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Keywords:

  • electronic health records;
  • primary care;
  • technology;
  • workforce

Abstract

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

Purpose

This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT.

Methods

Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires.

Findings

EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas.

Discussion/Conclusions

Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations.


Background

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

Effective implementation of electronic health records (EHRs)1 and health information technology (HIT)2 is necessary for both rural and urban providers to take advantage of the monetary incentives (between $44,000 and $63,000 over 5 years) and avoid the financial penalties (payments reduced by 1%-3% of the Medicare covered amount) included in the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the 2009 American Recovery and Reinvestment Act.[1, 2] Having a focused HIT “roadmap” is considered an essential tool to enable accountable care organizations to align limited organizational resources with accountable care goals and objectives, critical for achieving the health care quality improvement and payment reform goals of the federal Patient Protection and Affordable Care Act.[3]

Optimization of health care reform requires that primary care practices, Americans’ principal health care access portal, participate in networks of health care organizations that serve the spectrum of patient care needs. Patient information collection, utilization, and exchange tools such as EHRs and HIT and a workforce that knows how to use them are critical to the success of these networks in rural and urban areas. Adoption of EHRs by practices in rural areas have been reported to be comparable to those in urban areas among family physicians[4] and even higher among rural compared with urban for all office-based physicians.[5] Patel et al[6] found that physicians in larger or multispecialty practices had higher odds of adopting EHRs with greater capability of meeting core EHR “meaningful use” criteria (use of EHR technology to track quality measures, such as recording smoking status for all patients older than age 13, with outcome targets required for incentive payments from the Centers for Medicaid and Medicare Services),[7] but the authors found no significant differences between urban and rural practices.

Clearly, rural ambulatory practices have overcome many of the barriers to adopting EHRs. Because this technology is still relatively new, however, the workforce that can collect, manage, and exchange patient information collected through EHRs and used in HIT is in a developmental stage.[8, 9] In rural areas, where health care workforce shortages are well known, finding direct patient care clinicians, practice staff, and needed specialized technical support may be especially difficult. Existing and threatened gaps in the supply of rural primary care providers are well documented,[10-12] but little is known about rural primary care's access to EHR/HIT workforce resources. This study assessed EHR and HIT workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT.

Methods

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

Questionnaire

The survey questionnaire was derived from an instrument developed by the authors for use in Texas,[13] and it was adapted for this national survey of primary care practices with input from HIT education and policy specialists. The questionnaire included the instruction “Please direct this questionnaire to the person in your office who is most knowledgeable about staffing issues” and then asked questions to screen for ambulatory practices that provide primary care.

The 4-page questionnaire included questions covering 7 major topics: (1) EHR/HIT adoption (current and planned future use of EHRs and HIT, whether systems were part of a larger network, if the practice had difficulty accessing the Web/Internet); (2) current or planned implementation of major components of meaningful use (using EHRs in a meaningful manner, participating in electronic exchange of patient information, participating in e-prescribing, electronically exchanging data for public health and patient transfer purposes); (3) barriers to use of HIT (barriers to needed education and training, availability of consulting/vendor resources, recruitment and retention of qualified staff, and infrastructure adequacy); (4) EHR/HIT skills needed by the practice (need for and approach to obtaining specific sets of basic/entry-level, intermediate-level and advanced-level skills); (5) EHR/HIT workforce demand (current and expected future EHR/HIT staffing needs); and (6) practice characteristics (practice type, size, and location). A copy of the questionnaire can be accessed at http://depts.washington.edu/uwrhrc/uploads/HIT_Questionnaire.pdf. The questionnaire was pilot-tested using 3 practices in nonstudy states. Minor edits were made following cognitive interviews of pilot test respondents.

