EHRs the New Target of Malpractice Litigators

EHRs the New Target of Malpractice Litigators

Medical malpractice litigators have found a new target: Electronic Health Records (EHRs).

Amidst the concerns of data security and protecting EHRs from breaches, certain legal teams are finding ways to exploit the imperfect nature of electronic records for legal gain.

Targeting Electronic Records

Many EHRs are designed with a digital experience in mind. Information is stored in templates that populate correctly on a screen but don’t keep the same clean format when printed. This can create confusion for those viewing the printed records—data may populate in several locations at once, giving the appearance of mismanaged records and internal disorganization.EHRs the New Target of Malpractice Litigators

Litigators, whose job it is to discredit medical organizations during malpractice suits, prey on this confusion and use it as an example of poor healthcare practices. The argument is that if the record itself is confusing, it stands to reason that overall care will be marginal. Legal teams can take this even further by questioning the authenticity of the data itself.

This leads to situations where healthcare providers are embroiled in malpractice disputes about quality of care, but have to defend how their medical records work. This litigation is controversial—rather than discussing the actual issues the defendants in the complaint, litigators are shifting the focus to technical failings to help win their cases. Every healthcare organization must know of this trend and do what it can to prevent EHR templates from damaging credibility.

Avoiding Confusion

Litigators exploiting the shortcomings of EHRs rely on one primary element for their cases—confusion. If healthcare organizations can improve their communication and documentation protocols, they will be less vulnerable to the drawbacks of EHR paper documentation.

Understanding the context of care is essential when determining how to address malpractice concerns. Organizations must be able to defend their actions in the face of scrutiny, even when printed EHRs provide irregular readouts. Questions concerning how care is viewed, which provider did what, and when they did it all contribute to understanding health outcomes. Each of these questions must be thoroughly documented for each patient to prevent legal teams from using data confusion as ammunition for malpractice suits.

In addition, communication between C-suite staff, caregivers, and EHR providers must be seamless and transparent. Litigators targeting EHRs rely on the inherent disorganization that comes from transferring digital information into print. When processes and patient care are documented thoroughly, they become easy to understand at a glance. This helps reduce the likelihood that litigators can leverage the weaknesses of printed digital templates to discredit healthcare providers.

Desh Urs iBridge LLC

Written by Desh Urs

Desh Urs brings more than 20 years of entrepreneurial, start-up and Global 500 corporate experience in sales, marketing, and general management to the customers of iBridge. He has led sales organizations as SVP at Qsent, Inc. and VP at Acxiom Corporation, and has focused on the usage of data in data distribution, direct marketing, fraud prevention, and law enforcement.

As a Vice President of Global Sales, Services, and Marketing at Silicon Graphics, Inc., Urs managed engineering and non-engineering functions, developing solutions in sciences, telecommunications, manufacturing, media, business, and defense intelligence, for companies with revenues of several billion dollars. During his tenure as Vice President at Think Tools AG and Brio Technology, Inc., he ran business development and alliances providing solutions in Business Intelligence and Decisions Cycle Management to Global 100 corporations worldwide. In the late 1980s, Urs founded Indus Systems, Inc., which he profitably sold to a systems integration company.

Urs serves on several Advisory Boards, as well as many company Boards, in the United States and India.

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Personal Accountability: The Need for Patient Controlled Records

Personal Accountability: The Need for Patient Controlled Records

Though the use of clinician Electronic Health Records (EHRs) is the standard for patient data storage, researchers at Boston Children’s Hospital are pushing away from this framework in favor of giving patients more control over their data.

The Tech Myth

A common misconception in the healthcare industry is that medicine relies on complex and specialized IT systems for data storage.Personal Accountability: The Need for Patient Controlled Records The opposite may be true. Specialized software leads to extensive IT costs and strenuous physician workloads, all to aggregate data in a fragmented system that patients can’t access on their own.

This creates challenges on both the patient and provider sides: clinicians must struggle with burdensome systems and expensive IT infrastructure while patients must deal with having their information spread across as many EHR systems as providers they see. This system creates a lack of transparency for patient data and makes it difficult for both patients and providers to view the big picture for each patient’s health history.

Empowering Patients

Giving patients a centralized way to control and manage their health data offers several advantages over the current system:

  • Patients can collect data from many providers seen, providing a 360-degree view of health history and outcomes across providers
  • A comprehensive database of health encounters helps providers coordinate care across specialties
  • Data governance allows patients to supply their own information or correct errors that healthcare providers may not notice

Isaac Kohane, MD and chair of the Department of Biomedical Informatics at Harvard Medical School commented on the need for patient controlled records:

“EHRs and patient portals were plan B … We should go back to plan A, which was to create patient-controlled data stores that compile all pertinent data across a patient’s lifetime and is the patient’s to share as they see fit.”

