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Technology upgrades productive for rural providers
When the Minnesota Rural Health Co-op thought about initiating a telemedicine project, it knew that its 42-rural-member organizations were not as sophisticated technologically as many urban providers. The Willmar-based Co-op just didn’t realize how much.
"As we investigated telemedicine, we discovered that as late as 1994 and 1995, one of our communities did not have touch-tone dialing. It had rotary dialing," says Sharon Ericson, project director at the Minnesota Rural Health Co-op. Another member was not aware of a platform difference between Macintosh and IBM machines.
"In some ways, rural health gets to be like frontier medicine," Ericson says. "We don’t have all the equipment that more urban environments do." To communicate to members, the Co-op had to rely on members’ postal mail and an occasional fax.
Ericson and the Co-op realized that the communication and information sharing between the Co-op’s 17 hospitals and 25 medical clinics across 12 rural counties needed to be vastly improved. They decided to install remote systems management software for communication with all its members. The CONNECT:Remote system from Sterling Commerce in Atlanta runs on a Windows NT network.
"The decision was related to wanting our members to be able to continue to be in the business they are in," Ericson says. "That would require having a PC network."
Implementing the plan
Another problem the Co-op encountered in investigating members’ technological capabilities was that most of the information systems in the individual organizations were either proprietary or didn’t have the level of sophistication to make them function beyond a proprietary method.
"For example, even if one of our hospitals was sending a UB92 electronically, it couldn’t give [the Co-op] a copy," Ericson says. "We did an ER study to get some baseline data on urgent care vs. emergency room use. Several of our facilities could not tell us without doing a hand examination of the records what presented itself in a 12-month period in the emergency room."
Also, most Co-op members were so small that they didn’t have their own information management staff. "Everyone [in these organizations] is pushed in terms of work flow. People are doing lots of jobs. They might have multiple functions instead of individual functions."
When the Co-op made its decision to go to the network, Ericson knew that the upgrade would have to presented to members in a certain way. This presentation included emphasizing these points:
- The upgrade would give them information they need on a just-in-time basis.
"For example, they could download information about making referrals for networks to use when they need it," Ericson explains. "They certainly don’t want to have to search the office for the piece of paper that someone stuffed in a drawer."
- The upgrade could happen quickly.
The Co-op had to send someone who could upgrade the system and train the users without taking a lot of time away from the users’ jobs, she says.
The Co-op first wrote the grant to get the money for the project in 1995. Some grant money helped members purchase newer, basic systems, which included Windows 95 and 16MB of memory. "Our rationale for buying the systems for members was that it was so critical for people to have the information," Ericson says.
Member communities were upgraded at various stages. "Given our lack of resources, that’s been a good thing," she says.
Members remain at various levels of use, as well. Some remain resistant to the technology, but the Co-op has a sufficient core of members who are actively using the system to communicate and get access to information. "[The member participation] makes it a functional system," Ericson says. "We just have to try to convince the others that this is the right thing to do."
Keeping in touch
Since hooking up most members on-line, the Co-op’s copying bill has dropped from an average of $1,000 per month to $100, while the postage use has dropped from $300 to $75 per month.
The Co-op now is able to put administration manuals and their updates sent by health plans on the network where members can click on a topic and access that information at will. The network also provides information about providers and their participating health plans.
"We had made an Excel worksheet that outlines what specialty services are available when and what physician is in what network. But no one could ever find that piece of paper when they needed to make a referral," Ericson says. "Instead, we published it on the system and then connected it to different specialties. If members need a gastroenterology referral, they click on gastroenterology and it takes them to that part of the worksheet." The Co-op updates the worksheet weekly for members.
The Co-op also uses the network to publish information about the cooperative. This information includes:
- minutes and agendas of functional member meetings;
- information about contracts with health plans, as well as any information the health plans send to the Co-op, such as monthly performance results;
- information about quality improvement efforts;
- information about each of the members.
"We use the system to reduce the amount of travel time of the members participating in a quality improvement team. They can do some of the work from their desks," Ericson says. The information about fellow members is helpful, as well. "Some of them don’t know each other well," she says. "It shows what the others are doing and gives them a place to brag about their programs."
Although most members are not connected at the clinical level to the Internet, they do communicate with the Co-op and other members through system e-mail. "A strength of the system is problem solving through e-mail," Ericson says. "[For example], a clinic manager in one of the communities may have a specific operational issue. She is able to e-mail all the other clinical managers and say, I’m having this trouble; is anyone else? If you are, how are you solving that problem?’"
Member communities are not yet transferring patient information. They are, however, using a common referral form so that one day the information from the forms may be placed into a database so the Co-op can look at the referrals across the communities.
Ericson recently realized how well the system was working. The Co-op experienced a month-long system failure related to phone company problems that resulted from moving the server to another location. "The volume of phone calls from people who couldn’t get access to information increased exponentially without the system," she says. "From our vantage point, it’s an absolute necessary tool to do this kind of process across this kind of distance."