Sampling Frame

Comprehensive lists of rural primary care practices, including nurse practitioner-led practices, were not known to be available, so the study identified rural practices by starting with state provider license records. Initially for a related study of rural primary care providers,[14] the study identified 14,361 total physicians, nurse practitioners (NPs) and physician assistants with rural addresses using publicly available licensing rosters from 13 selected states. The states were selected from each US Census region and included a mix of states with either full practice authority for NPs (no physician oversight required), reduced NP practice (physician collaboration required), or restricted NP practice (physician supervision required and/or delegated prescriptive authority). All study states’ license records included physician specialty, which was used to select those most likely practicing primary care. Specialty was not available for NPs and PAs, but the questionnaire's initial screening questions eliminated respondents who did not represent rural primary care practices. To identify the medical practices associated with the more than 14,000 licensees, license records with identical addresses were identified and duplicates removed to create a list of unique practice addresses. Next, a reverse address “look-up” service was used to identify those addresses that appeared to be associated with health care, which yielded 4,888 potential practice addresses. Using Web searches and phone calls, where necessary, 1,370 of the addresses were subsequently determined to be out-of-scope (not likely to be primary care practices), leaving 3,518 unique rural primary care practices as the sampling frame. From these, a simple random sample of 2,000 practices was selected for survey, distributed by state as follows: Arizona (90), Georgia (234), Idaho (54), Iowa (125), Kentucky (271), Maine (103), Minnesota (95), Ohio (78), Oklahoma (174), Oregon (134), Texas (454), Vermont (66), and Virginia (122).

Rural locations were determined using the ZIP-code Version 2.0 of the Rural-Urban Commuting Area (RUCA) codes, which classify ZIP codes based on their location relative to Census Bureau-defined Urbanized Areas and Urban Clusters of various populations, and uses work-commuting patterns to surrounding cities and towns to measure functional relationships.[15, 16] The RUCA taxonomy was first used to identify provider licenses with rural addresses, and then to assign each identified practice to 1 of 3 mutually exclusive RUCA rural categories: large rural, small rural, and isolated small rural.

Mailings

The first mailing (July 2012) was sent via certified mail and included an introductory letter on the research center's letterhead that also provided a website URL and password that could be used to participate in the survey electronically; a paper copy of the questionnaire; and a postage-paid, return envelope. Mailings that were returned because of incorrect addresses were resent with address corrections when they could be found. Ten days after the initial mailing a reminder postcard was sent to all nonrespondents, and after 2 weeks all nonrespondents were again mailed (using first class postage) the invitation and questionnaire. As many as 5 separate invitations with questionnaires were sent to nonrespondents between July and October 2012. The fifth mailing again used certified mail and included a handwritten note requesting study participation.

Responses

After excluding 228 practices as out-of-scope (eg, duplicates, deceased or out of business, undeliverable) from the original 2,000 in the sample, the survey yielded 606 responses, or 34.2%. The survey had similar response rates across different rural area types (33.1% from large rural, 34.7% from small rural, and 35.9% from isolated small rural areas). By state, response rates ranged from 24.7% (Ohio, n = 18) to 51.3% (Iowa, n = 59). Subsequently excluded from analysis were 40 respondents that either could not be confirmed as primary care providers or who indicated they did not provide primary care. Another 53 practices were excluded from most analyses (with the exception of calculations of EHR adoption rates) because they indicated they did not intend to use EHRs or HIT. The final analytic dataset for HIT workforce analyses included 513 practices.

Responses were coded, entered, and verified in an electronic database, and they were checked for systematic errors during analysis. When data that were part of a series of questions could be imputed with a high level of certainty from other data, such imputations were performed. Data analysis was performed with SPSS Statistical Software Version 21.0 (IBM Corp., Armonk, NY, USA). Standard chi-square tests were employed to determine the statistical significance of differences.

Findings

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

EHR/HIT Adoption

Among the 513 primary care practice respondents, 42.5% were in large rural areas, 37.0% were in small rural areas, and 20.5% were in isolated small rural areas. The percentages of these practices using EHRs or HIT systems, 77.2% overall, were similar across rural categories (79.4%, 73.6%, and 79.0% in large rural, small rural and isolated small rural areas, respectively). Practice types were federally qualified Rural Health Clinics (22.6%, n = 116), private practices (not federally qualified Rural Health Clinics) (46.3%, n = 237), hospital-affiliated clinics (16.6%, n = 85), federally qualified Community Health Centers (8.5%, n = 44), and other types of offices or clinics (6.1%, n = 31).