Steps to Patient Controlled Records

Giving patients universal access to their health records will require a large-scale shift of industry priorities and initiatives. The current infrastructure doesn’t support cooperation between clinicians or data visibility. Kohane and the research team at Boston Children’s listed several steps that could help create a system where patient controlled data is the norm:

  • Receive stronger incentives from the Centers for Medicare and Medicaid Services, with private insurers that support giving patient’s access to data.
  • Create consistent public application programming to enable patients to access their data.
  • Establish tools to give patients governance over who can access or change their data.
  • Adopt exacting security standards and authentication protocols to ensure data protection and accountability.

Desh Urs iBridge LLC

Written by Desh Urs

Desh Urs brings more than 20 years of entrepreneurial, start-up and Global 500 corporate experience in sales, marketing, and general management to the customers of iBridge. He has led sales organizations as SVP at Qsent, Inc. and VP at Acxiom Corporation, and has focused on the usage of data in data distribution, direct marketing, fraud prevention, and law enforcement.

As a Vice President of Global Sales, Services, and Marketing at Silicon Graphics, Inc., Urs managed engineering and non-engineering functions, developing solutions in sciences, telecommunications, manufacturing, media, business, and defense intelligence, for companies with revenues of several billion dollars. During his tenure as Vice President at Think Tools AG and Brio Technology, Inc., he ran business development and alliances providing solutions in Business Intelligence and Decisions Cycle Management to Global 100 corporations worldwide. In the late 1980s, Urs founded Indus Systems, Inc., which he profitably sold to a systems integration company.

Urs serves on several Advisory Boards, as well as many company Boards, in the United States and India.

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Improving Engagement with Smart Data and Co-operation

Improving Engagement with Smart Data and Co-operation

Increased patient engagement has always been a goal for the healthcare field. Patient involvement leads to better informed decision-making, reduced perceived burden of care, and better overall health outcomes. While strategies to improve engagement are constantly evolving, data advancement and an improved patient/provider relationship are poised to become essential drivers of healthcare engagement strategies.

Emerging Tech Engagement

These days, a multi-pronged approach to patient engagement is necessary, including provider outreach, patient participation, and use of advancing medical technology to monitor and collect information.

Improving Engagement with Smart Data and Co-operation

Image Courtesy of Praisaeng at FreeDigitalPhotos.net

Patient-generated data is growing in the healthcare field. Wellness applications, exercise trackers, and even continuous blood glucose monitoring systems allow patients to actively generate and provide health data. Couple this with the emergence of Electronic Health Records (EHRs) that let patients view and monitor their own records from any location, and it’s clear that technology is allowing patients to take a more active role in their health status than ever before. And with Stage 2 meaningful use requiring a minimum of 5 percent of patients to view, download, and transmit their own health data, it’s clear that the push towards better patient engagement is well underway.

Co-operative Healthcare

While data and technology facilitate more opportunities for patient engagement, the process is relatively new. Many patients still view themselves as passive recipients of medical services rather than active participants in coordinated care. Thompson H. Boyd, MD at Hahnemann University Hospital in Philadelphia noted the importance of physician support in joining the efforts of patient and provider. “Getting the physicians involved—to tell the patients, ‘we want you to do this,’ is a critical early step. We’re trying to reduce the barriers to getting patients enrolled.”

The push to improve co-operation between patient and physician is at the heart of better engagement. Patients must develop personal connections with their healthcare providers and feel engaged in their own care. This communication helps patients feel heard and allows them to contribute to their own goals of improved health outcomes. Patricia Hyle of Healthwise, a company that develops health information and provides decision support tools for health centers, agreed that better patient integration is necessary for quality healthcare. “A patient has to be considered an active and equal part of that care team […] not just a passive person that we push information out to.”

Only time will tell how advancing healthcare technology will contribute to patient engagement, but regardless of how smart data changes the healthcare formula, patients and providers must work together every step of the way.

Dean Van Dyke iBridge LLC

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsourcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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New Contracts to Increase Military IT Interoperability

New Contracts to Increase Military IT Interoperability

A new military IT contract with Cerner, Leidos and Accenture will be implemented to increase the interoperability of EHRs nation-wide with thousands of civilian healthcare facilities. This contract promises to diversify healthcare outreach for the nearly 10 million active duty and retiree military members that receive care by privatized providers.

