Technology-facilitated care coordination in rural areas: What is needed?

• Published in: International journal of medical informatics (Shannon, Ireland) Ireland), 2020-05, Vol.137, p.104102-104102, Article 104102
• Main Authors: Gill, Emily, Dykes, Patricia C., Rudin, Robert S., Storm, Marianne, McGrath, Kelly, Bates, David W.
• Format: Article
• Language: English
• Subjects: Continuity of patient care; Delivery of Health Care, Integrated - methods; Documentation; Electronic health records; Electronic Health Records - statistics & numerical data; Female; Health information Exchange; Health Information Exchange - standards; Health information technology; Health Personnel - standards; Hospital Information Systems - statistics & numerical data; Humans; Male; Middle Aged; Primary health care; Primary Health Care - standards; Rural health; Rural Population; United States
• ISSN: 1386-5056; 1872-8243; 1872-8243
• DOI: 10.1016/j.ijmedinf.2020.104102

•Health disparity in rural settings is impacted by health IT systems.•Rural settings may contend with more unaffiliated electronic health records (EHRs).•Regulations should require useable exchange between unaffiliated EHRs.•Evaluation of interoperable health IT systems should focus on care coordination. Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination. Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States. We identified seven themes related to care coordination and information exchange: ‘insufficient trust of data’; ‘please respond’; ‘just fax it’; ‘care plans’; ‘needle in the haystack’; ‘re-documentation’; and ‘rural reality’. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings. Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.