The federal American Recovery and Reinvestment Act (ARRA) of 2009 provides financial incentives to health care providers for the “meaningful use” of EHR technology to achieve health and efficiency goals.[2] More than half the 513 survey respondents reported they had already implemented several of the key components required to meet “meaningful use” of certified EHR technology requirements: participating in e-prescribing (83.5%); using an EHR in a “meaningful manner” (73.2%); and electronic submission of lab or immunization data to public health agencies (52.9%) (Figure 1). Across these major components of meaningful use, from 89.1% to 96.7% of respondents had either already adopted or planned to adopt each of the requirements by 2014.

image

Figure 1. Adoption of EHR/HIT Meaningful Use Components and Plans for Adoption by 2014 Among Rural Primary Care Practices; Missing Values not Included in Calculations: participate in e-prescribing (n = 22), use EHR in a meaningful manner (n = 35), electronically submit lab/immunization data (n = 80), use EHR to submit quality measures (n = 114), exchange data between settings (n = 86), participate in HIE (n = 119).

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Acquiring EHR/HIT Workforce Skills

Respondents were asked a set of questions about their plans for accessing personnel with specific sets of EHR/HIT skills in the next 2 years, divided into 3 basic/entry-level skill sets, 4 intermediate-level skill sets, and 2 advanced-level skill sets (Table 1). More than half of respondents indicated they had staff with the listed basic or entry-level EHR/HIT skills and would not need additional training (responses ranged from 54.0%-79.1% across each of the 3 specific basic/entry skill sets). More than a third (40.9%) said they would obtain training to improve staff understanding of how the quantity and quality of data entered into an EHR affects the usefulness of information that HIT systems provide (one of the basic skill sets), about a quarter (26.6%) said they would obtain basic skills training for staff in operational medical terminology and clinical information flow, and a fifth (20.1%) said they would obtain basic skills training for staff in basic desktop/computer skills and computer/Internet navigation.

Table 1. Plans for Accessing Personnel With EHR/HIT Skills in the Next 2 Years, if Relevant to the Rural Primary Care Practicea
n = 513nbHas Staff With These Skills (Who Will Not Need Additional Training)Will Obtain Training for StaffWill Hire StaffWill Hire a Contractor or VendorDoes Not Need Personnel With These SkillsDon't Know
  1. a

    Percentages may sum to more than 100% because more than 1 response could be selected.

  2. b

    Difference from overall n is due to missing values.

Basic/entry-level skills       
Basic desktop/computer skills, computer/Internet navigation49379.1%20.1%5.7%0.4%0.8%1.8%
Operational medical terminology knowledge; understanding of how patient information should flow in clinical settings48969.1%26.6%5.7%0.8%1.4%4.5%
Understanding how the quantity and quality of data entered into an EHR affects the usefulness of information that the system can provide48754.0%40.9%5.1%1.2%1.2%6.4%
Intermediate-level skills       
Knowledge of HIT products, contracting, and privacy and security requirements48747.8%33.3%2.7%7.0%4.1%10.5%
Understanding how to comply with meaningful use requirements48851.8%39.8%2.9%5.3%2.0%7.2%
Clinical knowledge and understanding of uses of HIT for individual patient management/education needs48752.4%39.0%3.7%2.3%1.6%8.0%
Data management, analysis, report creation, and data-sharing skills48546.8%44.1%4.7%4.9%2.7%7.0%
Advanced-level skills       
Management skills to direct technical and nontechnical staff in use of EHR/HIT systems48450.7%33.6%5.6%3.9%3.3%9.5%
Ability to use data from HIT systems to manage care for patient populations48645.5%38.3%5.1%3.5%3.5%11.7%

With regard to respondents’ plans for accessing personnel with each of the 4 intermediate-level EHR/HIT skill sets (Table 1), from 46.8% to 52.4% of respondents reported their staff would not need further training. Another 44.1% of respondents said their staff would obtain training in the set of skills that included data management, analysis, report creation, and data sharing; 39.8% said staff needed training to understand how to comply with meaningful use requirements; 39.0% said staff needed training to obtain clinical knowledge and understanding of uses of HIT for individual patient management/education needs; and 38.3% said staff needed training to use data from HIT systems to manage care for patient populations.