Cooperation Is Necessary

EHR vendors have traditionally been slow at making their systems interoperable with other organizations, creating challenges for an industry that relies on communication and transparency for patient data and information sharing. This new contract was designed to overcome these shortcomings and enhance the business practices of hundreds of facilities that currently avoid cooperation.

Image courtesy of Jeroen van Oostrom at FreeDigitalPhotos.net

Image courtesy of Jeroen van Oostrom at FreeDigitalPhotos.net

This connectivity will not be simple to implement; hundreds of EHRs platforms will be integrated, including those provided by rival bidders. Over 1,200 military healthcare sites will experience changes, including international facilities in Iraq and Afghanistan.

Dr. Johnathan Woodson, Assistant Secretary of Defense for Health Affairs, spoke to the necessity of cooperation with these private-sector companies, which provide 60 to 70 percent of healthcare for soldiers and their families.

“Part of our requirement is to position ourselves to be interoperable with the private sector, but the fact of the matter is, the private sector has to make itself interoperable as well. What we’re doing today will help advance that public preparedness.”

Looking to the Future

This commitment to interoperability of the public and private sectors comes at a critical time, as the compliance deadline for the ICD-10 transition is less than two months away. Healthcare organizations in the middle of this transition must focus their efforts on communication and cooperation with other facilities to ensure that the quality of patient care does not suffer.

This is particularly true for the military and private-sector companies that must adjust their policies to reflect the needs of civilian and public-sector partnerships.

Federal Health IT Coordinator Dr. Karen DeSalvo commended the contract, calling it “…An important step toward achieving a nationwide, interoperable health IT infrastructure.” She pledged her office’s support of the Defense Department: “To help ensure its interoperability efforts align with nationally recognized data standards and industry best practices.”

While new standards of cooperation are a step in the right direction, military healthcare facilities will need to undergo rigorous testing to confirm the viability of their updates. Interoperability is necessary progress for the health field, but requires constant improvement to maintain its efficacy.

Dean Van Dyke iBridge LLC

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsourcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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How IT Services Can Boost Patient Engagement

How IT Services Can Boost Patient Engagement

Patient engagement is a practice that clinics have struggled with for years. Involving patients in the care process keeps them informed and leads to a higher quality experience, but relies on methods and infrastructure that many clinics are unfamiliar with. However, new meaningful use regulations may make patient engagement a necessity instead of a luxury.

Stage 2 of meaningful use requires over five percent of patients to be involved in their own care via electronic medical record or online portal for any provider. This means patients will become more aware of prevention screenings, more informed during inpatient procedures and will maintain better contact with their providers after they’ve gone home. Given the financial costs associated with disengaged patients who fall victim to preventable hospital readmissions, these regulations are understandable.

Personal Health Status On Tablet

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Despite the benefits to increased patient involvement, hospitals have shown poor adherence to engagement practices in the past. A recent survey conducted by consulting firm Technology Advice indicated that 48 percent of patients reported no follow-up from their provider after they were discharged, with a mere nine percent reporting contact via online portal. Hospitals have a long road ahead of them to increase their patient engagement to acceptable levels.

Increasing Engagement

Despite the challenges associated with making patient involvement a priority, new methods in development offer multiple ways for hospitals to engage their patients, particularly in the IT field. Applications being developed allow providers to monitor patient health status after discharge by providing wellness surveys for patient responses. If the responses indicate a decrease in health or wellness, the application notifies a nurse practitioner who can help the patient address the issue.

These applications are also being utilized during hospital stays and surgical procedures, providing ways for family to stay informed with live updates on the status of the patient. These methods combine new technology with electronic health records to create a positive experience that keeps patients informed.

Response to virtual information management has been positive from patients, but patient health outcomes have yet to be improved. Using applications to track the status of patients during procedures and during post-operative care doesn’t satisfy the government mandated State 2 meaningful use requirements, but is a step in the right direction toward integrating IT services and patient engagement.

You can view the full research study at Technologyadvice.com.

Dean Van Dyke

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsourcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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The Streamlining of Meaningful Use Measures

The Streamlining of Meaningful Use Measures

Changes do not always come easy in electronic healthcare reporting, but new regulations for the reporting of Stage 2 meaningful use measures may indicate that the voices of healthcare providers nation-wide are being heard.

