suggests that small and rural hospitals may be lagging behind their larger counterparts in adopting HIE technology. This report examines the reasons behind this discrepancy and suggests potential solutions to address the issue.
Background:
The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009 to encourage the adoption of electronic health records (EHRs) and support the development of HIE. As part of this effort, federal enhanced Medicaid matching funds were provided to states through 2021 to support electronic data exchange. Nearly all states used these funds, and most have identified other sources to sustain those efforts.
Despite these efforts, analysis of 2021 American Hospital Association (AHA) survey data found that small hospitals were less likely to participate in HIE via EHR vendor networks, national HIE networks, and regional HIEs than medium/large hospitals. The survey also discovered that rural hospitals were more likely than non-rural hospitals to report using fax or mail to share patient health information regularly.
Reasons for the Discrepancy:
Stakeholders The GAO interviewed noted that small and rural providers were less likely to have the financial and technological resources to participate in or maintain electronic health data exchange. Electronic data exchange can require significant investments in technology, staff training, and ongoing maintenance. Small and rural hospitals may not have the financial resources to make these investments or may struggle to find qualified staff to manage the technology.
In addition, rural areas may not have the same level of broadband access as urban areas, making it more difficult to share electronic health information. While telehealth and other digital health initiatives have grown in popularity in recent years, the lack of broadband access remains a significant obstacle to expanding access to healthcare in rural areas.
Potential Solutions:
The GAO report suggested that federal efforts, such as ONC’s Trusted Exchange Framework and Common Agreement (TEFCA), may address some obstacles to electronic HIE by mitigating costs through a simpler approach to healthcare interoperability. TEFCA is a set of technical and legal requirements designed to promote secure and seamless electronic health data exchange among disparate networks. However, interviewed stakeholders noted that participation in TEFCA is voluntary and does not address challenges to electronic data exchange among small and rural providers like health IT staffing shortages and gaps in broadband access.
To address these issues, stakeholders suggested that federal funding could be directed toward expanding broadband access and developing training programs for healthcare IT staff. In addition, initiatives like the Rural Health Information Exchange (RHIE) could help connect small and rural hospitals with larger healthcare networks, increasing access to electronic health information.
