Health develop within these communities, and the future of

Health Information Technology (HIT) has changed
health documentation worldwide to improve the safety and confidentiality of patients’
health records. Healthcare providers employ enhanced equipment that confirms
statistics of preventive health services. However, many small and rural
communities have limited resources, which creates challenges in establishing
health information technology. The
purpose of this study is to explore the low progress of health information
technologies in small and rural communities, the health care challenges that
develop within these communities, and the future of advocating change in health
care policies or programs in order to provide health information technology.

Keywords: health information
technology, rural communities

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Information Technology in Rural Communities

information technology (HIT) provides the world potential benefits in
documenting and exchanging health information. However, some geographic areas are
unable to access HIT. Electronic health records
(EHRs) are replacing paper-based documents in health care facilities, which are
upgrading to potential costly record-keeping equipment. To understand the absence
of EHRs or HIT, people need to research the conditions of the rural facilities.
Many rural communities have similar problems to insufficient resources and
closures. However, the latest programs strive to give the community access to
healthcare and at least provide insurance. Likewise, rural communities should
adopt HIT to make new plans and increase productivity. Although healthcare
professionals struggle to adapt health information technology in their
hospitals, new ideas and policies can bring improvements for low-income
populations and identify current and future healthcare needs in many areas.

Literature Review

Wishner et al. (2016)
discuss their research findings about the closure of rural hospitals. Wishner et
al. identify demographic, social, and economic challenges that produce the lack
of resources and infrastructure in providing care for rural communities. Hospitals
need healthcare delivery systems to exchange information and continue the
business in healthcare. New preparations can demonstrate a developed healthcare
system and bring a community together.

Skillman (2015) researches
the lack of skilled trainers in the health information technology field in
rural areas. Skillman (2015) provides data that demonstrates the lack of
education that results in many errors in the facilities. Workforce resources
are needed to break down the barriers to implementing EHRs and health
information technology in order to fully manage patient populations and
exchange health data with other healthcare systems.

In addition, Kruse
(2016) explains the financial limitations in rural facilities. Although the federal
government gave money to rural areas for them to adopt a basic electronic
health record, this has led to many medical errors. EHRs are unlikely to be established
for higher populations of low-income patients when certain states update to the
latest healthcare system. As technology changes, the costs of adapting to
modern standards become prohibitively high for rural facilities to adapt. Kruse
(2016) concludes that while technological advancements are becoming more
expensive, they must first fix the many errors in their healthcare systems.

Lastly, over the
years paper-based documents have been put into digital format. However, few
facilities have at least a basic EHR system. DesRoches (2013) investigates the
slow process of EHR adoption and concludes that many facilities do not meet
standards of Meaningful Criteria One and Two. The first standard addresses data
capture and sharing while the second standard focuses on advanced clinical
processes. Physicians argue that healthcare organizations need to fix their
complex systems by focusing on how to improve their data information and not
spending on meaningless investments. (DesRoches, 2013, p. 1484).


Background. Frequently, investigators
analyze the background statistics regarding the access of healthcare services
in rural communities. Researchers find that health technology is less likely to
adapt in organizations with high populations of low-income patients. Likewise, Wishner
(2016) identifies demographic, social, and economic pressures that contribute
to the closure of rural hospitals. She states: “They cited high poverty and
uninsured rates in rural communities, high rates of Medicare and Medicaid
coverage, and declining populations” (Wishner, 2016, para. 11). To explain, the
challenges of the small populations do not help in sustaining a facility. In
fact, the challenges lead to the closures of rural hospitals, reinforcing
negative impact upon rural communities. Many physicians and providers avoid
seeking job positions in rural communities due to the closures, thus increasing
economic strain through the surrounding community. To emphasize, Wishner (2016)
clarifies the importance for rural communities of obtaining financial viability
and sustainability to improve their surrounding communities. She states, “The
loss of jobs and residents has a negative impact on the tax base in the
community, shrinking available resources for schools and other public
services…impacting jobs in the public sector as well” (Wishner, 2016, p. 9).
Overall, rural hospitals need resources to provide healthcare and other public
services to their population. From the research findings, people are able to
understand the challenges of rural communities that hinder essential services
to their population. Researchers find effective methods to investigate and
override initial challenges to the support of rural communities.