Electronic Reporting Standards

On Aug. 29, The Department of Health and Human Services published its final mandate regarding the reporting period for online medical records, remaining firm on a 365-day window for allocation of records. Despite the supposed ease of use and flexibility this method promised, physicians, hospitals and healthcare facilities across the country were vocal in their protestations against this regulation that placed an undue amount of burden on an industry already bogged down with details.

The CEO of The College of Healthcare Information Management Executives (CHIME) Russell Branzell noted that if more flexibility could not be brought to the meaningful use program in 2015, the future of the program itself was in jeopardy.

Young Female Doctor Holding A Tablet

Image Courtesy of Stockimages at FreeDigitalPhotos.net

A Welcome Change

Somebody out there was listening, as The Centers for Medicare and Medicaid Services (CMS) recently announced that the reporting window for meaningful use measures in 2015 would be reduced to a 90 day period, ostensibly to reduce the complexity of online reporting and ease the burden on healthcare facilities.

This announcement was met with great applause from a multitude of leaders in the medical IT industry, including CIOs from CHIME, The Mayo Clinic and other prestigious medical colleges across the country. The news not only promised a smaller reporting window to allow greater flexibility for physicians to participate in the meaningful use program, but was also an indicator of an encouraging trend within the industry.

“… I think it reflects that the voices of CIOs and others in the industry are being heard […] It reinforces that we need to never give up. We need to have a voice,” said Sue Schade, CIO of University of Michigan Hospitals and Health Centers.

Government regulations have been notoriously slow to adapt in the past, so the news that CMS would amend its reporting standards based on the feedback provided by healthcare professionals is a significant change. Knowing that CMS and other government medical organizations are considering their opinions, physicians and other professionals are given confidence to continue participating in the program and to have faith that their issues can be addressed should a new problem arise.

The Future of Electronic Health Records

While still in its infancy, electronic healthcare reporting is a process that must be developed by communication between both the sponsors and the users. While there will be many more bugs that must be worked out of the system, the willingness to adapt and make concessions on both sides is an encouraging step in the right direction. With the new reporting standards in place, managing electronic health records will become simpler and more convenient for all involved.

Dean Van Dyke

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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Electronic Health Records: Boon or Boondoggle?

Electronic Health Records: Boon or Boondoggle?

In 2009, the U.S. Congress passed the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act, which requires doctors’ offices and hospitals to implement electronic health record (EHR) systems. Facilities face penalties if they do not implement EHR systems meeting certain standards by 2015. The idea of EHR systems is to improve the quality of care by enabling patient health record interchange among doctors, nurses, and other healthcare professionals, to coordinate care, reduce duplicate tests and conflicting medications and reduce errors. Hospital IT departments have been working hard to implement EHR systems, and, as is often the case with large-scale IT projects, the results so far are mixed. Although nurses and doctors using some EHR systems are satisfied, in many other cases they feel that the systems are ineffective and difficult to use.

What sets the successful EHR implementations apart from the rest? The answer is no different for EHR systems than it is for other IT projects, large and small: Get the requirements right, and involve the end users.

Source: freedigitalphotos.net

Source: freedigitalphotos.net

Get the Requirements Right

A successful EHR project starts with a complete, correct set of user-level requirements. Although the HITECH Act provides a high-level framework to work within, many of the details of how users are to interact with the system are left to the system designers and developers. Getting these details right means considering all of the end users of the system (such as doctors, nurses, and facility administrators), the processes that must be supported, and the working environments in which the users will use the system. For example, a general practitioner working at a desk will use the system in a very different manner from a nurse working in a hospital emergency room. This is a formidable task, especially in large facilities with many departments (and possibly multiple locations), each of which has its own special needs.

Get the End Users Involved

So how do the designers identify, document, and validate all of these detailed user requirements? The end users must be involved in every phase of the implementation. They have to be observed in their working environments, they have to be interviewed, they have to review and confirm the documented requirements and they have to help test the system.

Apart from ensuring a complete set of requirements and getting the bugs out of the system before it is rolled out, keeping the end users involved gives them a sense of ownership and empowerment. The alternative—deciding for them and cramming it down their throats—is a recipe for low morale, high turnover, and difficulty in attracting talented personnel, plus poor-quality care for the patients.

Without good requirements and end user involvement (plus good project management), you can implement an EHR system that meets the letter of the HITECH law, but is a complete disaster for practitioners and patients alike.

Dean
Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

Is New Focus Needed for EMRs?

Is New Focus Needed for EMRs?