About half of the practices (45.5%-50.7%) reported that they already had staff with each of the advanced-level EHR/HIT skill sets and about a third would obtain training for their staff for each skill set: 33.6% would obtain staff training in management skills to direct technical and nontechnical staff in use of EHR/HIT systems and 33.3% would obtain staff training to acquire knowledge of HIT products, contracting, and privacy and security requirements.

Among the 63.8% (n = 315) of practices indicating they would obtain staff training for any of the listed EHR/HIT workforce skill sets, 72.3% (n = 227) said they would obtain training for one or more of the basic/entry-level skills, 86.3% (n = 270) said they would obtain training for one or more intermediate-level skills, and 66.0% (n = 206) said they would obtain training for one or more of the advanced-level skills listed in the questionnaire (results not tabled).

No greater than 5.7% of respondents indicated they would hire new staff to acquire any of the specific basic, intermediate or advanced-level skills listed (Table 1). While it was the skill for which the highest percentage reported they would seek vendor/contractor assistance, only 7.0% of respondents indicated they would hire a contractor or vendor to help staff acquire knowledge of HIT products, contracting, and privacy and security requirements. Another 10.5% said they did not know how they would obtain that skill—which was the EHR/HIT skill that received the highest percentage of “don't know” responses. For any of the individual skills listed, fewer than 5% of respondents reported they did not need personnel with the skill.

Workforce-Related Barriers to EHR/HIT Use

From a list of potential workforce-related barriers to implementing and/or using EHRs and HIT (including education and training, recruiting and retention, consultant/vendor, and software system factors), the factor reported most frequently by respondents as a barrier (major or minor) was “consultants and/or vendors with understanding of the needs of our facility are too expensive” (Table 2). Nearly one-third (30.8%) cited consultant/vendor expense as a major barrier and 23.8% cited it as a minor barrier. Other factors that were cited as barriers (major and minor combined) by a large percentage of respondents included “finding resources (including funds and/or release time) for training about how to use EHRs and HIT” (44.8%) and finding qualified candidates (43.0%). More than one-third of respondents (36.6%) reported that not having relevant consulting and vendors available was a barrier.

Table 2. Workforce-Related Barriers to Use of EHR/HIT Among Rural Primary Care Practices
n = 513naMajor BarrierMinor BarrierNot a BarrierNot Applicable
  1. a

    Difference from overall n is due to missing values.

Education and training     
Basic computer literacy training is not readily available4905.7%28.2%56.1%10.0%
In-person training (nondegree) about how to use EHRs and HIT is not available48711.7%25.5%50.7%12.1%
Online (eg, Web-based) training about how to use EHRs and HIT is not available4866.4%17.5%60.7%15.4%
Community college training about how to use EHRs and HIT is not available48110.0%16.6%43.9%29.5%
Baccalaureate or high-level training in HIT-related skills is not available48011.9%19.8%41.5%26.9%
Resources (including funds and/or release time) for training about how to use EHRs and HIT are not available48422.7%22.1%40.1%15.1%
Consulting/vendor resources     
Consultants and/or vendors with understanding of the needs of our facility are not available48312.8%23.8%48.4%14.9%
Consultants and/or vendors with understanding of the needs of our facility are too expensive48430.8%21.5%32.4%15.3%
Recruiting and Retention     
The HIT career ladder is not well defined, which reduces interest in EHR/HIT training47613.2%19.7%38.9%28.2%
It is difficult to find or access qualified candidates47717.8%25.2%33.3%23.7%
The highly competitive market makes it difficult to retain qualified staff with EHR/HIT skills48015.6%19.2%41.0%24.2%
Infrastructure     
Our facility's HIT software systems are not well suited to our practice/office4818.7%20.4%47.8%23.1%

Several of the listed education/training factors were considered to not be a barrier by a relatively high percentage of respondents. Nearly two-thirds (60.7%) reported that availability of online training was not a barrier and about half (50.7%) reported that finding in-person training about how to use EHRs and HIT was not a barrier. Community college and baccalaureate-level training in the use of EHRs and HIT was reported to not be a barrier by 43.9% and 41.5%, respectively, of practices. Responses about education and training resources were mixed, however, as more than a quarter (26.6%) reported the lack of availability of community college training as a major or minor barrier, and nearly a third (31.7%) reported access to baccalaureate or higher-level training as a major or minor barrier. Another 26.9% reported community college training and 29.5% reported baccalaureate or higher-level training as “not applicable.”

