Rural Hospitals Meet Informatics Challenges

To make informatics initiatives succeed at small and rural hospitals, it’s important not to go it alone, said Stephanie Baker Justice, director of pharmacy services for St. Claire HealthCare in Morehead, Kentucky.

Justice said the organization has received valuable insights from trade shows, technology product vendors, and consultants.

But one of her best sources of information about electronic health record (EHR) systems and related technology has been other hospitals that have already deployed these products.

“We’ve done site visits to see . . . how all of the systems work and how they integrate,” Justice said. Even when the host site lacks some parts of the technology package that Justice would like to evaluate, the visits are still incredibly helpful, she said.

To reciprocate, Justice said, 159-bed St. Claire Regional Medical Center has demonstrated to other hospitals the video-monitoring software that allows pharmacists to remotely check the work of pharmacy technicians who prepare i.v. admixtures.

The hospital last year earned a spot in the American Hospital Association’s “most-wired” list, ranking among the top 20 small and rural hospitals.

Justice said in late March that the hospital was upgrading its EHR system and installing new automatic dispensing cabinets that are expected to improve interoperability and make the pharmacy workflow more efficient.

One expected benefit is the elimination of calls from nurses about the status of medications that have already been delivered. Justice said this happens because the nurses “can’t see when the techs deliver medications.”

Once it’s implemented, the system will alert the nurses to the deliveries.

“So, it helps allow more of our providers to have more time with the patients and less time on the phone trying to track down medications,” Justice said.

She’s also looking into switching to a different brand of infusion pump that would better integrate with the EHR system.

“Right now, we’re losing quite a bit of revenue because we’re having trouble getting all the [i.v. infusion] start and stop times documented,” including data on fluid and antibiotic quantities, Justice said. After the upgrade, that information will be automatically recorded in the EHR system.

Justice predicted that the change will produce “a nice return on investment” along with patient safety improvements resulting from a more accurate medication administration record.

She said these projects grew from collaborative discussions involving many disciplines at the hospital, including the informatics staff.

“You really need to take your time and try not to rush the decisions,” Justice said. “Figure out which vendor is right for you and what your long-term goals are for patient care.

And that’s really what triggered us to move forward with some of these switches and looking at these different products.”

Rebecca Miller, clinical pharmacist–informatics specialist at Bozeman Health in Montana, said a collaborative process has been integral to the rollout of inpatient and outpatient EHR systems, automated dispensing cabinets, smart and conventional infusion pumps, and a planned deployment of electronic prescribing of controlled substances.

Bozeman Health, with its flagship 86-bed Deaconess Hospital, was named 1 of the top 20 rural community hospitals for 2018 by the National Rural Health Association. The health system in April officially launched a $75.5-million expansion that’s expected to be completed in 2020.

Miller is 1 of 2 informatics pharmacists at the hospital.

“We work on a multidisciplinary team of clinical informatics [personnel]. We have nurses. We have people with past coding experience. We have people who have worked in clinics and in inpatient areas, surgical floors, and cancer floors,” she said.

She said the informatics group uses a “project management” approach to informatics tasks—a goal-oriented, structured system for initiating, planning, executing, monitoring, and accomplishing a specific activity.

When someone requests informatics support, such as adding a drug product to smart-pump drug libraries, it’s important for the informatics group to ask specific questions about the patient populations, the drug’s indications, and whether the requester is following a clinical protocol, Miller said.

“That allows you to build safety elements into the system you’re trying to manage,” she said.

Miller said that training staff in the use of technology is one of the biggest challenges her informatics group faces.

She said the pharmacy department has “supertrainers” who train staff pharmacists. The pharmacists then train pharmacy technicians. In addition, she said, “we standardize our education so that if I were not available, then someone else could take my material and do the same education I would do.”

She said product vendors can be critical sources of information to help staff get the most out of the hospital’s technology products.

“A lot of the vendors that we work with will actually come to us and do what they call a touch-up training 6 months or a year into implementing a new piece of software,” Miller said. “Circling back to optimize your system after you’ve implemented something can be a key to success.”

If product vendors can’t supply the desired level of support, reputable online user groups and websites can help fill that knowledge gap, she said.

Miller said small and rural hospitals can find it more difficult than larger hospitals and hospital systems to keep up to date with informatics and technology.

“We offer a lot of the same services that a larger hospital would have. But because of our rural nature and our population size, we may not always have the resources that a larger hospital would have in terms of people, time, and funding for our projects,” Miller said.

The Centers for Medicare and Medicaid Services (CMS) on May 8 acknowledged such concerns and announced that it will address them as part of a national rural health strategy.

According to CMS, the rural health strategy will explore “opportunities with the Office of the National Coordinator for Health Information Technology and other federal partners to promote interoperability of health information and increase the use of electronic health records among individuals and their healthcare providers and care teams.”

[This news story appears in the July 1, 2018, issue of AJHP.]