Almost all of Illinois’ 51 critical access hospitals have had electronic health record (EHR) systems for a while. One of the more pressing challenges — aside from declining funding and late Medicaid payments from the state — has been health information exchange.
Critical access hospitals (CAHs) serve many of Illinois’ rural areas, and often refer patients to specialists at urban health systems in St. Louis, Terre Haute, Chicago and cities in central Illinois. Yet information exchange between the CAHs and specialists has often been slowed, or hindered, by what Illinois health IT officials call a “white space” — a gap in health information exchange capabilities for small physician practices, federally-qualified health clinics and CAHs.
Now, Illinois CAHs are getting some support to connect to regional HIEs or the Illinois Health Information Exchange, the statewide HIE that’s just getting up and running. As part of a recent $1.3 million round of HITECH Act funding awards for health information exchange, the Illinois Office of Health Information Technology has awarded $338,000 to the Illinois Critical Access Hospital Network, which is helping CAHs reconfigure their health IT systems and build new HIE interfaces.
“It’s going to be quite a mix of connections,” said Mary Ring, a senior policy advisor at the Illinois Critical Access Hospital Network. “We’re probably going to focus on 19 or 20 hospitals, those without a single regional HIE that would make more sense for them.”
A number of Illinois’s HIEs and RHIOs are in various stages of development and operation, and most are set to connect to the Illinois Health Information Exchange or ILHIE, a public HIE in its second year of implementation that will also be a primary connector for many CAHs.
There’s not a lot of funding to “support a single connection, let alone two,” Ring said. “For those hospitals, we’re recommending looking at the Illinois HIE, so they have a single connection.”
Ring said the CAHs are going to have about $15,000 each from the grant, to help with installation, maintenance and training, to work with ILHIE’s vendor, InterSystems, based in Cambridge, Mass. Interoperability will be one of the primary objectives; many of the CAHs built their EHR systems over time, and have multiple vendors, Ring said.
First given their federal designation in 1997, after nationwide trends of rural hospital closures, critical access hospitals are now looking for new ways to fulfill their mission as rural providers — amid competition from urban health systems, an increase in uncompensated care during Great Recession, backlogged state Medicaid payments, aging demographics and reimbursement changes under the Affordable Care Act, with payments based on quality outcomes through the Medicare Value-Based Purchasing program.
“All of that, coupled with the need to proceed with HIT development, they’re only able to do what they need.” Ring said. “They’re not doing Cadillac versions of anything else.”
Ring is optimistic that Illinois’ CAHs will be able to adapt, in part through health IT — 10 have attested for Meaningful Use and more are in the process — and in part through new delivery models, such as patient centered medical homes.
Meanwhile, the Illinois HIE and state officials are hoping to lift many HIE boats with what remains of the state’s $18.8 million in federal funding from the HITECH Act.
“Illinois’ health information exchange network is only as strong as the volume and geographic diversity of providers connected to it,” Laura Zaremba, the director of Illinois’ Office of Health Information Technology, said in a media release.
As part of the grant to Illinois critical access hospitals, the Chicago Health Information Technology Regional Extension Center, a Meaningful Use advisory nonprofit, received $495,000, and Southern Illinois Healthcare, a three-hospital system in Carbondale, received $500,000.