Earl Ferguson


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Earl Ferguson

  1. 1. Experience from Front Line: Rural Provider Perspective California State Legislature Rural Caucus Health InformationTechnology Informational Hearing June 9, 2010 Earl W. Ferguson, M.D., Ph.D. President-elect, California State Rural Health Association; Director, Southern SierraTelehealth Network; Director,Telemedicine and Rural Health Development Ridgecrest Regional Hospital, Ridgecrest, CA
  2. 2. Advanced HIT Implementation in Rural Areas • Electronic Health Records (EHRs) • Health Information Exchange (HIE) • Telemedicine/Telehealth • Integration of these technologies • What does future look like?
  3. 3. Electronic Health Records (EHRs) • Southern Sierra Medical Clinic (SSMC) – Selection of EHR (1996-2000) – Work flow redesign for EHRs (2000-2001) • Automation of front office – Scheduling, Registration, Coding, Billing, Collections • Back office/Nurses station redesign – Patient assessment, vital signs • Implementation of computer systems at all work stations, provider offices and examining rooms • Workforce training
  4. 4. Electronic Health Records (EHRs) • Southern Sierra Medical Clinic – Implementation of Comprehensive EHR System (2002) • Provider training and mentoring • Transition from paper charts • “Paperless” EHR System by end of 2002 – “e-Prescribing” (2003) – ELINCS (EHR-Lab Interoperability and Connectivity Specification) HIE (2004)
  5. 5. Health Information Exchange (HIE) • ELINCS (EHR-Lab Interoperability and Connectivity Specification) HIE (2004) – Ridgecrest Regional Hospital (RRH) – Southern Sierra Medical Clinic – Other investigators • Lab reports automatically sent from RRH into SSMC EMRs • Labs, PACS (radiology) images, RRH EHRs (since 2009) and other information available via secure RRH websites.
  6. 6. Telemedicine/Telehealth • Southern Sierra Telehealth Network (SSTN) – Telemedicine Consults from RRH to Southern Inyo Healthcare District, Lone Pine and to RRH from consultants outside our region (2001) . – Telehealth educational programs • Nursing educations (LVN to RN, RN to BSN) • Staff and patient education
  7. 7. Integration of Health Information Technologies • Telemedicine visits with interactive video on one screen, EHR on another, and PACS images on a third demonstrated in 2006 using combination of SSTN telemedicine system, SSMC EHR system, and RRH PACS system.
  8. 8. What does future look like? • Broadband enabled integration of all these systems into systems that will provide information whenever and wherever it is needed to support health and healthcare decision-making. • Marked improvements in the quality, efficiency, cost-effectiveness and accessibility of healthcare in rural areas.
  9. 9. What does future look like? • Chronic disease management of patients at home – Monitoring patients and alerting providers of problems – Marked decrease in need for hospitalization and emergency visits – Increased efficiency and decreased healthcare costs
  10. 10. Summary of Major Issues • Broadband connectivity is essential • Purchasing advanced HIT and telehealth hardware, software and services • Cost-effective telemedicine systems can be implemented • Costs of other advanced HIT systems are high, but incentives and funding encourage adoption • Staffing/Workforce must be developed • Reimbursement must support services • Advanced HIT systems will be integrated • PHRs/EHRs/HIE/telemedicine/telehealth systems
  11. 11. Conclusions • Reimbursement for services, particularly in rural and remote areas, must be adequate to sustain healthcare systems • Reimbursement should be focused on addressing community needs and overcoming barriers to healthcare access • Biggest issues for success are regulatory policies and funding, not technologies • Keeping decision-makers informed must remain a high priority