Getting rural providers, including critical access hospitals, to adopt electronic medical records is a monumental challenge, as the healthcare industry and advocates of healthcare IT are experiencing.

With health information exchange playing a more prominent role in the next stage of meaningful use requirements, established HIEs could help regional extension centers demonstrate the value of connectivity through the implementation of an EMR.

Take HealthBridge and HealthLINC, for example. HealthBridge, a veteran HIE that serves 17 counties in Kentucky, Indiana and Ohio (the greater Cincinnati area), boasts 5,000 providers. HealthBridge's infrastructure supports HealthLINC, another veteran HIE serving the Bloomington region in southeastern Indiana. One of the value propositions for providers to connect is getting results from local referring hospitals, said David Groves, executive director of the HealthBridge Tri-State REC (Regional Extension Center), which serves 67 counties.

"The flow of information back to the provider setting is the foundation of HealthBridge," he said. The ability to share information is of high value to providers. Groves recounted the feedback from a newly connected physician who began getting results from a local hospital to his EMR: The physician said that his practice "changed in a dramatic way."

Todd Rowland, MD, executive director of HealthLINC, related his own story of a rural pediatrician who, through his affiliation with the University of Cincinnati and Indianapolis, had a subsidized EMR. Once he connected to both HealthLINC and HealthBridge and began getting external data from both, however, he realized a better level of communication with specialists because of access to the data.

Rowland cautioned that the value of an HIE is dependent upon the size, maturity and number of providers connected to the HIE. "If 80 percent of the people you want to connect with are on the network, there's a higher value," he said. "When people jump onto a mature HIE, they get a totally different experience - immediate communication - than if they joined an early HIE."

When HealthLINC had been operational for three years, a large medical group that does rural outreach connected to a lab system through the HIE. Within two weeks, the medical group's internal lab, which comprises 55 physicians and sends out 37,000 labs a month, saw a 50 percent reduction of phone calls. "It's because they jumped on a moving train," Rowland explained.

With EMRs, once the data entry is reduced and it is connected to an HIE, physicians will see the value, he said. "If you pre-connect an EMR to an HIE, you are data connected from the beginning," Rowland said. This is something that the Tri-State REC is working to provide, Groves said.

An ecosystem that comprises EMR, REC, HIE, quality improvement programs and revenue initiatives that pay for the quality improvement programs would optimize the physician's use of clinical IT, Rowland said. Tri-State REC is trying to develop a likeminded framework.

"It's a challenge for critical access hospitals to feel confident about the HIE investment," Rowland pointed out. Rural providers have to understand the value, he said. Their local needs must be met first before they can even think about regional connectivity. Local connectivity, which delivers data from referring hospitals to the physicians, meets the immediate needs, Rowland said. Local HIEs can provide that capability, and in doing so help drive the meaningful adoption of EMRs.