A Success Story In American Health Care: Using Health Information Technology to Improve Patient Care in a Community Health Center in Washington

Health Care Challenges in Rural America

Nearly 50 million Americans living in rural areas face challenges accessing health care. Developing a health information technology (IT) infrastructure can improve the quality and continuity of care for millions of patients.

Many areas in the United States suffer from a lack of access to comprehensive, high-quality health care. It has been estimated that approximately 65 million Americans live in communities with shortages of primary care providers¹ – of which nearly 50 million live in rural areas.²

Community health centers serve as a vital health care safety net for these communities. They provide comprehensive preventive and primary health care services to approximately 17 million people at over 7,500 sites across the country, and reach one in three people living in poverty.³

Health information technology, and specifically electronic health records, can improve health care quality and patient safety, promote care coordination and continuity, and assist in clinical decision making and the use of evidence-based guidelines. Electronic health records can also decrease administrative hassle, increasing workplace satisfaction and productivity.⁴

Health information technology holds particular promise for rural areas, where increased provider productivity can enable providers to help more patients in the same amount of time, and increased workplace satisfaction can encourage people to practice in those areas that need them most.

A Success Story for Information Technology and Rural Health

The Columbia Basin Health Association is an example of how information technology can improve the efficiency and quality of care for Americans living in rural communities.

The mission of the Columbia Basin Health Association (CBHA) is to provide equal access to quality health care to all persons – regardless of age, sex, race/ethnicity, or ability to pay. CBHA provides a variety of medical, dental, prescription, and other services to nearly 25,000 patients in central Washington.⁵

CBHA was one of the first community health centers in the United States to fully transition to an electronic health record (EHR) system from paper-based charts. CBHA sought to use its EHR system to better deliver health care in rural areas.

Today, Americans in rural communities struggle to get the care they need. Rural residents are more likely to suffer from chronic diseases than urban residents,⁶ and less likely to receive preventive care.^{7, 8}Diabetes in particular is more common among rural residents than urban residents,⁹ and the percentage of diabetes patients who received all three recommended exams for diabetes is lower for patients in rural areas than in metropolitan areas (32 percent versus 42 percent).¹⁰ Indeed, at CBHA, in January 2008 only 31 percent of patients had received a foot exam and only 37 percent had received an eye exam, in the last year.¹¹

CBHA decided to make diabetic care a priority and began tracking 1,302 diabetic patients, using their EHR system to monitor whether the patients received recommended exams. CBHA then provided feedback to health care providers on their performance. By June, 86 percent of patients had received a foot exam and 63 percent had received an eye exam in the last year.¹²

CBHA has also used health IT to improve efficiency for both providers and patients. For example, through practice management software, CBHA has decreased ‘no-shows’ for dental patients’ appointments by about 50 percent, and has filled 100 percent of available appointment slots, allowing clinicians to see more patients and to provide timely care.

Since implementing their health IT systems, provider productivity at CBHA (as measured by the number of patients seen per provider in a day) has roughly doubled.¹³ And since implementation, CBHA has consistently ranked above the 95th percentile nationally in total medical and dental team productivity, as reported in the Bureau of Primary Health Care Uniform Data System.¹⁴

Beyond preventive services, CBHA has harnessed the power of electronic health records to enable improved continuity and coordination of care across health care institutions when patients become ill. CBHA partnered with the nearby Othello Community Hospital to enable both organizations to have access to each other’s EHR systems, while ensuring patients’ privacy.¹⁵ As a result, patients enjoy a fluid continuity of care regardless of where they are treated.

The Future Under Health Insurance Reform

The story of the Columbia Basin Health Association is just one example of information technology improving the quality of care for patients in rural areas. President Obama and Secretary Sebelius have made supporting care in our nation’s rural areas through information technology a priority.

Building from the Foundation of the American Recovery and Reinvestment Act

The American Recovery and Reinvestment Act invests in new resources with the goal of improving the quality of care for patients, enhancing the performance of the health care system, and developing a nationwide, interoperable network.¹⁶

Through incentive payments, funding from the Recovery Act will accelerate the adoption of health information technology. The Recovery Act also includes new resources to help provide health care professionals the tools they need to improve health care quality, reduce errors, and decrease costs.

Helping Rural Areas through Information Technology in Health Insurance Reform

Administrative Simplification. A recent study found that a physician spends an average of three hours a week just dealing with health insurance bureaucracy.¹⁷ Especially in rural areas, where physicians are in short supply, this steals precious time from patients. Health insurance reform will simplify and streamline administrative procedures, including reducing and standardizing paperwork. Coupled with modern electronic health records, administrative simplification will enable rural doctors to care for their populations more efficiently and effectively, improving quality and access in underserved areas.

Improving Quality. Health insurance reform makes significant investments in developing and reporting quality of care measures across the health care delivery system. Health information technology provides a conduit to collect and analyze this information to ensure that quality standards are met. This means higher quality of care for patients and additional information for patients to make more informed choices among providers.

Investments in Telehealth. Too many rural areas lack access to specialized treatment. Health insurance reform invests in telehealth technologies as part of a continuum of health information technology to enable residents of rural areas to access the care of physicians outside of their local community, increasing the range of services that are accessible.

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