1. Rural Electronic Records Fact or Fiction? Renee’ Rowell, MS, RHIA 7.04 Rural Electronic Records 10/23/04

2. Where in the world is Tecumseh, Nebraska ? Do they even use computers? And…..

3. Johnson County Hospital 18 bed 18 bed Critical Access Critical Access Swing Bed Unit Swing Bed Unit OB Unit OB Unit ICU / ER ICU / ER 10 Outpatient Clinics 10 Outpatient Clinics 78 total staff 78 total staff 4 physicians, 2PA, 1NP 4 physicians, 2PA, 1NP 1 hr SW of Omaha population 2,000 1 blinking stoplight Only hospital in county

4. Rural Midwest = Greater geographic distances, isolation New York = Socio-economic status

5. Fiction Fiction is the term used to describe works of information created from the imaginationinformationimagination This is in contrast to non-fiction, which makes factual claims about reality.non-fictionreality

6. Myths Universal physician resistance Universal physician resistance Small facilities play no role Small facilities play no role Same culture, same agenda Same culture, same agenda It won’t take long, once we decide It won’t take long, once we decide Rural is smaller so it’s less complex Rural is smaller so it’s less complex

7. Double edged sword? In one sense it’s easier to implement and control because we’re smaller…..but at the same time it’s harder because it’s so large of a project that something may be overlooked.

8. Depopulation of Great Plains Youth are leaving Professionals in other career fields Culture is changing

9. Rural Patient Facts  Elderly  Poor, high rate of poverty  Economically dependent  Risk of leaving is a barrier  Hope for growth

10. Rural Facts Financial burden Financial burden Fear of change Fear of change Lack of qualified professionals, specialists Lack of qualified professionals, specialists Baby steps, technology lacking Baby steps, technology lacking Access to care Access to care Shortage of services Shortage of services

11. Positive Note Alliances Networks Dedicated & Committed Grants

12. Partnership Heartland Health Alliance Nebraska Hospital Assn COMS – Clinical Outcomes Management System

13. COMS  Flex program – Office of Rural Health  COMS uniform discharge reporting system  Peer comparison, statewide  Grants fund pay 1/2

14. UNMC Medication Errors Project

15. Benchmarking Project Quality Montana Michigan Nebraska Kansas

16. Digital Link  Nebraska Public Service Commission  $900,000 calendar year  Currently 31  Opportunity for 48/85 hospitals  Secure broadband intranet  Subsidize monthly connection fees

17. Radiology - Telemedicine

18. Trauma Lifeflight Regional Trauma Centers Better Communication

19. Educational Opportunities  Video Conferencing  Nursing Inservices  Workshops  Professional CEU’s

20. Mental Health Services not readily available Counseling Emergency Admit

21. Bioterrorism / Security

22. Geographic Terrain

23. EMS FOCUS

24. Benefits of EMR Immediate access No lost charts Standardization of patient care Organized data, easy analysis Reduction of errors Coding efficiency Data availability for QI, risk, utilization

25. How will this be accomplished?  National level to oversee  Statewide agencies, similar to QIO’s  Coordinated to ensure consistency  Training and education

26. Strategies Incentives Incentives Reduce the risk of investment Reduce the risk of investment Promote implementation in rural and underserved areas Promote implementation in rural and underserved areas

27. TechnicalOperational HIM Professionals Bridging the gap……….

28. Incubation phase Incubation depends on the maturity of the infrastructure needed to support the technology. Incubation depends on the maturity of the infrastructure needed to support the technology.  50 years for stethoscope

29. “in this room” You have made a choice to listen You have made a choice to listen You have expressed an interest You have expressed an interest Will become advocate or adversary Will become advocate or adversary Critical stakeholder Critical stakeholder Rural needs a voice in Washington, DC Rural needs a voice in Washington, DC

30. Thank you for sharing your time Have a safe trip home…