The 2009 economic stimulus package, designed to help the US recover from a record financial downturn, included several smaller, targeted programs supporting projects in a variety of fields. In healthcare, federal grants for converting from paper medical records to electronic medical records (EMRs) provided clinic and office-based physicians with significant monetary incentives to accelerate their transition to a 21st century healthcare records system. While the shift to digital is a smart and necessary move for a planet struggling to stave off climate change by reducing waste, it doesn’t come without complications.

Source: freedigitalphotos.net/stockimages

EMRs and Incompatibility

One large issue with EMRs is that, like iPhones and Androids, their proprietary software makes them unable to “talk” to EMRs created on a competitor’s system. If a hospital system uses EMR software from Acme Corporation, but your records are from a hospital in a neighboring state that signed a contract with Beta Industries, you may be in trouble when you show up at the Acme Corporation hospital without identifying information.

Part of the goal of the Affordable Care Act (“Obamacare”) was to make healthcare more portable, preventing job changes or unexpected unemployment from costing Americans their healthcare insurance. What the ACA doesn’t make more portable, however, is EMRs.

At this point in the EMR revolution, it’s time for the US to have a serious conversation about data portability. Hospital administrators should be very selective when choosing an EMR vendor and verify that data is formatted in a way that is compatible with other popular systems:

  • EMR data should be easily exportable; ease of data export should be a built-in feature of any software solution.
  • Data must be formatted in a non-proprietary fashion recognized by other popular software.
  • Be sure that data and databases are organized in a logical fashion. A standard import/export language and the ability to transfer data in a standard table or Excel file format will be of great value should a healthcare organization must update or change EMR systems.

EMRs and Security: A Complex Proposition

Data breaches continue to stack up. As security experts come up with more creative ways to secure patients’ healthcare data, hackers, and digital miscreants are rising to each new challenge and finding novel ways to access and capture private health data. Harsh penalties have not been enough to slay the security beast and retroactive actions like offering identity theft insurance to affected patients isn’t enough.

Going digital shouldn’t mean danger. At this critical turning point in U.S. healthcare policy, as much or more attention should be focused on securing patient information and EMRs as is focused on insuring the uninsured and controlling rising costs.

Written by Dean Van Dyke

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

How Can Less Tech-Savvy Hospitals Move Forward with EHR?

How Can Less Tech-Savvy Hospitals Move Forward with EHR?

In urban areas, it’s typical and even expected that larger healthcare organizations and hospitals are already using the latest medical breakthroughs and technological advances, including making (or having already made) the transition to electronic health records (EHR). Yet, rural practices are often stuck years behind their big city counterparts in a number of ways, and EHR adoption is no exception. How can smaller medical practices and hospitals catch up, let alone move forward?

Pipeline Problems

There are a lot of things people living in larger metropolitan areas take for granted, like 24-hour grocery stores or extensive public transportation. Smaller communities are faced with a number of unique challenges related to their relatively remote, isolated locations.

This dynamic is reflected in the healthcare industry as well. When it comes to making tech upgrades, the problems an urban hospital faces are most often related to issues like figuring out the best way to transform a large volume of paper records into digital format, or how to rearrange the budget to pay for the transition. In rural areas, though, complications occur at a much more fundamental level.

The question that smaller practices face isn’t necessarily how to schedule the time or the best way reprioritize the budget, but may instead be as basic as how can they find a technician or vendor to perform the service at all. Facilities that only have a couple dozen beds to begin with may have trouble even getting the latest medical equipment, and definitely don’t have access to the expert guidance they need to install and implement the hardware and software that’s necessary to build and maintain effective electronic records management.

Lack of funding in general is another serious issue facing rural practices. On average, the nation’s 2000 or so rural hospitals already run at an eight percent loss, so the question of finding the necessary investment to adopt EHR—often in the range of about a million dollars—can feel impossible. Yet, these changes need to be on track in order to comply with the mandatory 2015 deadline, so an answer has to be found.

Joining Forces

The solution adopted by increasing number of smaller practices involves a trade-off: giving up their independence in exchange for being absorbed into a larger nearby healthcare organization. Rural hospitals can align or merge with the nearest large metropolitan area hospital system and receive the benefits of more generous financial backing, along with superior access to the necessary technical support. Often, the urban facilities are already using EHR, so making the upgrade is a fairly streamlined—and less financially strapped—process. While some small hospitals remain stubbornly independent and are determined to find funding somehow on their own, others are benefiting in a big way from creatively joining forces with other healthcare providers.

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