How Tech Can Bridge Gaps in Rural Healthcare Data Struggles

Rural healthcare remains a top priority for the Department of Health and Human Services. Growing needs in the area are resulting in initiatives and policy from the Office of the National Coordinator to use technology as a way of lower care costs, according National Coordinator for Health IT Thomas Keane. 

“Our goal is to make sure that this technology is leveraged to lower costs. Number one and number two, our goal is to make sure that those people who’ve been left out of the technology ecosystem can get into it,” Keane said Tuesday at the InterSystems Ready event in National Harbor, Maryland.  

Last summer, ONC mandated that the existing installed base of electronic health records have to support prescription benefit information. The mandate allows patients and providers to make decisions that overall lower the cost of care, Keane said.

Currently, ONC is working with insurance companies to get the information up to date and accurate, but also with the drug companies to get their direct-to-consumer pricing available to the patients, which sometimes can be cheaper than insurance.  

“This means that at the point of care, physicians, in conjunction with the patients, have to be given information about the cost of the drug they’re selecting for the patient, and they have to be given information about what the price of therapeutic alternatives are,” he said. “I cite this as an example because we find that prescription abandonment or the unaffordability of prescriptions — the sticker shock at the pharmacy counter — is a major cause of health care complications and leads to many, many deaths.” 

But mandating the technology is only part of the solution. For it to be effective, the programs need to be implemented and utilized. Getting the information out to rural providers has been a challenge, Keane said.

“It’s not leveraged as much as it can be. We’re finding only about 10 to 15% of providers are even aware that that potential is there,” he said. “How do we educate the providers? Why aren’t they using it as much as we thought that they would use it?”

Tim Ferris, vice president of healthcare practice at InterSystems, said it’s important for patients to encourage their providers to take advantage of the programs that could benefit the practice and the patients. 

“Ask your doctor if that doctor can see all of your medical records right now, no matter where those records are from. And if the answer to that question is no, your response should be, why not?” Ferris said. “It’s available to you. If you’re not seeing it, then your organization hasn’t done the work. And it is work, but it means that your organization hasn’t prioritized that work.”  

Ferris suggested setting health-based goals as a way to encourage healthcare providers to take advantage of the technology that currently exists.  

“Let’s set those goals and then use that to drive the technology that enables that goal because really it’s very difficult to motivate a general audience around healthcare technology, unless we tie that adoption of healthcare technology to measured improved health,” he said. 

Health Data Frameworks

The Trusted Exchange Framework and Common Agreement, or TEFCA, launched in 2023 to create a unified, secure and interoperable network for sharing electronic health information nationwide. In February, it hit a major milestone, reaching half a billion health records exchanged.  

ONC’s five Health Data, Technology, and Interoperability (HTI) Rules — four of which have been finalized with the fifth rule still a proposal — are also an effort to combat some of the challenges associated with health technology, especially in rural areas. To lower the barriers to developing health IT, HTI-5 proposes decreasing the 60 certification criteria that are required to be certified health IT by 41. 

Most recently, Congress allocated $50 billion to rural areas as part of the Rural Health Transformation Program. The money is intended to help providers meet the needs of their rural population improving healthcare access, quality and outcomes by transforming the healthcare delivery ecosystem. 

“We understand that when technology meets actual provider workflows, actual caregiver workflows, that it doesn’t always work,” he said, but encouraged providers to reach out to ONC. “We have a whole group within our agency that tries to address this. And if you go to our website, we have a whole bunch of resources that can help people understand how to best leverage technology.”