This survey was undertaken to inform discussions about the scope of IT investments by rural hospitals and the factors affecting their adoption of new information technologies. The survey sample was national in scope and included both critical access hospitals (CAHs) and non-CAHs. Responses were received from 238 of the 800 hospitals sampled, for an overall response rate of 30 percent.

Data were analyzed using a mix of bivariate and multivariate techniques. Results indicate significant disadvantages for smaller, stand-alone facilities with regard to health IT readiness and use. Smaller hospitals (including most CAHs and stand-alone facilities) devote fewer financial resources to IT, are less confident that their IT staff can successfully implement new technologies, and are less likely to have a written IT strategic plan or a full-time Chief Information Officer. Implementation of an electronic medical record (EMR) has begun in just over one-half of the rural hospitals surveyed. Computerized order entry of lab tests and radiology exams, and electronic review of results from these tests, was a fairly common EMR functionality, while computerized order entry for prescription drugs and drug interaction alerts were somewhat less widespread. Incorporation of clinical decision support software into the EMR was also not widespread. About 70 percent of hospitals reported using some type of pharmacy management system, 45 percent have automated dispensing of prescription drugs, and 23 percent have access to off-site pharmacists for review of medication orders. Use of information technology at the patient's bedside - such as personal data assistants, bedside barcoding for administration of prescription drugs, and other bedside charting systems or point-of-care monitoring software - was the least common form of health IT. Use of these various technologies was often significantly lower in CAHs, stand-alone hospitals, and smaller hospitals.

Hospitals overwhelmingly cited a lack of financial resources as the largest obstacle to health IT implementation, with CAHs, stand-alone hospitals, and smaller facilities much more likely to say limited financing was a barrier. Looking to the future, rural hospitals are most interested in implementing or expanding EMR systems and in developing connected information systems that will permit them to exchange health data electronically with other providers. Smaller, stand-alone hospitals - and, by implication, many CAHs - are less likely to anticipate quick adoption of new technologies and less confident that implementation will be achieved on schedule, even with their longer anticipated timeframe.

Publications

• Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals
  Policy Brief
  NORC Walsh Center for Rural Health Analysis
  Date: 04/2007
  This policy brief reports findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology.
• Small, Stand-Alone, and Struggling: The Adoption of Health Information Technology by Rural Hospitals (Working Paper)
  NORC Walsh Center for Rural Health Analysis
  Date: 02/2007
  This paper reports the full findings from a national survey of rural hospitals designed to investigate how differences among the hospitals affect their implementation of health information technology.