Very few of the barriers to using HIT differed by size of the practice (1–4, 5–9, 10–20, or more than 20 total full-time equivalents [FTEs]) or rural community size (large rural, small rural, isolated small rural areas). More large practices than small practices reported “our facility's HIT software systems are not well-suited to our practice/office” as a major or minor barrier (38.5% [30 out of 78] among practices with more than 20 FTEs, 34.8% [39 out of 112] among practices with 10–20 FTEs, compared with 19.1% [17 out of 89] in practices with 5–9 FTEs and 17.3% [13 out of 75] of those with 1–4 FTEs) (Chi-square = 14.56, df = 3, P = .002); results not tabled). Higher percentages of practices in isolated and small rural communities (61.0% [47 out of 77] and 54.0% [74 out of 137], respectively) reported “consultants and/or vendors with understanding of the needs of our facility are too expensive” as a barrier (major or minor) than practices in large rural areas (44.4% [72 out of 162]) (Chi-square = 6.38, df = 2, P = .041). More practices in isolated and small rural communities cited “it is difficult to find or access qualified candidates” as a major barrier to HIT use (19.7% [15 out of 76] and 23.1% [31 out of 134], respectively) than those in large rural communities (11.3% [18 out of 160]) (Chi-square = 7.60, df = 2, P = .022).

Difficulty in accessing the Web/Internet because of lack of Internet access and/or too little bandwidth for effective use was reported as a problem for 16.4% (82 out of 501) of all rural primary care practices (results not tabled). More of the practices in isolated small rural areas (23.1% [24 out of 104]) reported this problem compared with 18.9% (35 out of 185) in small rural areas and 10.8% (23 out of 212) in large rural areas (Chi-square = 9.02, df = 2, P = .011).

Limitations

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

This study's response rate was low, which could increase the likelihood that the responses are biased in some way. Because of the complicated manner by which the sample of practices was identified, however, many of the addresses from which there was no response may not have been active medical practices. In support of the sample's representativeness, the rate of adoption of EHRs among this study's respondents appears comparable to other reported adoption rates for primary care practices. Using American Board of Family Medicine certification census data, Xierali et al[4] found 68% of family physicians had adopted EHRs in 2011 (up from 37% in 2006) with no significant rural-urban differences. When the 53 practices indicating they had no plans to implement EHRs were included, the overall rural primary care EHR/HIT adoption rate was 70%. This study's 2012 finding of a 70% adoption rate among all primary care respondents (77% among those who were using or intended to use EHRs) appears consistent with the Xierali et al findings. Using National Ambulatory Medical Care Survey data, Hsiao et al[5] found 72% of office-based physicians overall using any EHR system in 2012, with somewhat higher rates of EHR adoption among rural compared with urban physicians.

Respondents to this survey had implemented, or planned to implement, EHRs and HIT systems and so may have overcome some of the workforce barriers to EHR/HIT use and may underemphasize the barriers that those still attempting to implement these tools face. Finally, while response rates varied by state, they were similar among subrural area types, suggesting that any response bias of these subgroups is comparable.

Discussion

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

This study shows that rural primary care practices from 13 states across the United States will rely primarily on their existing staff to continue implementation and use of EHR and HIT systems. Most practices did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill skills gaps. Many practices indicated they already had staff with each of the basic/entry, intermediate and/or advanced-level EHR/HIT skills. Nonetheless, nearly two-thirds of respondents indicated they would seek some training in EHR/HIT skills for their staff.

There are challenges, however, to obtaining needed EHR/HIT skills and training. Affordable access to vendors/consultants, vendors/consultants with understanding of the needs of their facilities, and availability of community college and baccalaureate-level training were the workforce-related barriers to implementing and using HIT cited by the highest percentage of respondents. Accessing the Web/Internet (needed for full HIT operability as well as some training resources) was a problem for nearly a quarter of practices in isolated rural areas and nearly a fifth of those in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers for practices in small and isolated rural areas than for those in large rural areas.

