Electronic medical records: The costly and time-consuming process for small, rural hospitals

Officials moving forward as deadline for American Recovery and Reinvestment Act of 2009 compliance approaches

Liz Martin/The Gazette

RN Karla Welch of Manchester works on charts at a mobile work station at the Regional Medical Ce
Liz Martin/The Gazette RN Karla Welch of Manchester works on charts at a mobile work station at the Regional Medical Center in Manchester on Thursday.

By Chelsea Keenan, The Gazette

At Regional Medical Center in Manchester, there’s a room filled with file after file of patients’ medical records.

But since 2010, the hospital has been slowly working to make these paper records electronic — and it’s nearly complete.

“When we first went to electronic medical records (EMRs), the space needed to store them was twice as big,” said Rose Mary Hunt, medical services director at the hospital. “We have about 85,000 patient records total, and we’ve definitely trimmed that down.”

Hunt said all the paper records in the room have been transferred — the hospital now needs to take the necessary precautions before it destroys them.

EMRs provide a comprehensive patient history that allows hospitals to track data, better monitor patients and improve quality of care.

As part of the American Recovery and Reinvestment Act of 2009, the federal government has mandated that all hospitals implement electronic records by 2015, and that EMR systems be capable of certain tasks that constitute “meaningful use.”

To ensure that universal adoption throughout the health care industry actually works, the government has set thresholds that hospitals, professionals and critical-access hospitals must meet to prove they are actively using the records. Those that do can apply for incentives.

And those hospitals that don’t will face penalties — which includes a decrease in the amount of Medicare reimbursements.

‘Big or small’

But implementing EMRs is a huge undertaking that involves large investments of time and money.

“The industry is struggling, it doesn’t matter if you’re big or small,” said Kurt Kramer, information systems manager at Regional Medical Center, a 25-bed critical-access hospital. Critical-care hospitals differ from acute-care facilities in that they meet Medicare conditions of participation, which include having no more than 25 inpatient beds.

For smaller, rural hospitals, implementing EMRs can be a huge expense to purchase the software and hardware, and to train employees.

“It was a significant investment,” Kramer said.

Brock Slabach, senior vice president for member services at the National Rural Health Association, said access to capital is a challenge for rural hospitals, especially if they can’t qualify for a loan. EMRs can cost anywhere between $800,000 to $1.5 million, he said.

One big issue going forward, Slaback noted, will be how hospitals can pay maintenance and upkeep fees for the software once the government incentives end in 2015.

Kim Gau, CEO of Guttenberg Municipal Hospital, said the 20-bed critical-access hospital had to shell out more than $1.2 million for the hardware and an additional $33,000 for training. That was a big cost for the hospital, which has an annual operating margin of about $200,000, she said.

“It has definitely been a journey,” Gau said.

The hospital — a UnityPoint Health affiliate — started making the switch to Epic, an EMR system based in Wisconsin, in 2010. Gau said the hospitals affiliation with a large health system gave it helpful resources, including a rural access team, which helped train the clinical users.

More work to do

... An extra 50 people basically moved into the community when we went live” in June 2013, Gau said.

Now that the EMRs are mostly implemented, the hospitals are working on changing workflows. Registration of new patients can take a bit longer because more information is required, and doctors and nurses need to input information in real time, hospital administrators said.

“As nurses are taking someone’s blood pressure or asking questions, they have to put in information — they can’t get backlogged,” Gau said.

The state of Iowa also os working on a Health Information Exchange, which will allow hospitals and clinics to easily exchange patient data. So if a patient in Manchester needs to see a specialist at the University of Iowa, the doctors electronically can exchange information if they are not using the same systems.

But Kramer said there is still a lot of work to be done before that is up and running.

And hospitals still have goals to meet. The roll out has been done in stages, with different hospitals at different stages depending on when they moved to EMRs.

The Centers for Medicare and Medicaid Services recently extended Stage 2 another year, putting off the start of Stage 3, Slabach said.

“As you move stages, it raises the level of complexity,” he said. “The bar gets raised.”

Regional Medical Center, which is in Stage 2, is working on a portal that allows patients to view their medical records online. Hospitals must have at least 5 percent of patients to use the portal.

“In a rural area, that’s more difficult,” he said. “We have a lot of elderly patients who don’t have email or access to a computer. We’ve seen that other hospitals are struggling with that and I expect we will too.”

Give us feedback

We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

Or if you have a story idea we should look into? Tell us here.