Medsphere

Medsphere Team


Best EHR Features for Rural Emergency Hospitals

January 13, 2025


EHR, Rural Healthcare 6 Minute Read

The federal government’s response to the closure of many small, rural hospitals over recent years was the creation of the Rural Emergency Hospital (REH) designation. Effective at the beginning of 2023, REH status targets small rural hospitals that often provide care where little is available and that flirt with insolvency on an annual basis. According to some analyses, 193 rural hospitals have closed or altered their services since 2005, and more than 450 U.S. hospitals qualify as “financially vulnerable,” both of which are compelling facts underlying creation of the REH option.

Critical access hospitals (CAHs), rural acute care facilities, and tribal and Indian Health Service hospitals—all with fewer than 50 beds—are eligible to apply for REH status if they were open on December 27, 2020. Facilities that meet the criteria, but which closed before the December 27 date, can apply to reopen as REHs.

Services REHs are Required and Permitted to Provide

As the name implies, REHs provide emergency services where there are little to none. An REH must provide 24-hour emergency services, lab services as defined by CAH criteria, and diagnostic radiology services. It must also have an onsite pharmacy or secure drug storage area, and discharge planning supervised by a medical professional. Beyond these requirements, REHs are permitted to provide behavioral health, radiology, laboratory, and rehabilitation outpatient services.

Importantly, an REH cannot provide inpatient beds or average more than 24 hours onsite per patient annually, but it can license an onsite skilled nursing facility. The Centers for Medicare and Medicaid Services (CMS) grants that stays of a week or more may sometimes be necessary for psychiatric treatment or rehabilitation, but the expectation is that these longer stays will not happen often enough to throw off the annual average length of stay.

What to Look for in an Electronic Health Record

So, with these overarching requirements and definitions for an REH, what should you look for in a comprehensive health IT platform?

Clinical Documentation, Decision Support, Alerts & Notifications, Orders & Results Management

At the core of any EHR is technical support for primary patient care. The system should use readily available templates, embedded interactive forms, and dropdowns that enable the clinician to quickly document a patient’s condition, as well as tests and treatments. It should also interface with different data input devices and applications such as voice recognition to perhaps take some of the documentation burden off the clinician.

The right EHR will also remind clinicians to perform certain clinical interventions and assessments based on a patient’s presenting symptoms and diagnostic findings.  At an emergency facility, the reason for the patient’s presence will obviously take priority over all else, but additional questions and responses could play a crucial role in effective triage and treatment.

Medication Management

When it comes to medications, the value of an EHR’s pharmacy module is in how much automation it brings to the prescribing process. At a bare minimum, any pharmacy or medication management module should check for drug/drug and drug/allergy conflicts; give the clinician an easily and rapidly digestible view of active orders and prescriptions; employ bar coding technology for rapid confirmation of correct patient, drug, route, dosage, and time; provide a calculator that quickly displays correct weight-based dosages; and utilize medication reconciliation, verification, and exchange functionality to guard against errors.

Image Capture

Image capture enables you to attach patient ID photos, relevant images of patient anatomy, and scanned documents that work together to promote rapid and comprehensive onsite treatment. The availability of these and other images also hastens the process, if necessary, of communicating with clinicians at an affiliated trauma center.  

Communications

The need for near-instantaneous communication can arise most any time throughout emergency patient treatment. For this reason, multiple communications channels available from within the EHR are necessary, including emailing inside and outside the organization along with electronic faxing of patient information.  

Discharge Planning

The last opportunity a clinician has to communicate with a patient before sending them home is through discharge instructions. Any EHR worth the investment will include detailed, treatment-specific home instructions available in multiple languages. Because every patient has some unique needs, instructions must be easily editable. Perhaps the most important component of discharge instructions are pharmaceutical details. A robust system will rapidly produce prescriptions complete with relevant dosage, timing, and duration information, as well as licensing and DEA information, where required.  

Charge Capture

Having made the conversion to REH status, you will be very familiar with the importance of revenue to keeping the hospital up and running. A health IT platform that incorporates automated charge capture and coding provides value for every action you perform and makes sure that nothing falls through the cracks.

Reporting

You can make the reporting process straightforward with the right tools in place. For starters, the system you choose should include a real-time dashboard that gives everyone in the system a snapshot of the current organizational state, e.g., patients waiting, length of stay, etc. Even if your REH has just one patient at any given time, it’s easier for everyone in the facility to see the status on a dashboard than to have to ask around.

The system should also include a wide variety of standard and customizable reports, and the audit functionality available to create custom reports should be robust. If reporting is just okay in a system that is otherwise highly functional, make sure that it can export data to a more versatile reporting tool.

Behavioral Health

Many organizations will select REH status because they are far from other facilities and primarily responsible for the health of area residents. In these cases, while CMS does not require behavioral health and rehabilitation services, there is a strong likelihood some of the locals will need them. In these cases, multi-disciplinary treatment planning and group notes modules are much better tools for initiating the mental health care process than a standard EHR focused entirely on physical care. Instead of looking just at what is required, take the time to plan for realistic care requirements that prepare you for almost any scenario.

Even if this basket of suggested EHR features gets close to what a newer REH might need, it probably won’t completely fit the bill, which is why it is so important to choose an adaptable platform. In many instances, interfaces will be essential to fill in the gaps around the selected solution. In making a final selection, weed out systems the charge for more than you need. They’re shiny and flashy, yes, but that flash is expensive and most of it will remain unused. Just enough functionality is your goal and the key to finding an affordable and sufficient health IT platform.



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