While access to consultants and vendors with understanding of the needs of the respondents’ facilities was among the greatest barriers reported by respondents, nearly half reported such access was not a barrier to using HIT. Very small percentages (7% or less) indicated they would use vendors or contractor personnel to obtain specific HIT workforce skills. The reluctance to use vendors and contractors may largely be explained by the finding that more than 52% of respondents reported vendor/consultant expense as a major or minor barrier to their use.

Rural primary care practices have made considerable progress in adopting and implementing EHRs and HIT systems. Effective use of these new technologies, however, may be more difficult than some rural practices anticipate. In a case study of information technology implementation in a rural hospital, Spetz and Keane[17] found weak leadership, poor planning, and underestimation of required resources for implementation were associated with increased risks to patient safety. It is likely that some, if not many, rural practices do not fully anticipate the HIT workforce skills they will soon need. Direct experience may be necessary to recognize the infrastructure and workforce-related barriers that must be overcome to fully use and benefit from these systems for managing patient populations and exchanging patient information among care system partners.

Conclusions

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References

As rural primary care practices enter the next stages of HIT implementation and information exchange, they will need to strengthen available workforce skills. Developing a workforce that can manage and use all of the data that EHRs collect and can exchange among other players in the health care system will likely test the limited resources of many rural primary care practices.

Few respondents intended to use vendors, contractors, and consultants to help fill these gaps. This is not surprising because rural ambulatory practices, especially small and independent ones, are not likely to be able to compete successfully for services with the generally better-resourced urban practices and hospitals. Instead, they will develop staff skills in-house. However, many respondents do not seem to be aware of existing sources for staff skills training, or perhaps did not consider them well-suited to their needs. For example, the workforce program of the federal Office of the National Coordinator for HIT (ONC) provided $116 million in curriculum development and activities for community college and university-based HIT education through 2012.[18] Most of the education programs from this initiative were designed to be delivered through distance learning methods, which can improve access for rural and incumbent workers. This of course is problematic for the 20%-25% of practices in small and remote rural areas where Web/Internet resources are not available or reliable. In spite of the ONC's major national effort, more than a quarter of practices surveyed for this study said that community college programs and baccalaureate programs in HIT were not applicable to their practice.

Another important resource for rural primary care practices has been the ONC's Regional Extension Centers (REC) program, designed to provide technical assistance to individual and smaller-sized practices, especially those in underserved and under-resourced areas, to implement and use EHRs. By 2013, 51% of rural primary care providers across the United States were enrolled in a REC and most were actively using an EHR.[19] The REC program, however, does not directly address workforce development and consideration of how RECs can help practices access appropriate EHR/HIT education resources may be useful.

A more recent federal initiative that directly addresses HIT workforce development is the federal Health Resources and Services Administration's (HRSA's) Rural HIT Workforce Program through which $4.4 million was awarded in 2013 to 15 states for recruiting and training current health care staff, local unemployed workers, rural veterans, and others to help meet rural hospitals’ and clinics’ technology needs.[20] This program's goals include expanding the rural HIT workforce and use of telehealth by supporting the development of rural-focused community college HIT training programs. These programs should provide needed linkages between rural primary care practices and college HIT education programs and support growth of this workforce in rural communities.

Many resources are needed to implement and support ongoing skills training for the workforce that will implement, maintain, and use EHRs and HIT systems and meet “meaningful use” standards in rural clinics, as well as other patient care settings such as hospitals and long-term care sites. While some new staff will be employed solely to focus on EHR/HIT functions, much of the rural health care workforce will add EHR/HIT competencies to their overall skill sets. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations.

Notes
  1. 1

    An EHR is defined by the President's Council of Advisors on Science and Technology[1] as an electronic record of health-related information for a patient that contains information captured in clinical visits, lab and imaging studies, and other information important to the patient's medical past.

  2. 2

    HIT is defined by the President's Council of Advisors on Science and Technology as technology that manages and transmits health information for use by providers, consumers, payers, insurers, and all the other pertinent groups.[1]

References

  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Findings
  6. Limitations
  7. Discussion
  8. Conclusions
  9. References