Rural California Hospitals Slow to Digitize

By Eve Harris

High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital.

Plumas District joins a digitizing trend at least partially sparked by financial incentives in the federal health care law. Plumas District CEO Doug Lafferty was recruited just nine months ago to get the EHR up and running. In a recent interview he said his adopted community is full of “wonderful people.”

But in contrast to his own prior experience in major, urban hospitals, Lafferty said most of the Plumas District staff have never worked anywhere else. Sure, the iPads are welcome, but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful. The culture of “consistency” leaves no doubt that he is “a change agent,” Lafferty said.

While Plumas District has been fortunate to have the capital and leadership to make this change, other California towns are not so lucky. A recent nationwide report confirmed the widely-held concern that small, nonteaching and rural hospitals are lagging behind their urban counterparts in adoption of electronic health records.

That lag has a direct effect on the five million Californians who live in rural areas. Only about half of the state’s 293 designated rural health centers are already using or in the process of implementing an EHR system, according to a recent report by The California Healthcare Foundation (CHCF).

Resources are an issue. In California, large clinics are more likely to use EHRs than small clinics. Many rural clinics are feeling financially unstable, CHCF wrote, and limited resources are the most important obstacle to increased adoption of EHRs. Initial purchase cost is the biggest barrier cited by rural hospitals, although the perceived cost and difficulty of implementing an EHR system was a close second, CHCF reported.

There is a federal financial incentive, but there are other reasons to digitize, too. Lafferty said trading paper files for digital can result in a more complete medical record. EHR software makes charting, billing and ordering labs easier because “it prompts the physician” to record information in a very specific format. “It’s readable and more consistent,” Lafferty said.

EHRs improve the collaboration with providers who are at a distance -- a great advantage in rural areas of the state.  Plumas patients in need of specialty care travel to Chico or Reno “a lot,” said Lafferty, but now their medical records can go with them on a thumb drive.  Most rural clinics with EHRs use them to record and track patient information; more than half also order and track prescriptions and lab tests electronically, according to the CHCF report. These functions were among the most easily adopted at Plumas and are likely to save time and reduce errors.

Although high speed Internet access has improved in recent years, a persistent challenge in rural parts of the state is the relative shortage of IT professionals. Lafferty said “many pieces came together” to create the strong IT staff working on EHR implementation. The Plumas Hospital's in-house information systems director, for example, “has spent countless hours” on the project, he said.

And additional tech support? “Well, it’s not too hard to recruit,” Lafferty said, “because this has got to be one of the most gorgeous places in California.”

Still, Lafferty acknowledged that updating the care delivery systems at Plumas District presented challenges. “It’s a culture change,” he said, “but it’s the right choice for the future.”