Managing Care Transitions in Rural Areas with the EHR

Orie Browne practices medicine in rural southern Idaho, an area he describes as having more buffalo and bears than people.

Lack of access to specialty care and ancillary services such as  imaging, labs, and physical therapy can make practicing medicine a challenge. Still, he remains focused on his goal of serving each of his patients as if they were family. The 30-minute drive between the two outpatient clinics, which are affiliated with Lost Rivers Medical Center in Arco, is another challenge he faces on a regular basis, along with the rest of his clinical team.

In order to provide access to these much-needed clinical services and facilitate communication between the physicians who practice at both locations, the outpatient clinics chose a cloud-based EHR.

The outpatient clinics where Browne practices are located in Arco and Mackay, Idaho, which are home to many farmers and elderly patients. Thus, hip operations are relatively common. A 72-year-old woman, one of his patients, recently needed access to specialist care for her hip. In this case, Browne said he can use the practice’s EHR to coordinate access to an orthopedic surgeon, then transition his patient into a rehab facility and even home health services, if necessary.

Another one of his patients -an 81-year-old woman -recently discovered a mass in her breast. After seeing her at his practice, Browne entered an order for an imaging exam into the EHR, secured prior authorization, and then sent the order to the local imaging facility which scheduled his patient’s imaging exam immediately.

“It’s an easy way to take care of this for my patient. And it’s faster than spending time ordering these exams on the phone,” he said.

After her imaging report was interpreted at the imaging center, Browne received an update within his EHR that his patient would need a biopsy of her breast. He received the report while his patient was still at the imaging center, which meant that follow-up care could be scheduled virtually in real time.

“If it’s a benign finding [with this patient], I’ll note that in the EHR. If it’s not, I can schedule an appointment with a specialist by ordering a referral within the EHR, then my staff calls to let [my patient] know,” he said.

Just shy of 1,700 miles away in Malvern, Ark.- which is known as “The Brick Capital of the World”- Shawn Purifoy, a family physician, also serves a rural population. His practice uses an add-on app that crunches data from the EHR and area hospitals to find out which patients are in the hospital and who’s about to be discharged. There’s some toggling back and forth back and forth between the add-on app and the EHR, but Purifoy said it’s worth the minor inconvenience.

The information gleaned from the add-on app drives conversations at the daily team huddles at the practice, he said. Access to this information about his patients -virtually in real time -will become increasingly important as his practice transitions away from a fee-for-service model into value-based care, said Purifoy.