            For instance, healthcare organizations use health
information exchanges (HIE) to detect and improve population health. To
clarify, healthcare organizations focus on managing patient populations to
improve outcomes and reduce the costs. Meyer (2017) states that HealthInfoNet
in Maine focuses on bridging the gap between healthcare services and social
services in rural areas. According to Meyer (2017), “HealthInfoNet is facilitating
the integration of EHR data from critical access hospitals and federally
qualified health centers with social data from community agencies” (para. 5). Healthcare
organizations strive to research the areas with insufficient funds, provide
health services, analyze the healthcare systems, and predict new models to
modify their hospital performances and healthcare management. Healthcare
organizations plan to seek new methods in helping rural communities revive
their productivity to aid their surrounding community by meeting medical needs.

            Lack of Education.
Education is crucial in healthcare, allowing providers to find effective
methods to improve patient care. Healthcare professionals need training to fulfill
the standards in the latest developments, skills, and modern technologies that are
renovated frequently in their fields. Unfortunately, in rural communities there
is a lack of training for future staffs. Rural communities have less access to
educational resources and have greater barriers in finding qualified staff than
large urban areas. Skillman (2015) discusses the percentage of low educational
skills in primary care facilities: “Many practices had staff with some
basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds
(61.4%) needed more staff training” (p. 58). The lack of educational training
leads to many negative effects upon medical practices in rural communities. Rural
primary practices will not have access to internet resources that distribute information
among other healthcare providers. Importantly, the lack of unskilled and
unknowledgeable workers can increase the chances of closures in rural areas and
fail to provide the best educational programs, such as internships and
volunteering. Dominant leaders can prevent rural facilities from being planned
poorly by implementing a direct infrastructure that will benefit many healthcare
systems as they exchange information and manage patient populations understanding
the required resources increases productivity. 

            To demonstrate, healthcare systems are costly for rural
hospitals to obtain. Healthcare organizations strive to implement medical and
coding databases to rural hospitals although they do not have financial funds. In
Iowa, rural healthcare providers struggle when it comes to ICD-10-CM/PCS
implementation since Idaho has twenty-nine critical access hospitals and only
seventeen are considered urban hospitals. Butler (2014) discusses what Kaelyn
Coltrin, RHIT, co-chair of Idaho ICD-10 collaborative, says about lack of people
working on EHRs and the need to promote educational programs to help rural
hospitals to continue providing patient care. Coltrin states: “Given the rural
nature of our state and geographically widespread nature, we knew education
would be a feature to focus on, to ensure people would have access to affordable
education” (as found in Butler, 2014, para. 6). To develop a functional plan, healthcare
organizations must seek out universities, counties, and sponsor organizations
to establish a committee and decide how to financially fund and continue the
hospital industry. All institutions can have an impact on productivity in the
healthcare industry in order to produce efficient work and implement future
technological advancements.

Limitations. Health information technology has many barriers to
implementing healthcare delivery systems. Similarly, the crucial barrier that
prevents healthcare professionals from running their rural facilities is the
lack of financial resources. Society views financial resources as beneficial to
productivity and as supporting their surroundings. However, this is not the
case. Kruse (2016) explains that local initiatives struggle to receive
incentives to adapt a basic EHR system in rural hospitals, even though United
States Federal Government has donated and passed acts for low-income
populations. Kruse (2016) explains: “Altogether, the United States Federal
Government has invested more than twenty billion dollars to boost EHR
implementation rates” (p. 1). Local initiatives received help from the
incentives offered by Federal Government; however, not all hospitals and
healthcare organizations can adopt the latest health information technology. Researchers
concluded that financial investments produced many errors and prevented
efficient coordination in rural hospitals. According to Kruse (2016), “The
initial cost of implementing a system is consistently considered a top, major
barrier to the implementation of electronic health record systems appeared
14.4% if all occurrences” (p. 3). The initial costs affected the workflow of
rural hospitals and affected technical concerns, implementation, and physicians’
perceptions. Many professionals are unsatisfied by the insufficient funds and minor
changes in common barriers. Policymakers and incentives play a crucial role in
improving health information technology in hospitals. However, they do not improve
to the extent that healthcare needs. Healthcare needs changes in their lack of
progress in interoperability, external factors, maintenance/ongoing costs and
overall system complexity.

            For instance, Dimick’s (2016) explains the use of health
information exchange (HIE) and the beneficial use for accountable care
organizations (ACOs). ACOs “incentivize competing providers to link together
and exchange data in order to lower costs and share savings” (para. 2). ACOs
are useful for connecting local and state HIEs and offer a wide range of shared
information. However, there is a struggle to improve access between private and
state HIEs. Dimick (2016) explains that private and state HIEs have common
positive feedbacks from the usage of ACOs that reduce and analyze the costs,
share information among hospitals, analyze the population and health of their
patients, and, overall, improves their coordinated care. Therefore, healthcare
organizations need to create useful programs that target the economic flow in
hospitals that will overall affect the workflow. In addition, focusing on both the
private sector and the state will bring positive benefits for the population
and community of patients and physicians. Healthcare organizations are
attempting to provide efficient methods in modifying the complex system in many
areas at the state, local, and federal levels.

            Implementation. Adoption
of electronic health records and advanced healthcare information technology has
grown rapidly. However, few healthcare organizations have implemented at least
a basic system. Although there are programs and acts established to receive
funds and assistance in upgrading the technological needs in hospital
facilities, there has not been an implementation, even in the nationwide health
information technology infrastructure. DesRoches (2013) discusses her research on
the use of a basic EHR system in 2012: “we used the most recent longitudinal
survey of US hospitals to track how they are adopting and using EHR systems.
Only 44 percent of hospitals report having and using what we define as at least
a basic EHR system” (p. 1478). To clarify, rural hospitals were more likely to fall
under the category of hospitals with at least a basic EHR system and a digital
divide that potentially falls behinds improving technological systems. Although
rural facilities obtain assistance from the federal government to improve their
healthcare systems, it is not clear whether the assistance is working or
sufficient. There are other challenges that prevent the adoption of EHRs in that
DesRoches supports.

In the following
example, Butler (2016) mentions the Committee Chairman Senator Lamar Alexander,
who discusses the lack of EHR interoperability, and the lack of discussion regarding
EHR adoption since the HITECH act passed in 2009 and questioned the success of
“meaningful use” EHR incentive program that promotes the use of health
information technology adoption. Butler states, (2016) “Alexander pointed to a
study that found half of physicians haven’t met meaningful use
requirements and face penalties…reporting that 70 percent of physicians don’t
think their EHR investment has been worth it” (p. 4). At this instant, findings
indicate that payment structure does not entail improved coordinated care. Many
rural hospitals do not meet the meaningful use criteria that enables them to
improve the quality of care and reduce health disparities. Many rural hospitals
realize that there has been a narrow focus on technology rather than on how data
is processed and governed. Implementation has a complex structure that must be
reconstructed to apply to all nationwide facilities regardless of their


            In order to understand the challenges in rural
communities, there must be research to determine the causes and implement new
solutions. Health information technology has rapidly grown; however, rural
communities need assistance in providing the latest services to their patients.
Healthcare organizations must start in modifying their infrastructure to
include small populations health centers. To help local and state departments
in developing public services to their populations, some crucial factors to
understand are economic stability, educational support, and community


Policy makers should
consider creating policies and incentives for small and rural communities to
fix the disparities. Local planners can learn new strategies from urban areas
to educate, to engage residents, to assist in community needs, and to communicate
and integrate healthcare systems: for example, a separate modified electronic
health record system for rural communities. Large populations for low-income
patients and reduce the adoption rates of electronic health records. A modified
electronic health record system is easier for physicians and organizations that
deal with high numbers of low-income patients. This can help reduce health
disparities by providing accurate patient health information to analyze patient

In addition, Telemedine
must be discussed in healthcare organizations. Telemedicine can connect with
people through internet access in any emergency. Transportation was a major
issue preventing small populations from arriving at their appointments. Therefore,
telemedicine must be adapted for rural facilities to communicate with patients
for any emergency. Overall, rural communities often lack essential
infrastructure. Therefore, effective policies and programs can track the
population’s stability.

Lastly, rural
communities need EHR technology in their facilities. To receive the EHR technology,
rural hospitals need to provide evidence their current use of health
information technology to receive incentives. For this reason, community
college programs can communicate with their local health departments and community
hospitals to further their training. College students can also teach and assist
those current health staff, local unemployed workers or volunteers that want to
work in the health care field. The programs can benefit the clinics’ technology
needs such as providing the usage of EHRs and HIT systems and the critical
needs of health information technology for rural communities.