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The $19 billion in stimulus funds for health information technology included in the American Recovery and Reinvestment Act of 2009 has the potential to close the gap between digital and paper-based healthcare organizations. Yet rural healthcare providers are being left behind.

The Office of the National Coordinator for Health Information Technology started off on the right track with both a policy and a standards committee, says Alan Morgan, chief executive officer of the National Rural Health Association. "Then it just went horribly awry," he says. "Providers with the most need are not even mentioned in terms of target."

Out of 20 members on the ONCHIT policy committee, there is no rural representation, and there is only one rural expert on the 23-member standards committee. "It is not rocket science," says Morgan, adding that it is "outrageous" that out of 43 people only one rural expert was included. "You have a tremendous amount of potential and a narrow time frame, but all of the indications so far show a lack of interest in rural."

Short-term pain
Most experts—including Morgan—are still hopeful that the stimulus funds will have their intended effect and narrow the gap between larger healthcare systems and community and rural hospitals. Smaller institutions may even have some distinct advantages. For example, they can get all of their medical staff in one room and have a conversation, says J. Marc Overhage, MD, PhD, president and CEO of the Indiana Health Information Exchange and director of medical informatics and research scientist at Regenstrief Institute Inc.

David Whiles, director of information systems at 210-staffed-bed Midland (TX) Memorial Hospital, agrees. "We are a standalone hospital district and are on the smaller side of the scale and that was our challenge," he says. "We were not in a position of strength and aren't today making hundreds of millions of dollars to invest in IT."

Midland Memorial was able to implement Medsphere's OpenVista EHR system at a cost of $7 million, in part because OpenVista requires no upfront costs for the technology. Midland Memorial has been paperless now for two years.

There is a catch-22 with stimulus funding, says Keith Mueller, PhD, director of the RUPRI Center for Rural Health Policy Analysis in Omaha, NE. The government hopes to incentivize providers to adopt HIT, but providers can't get the money unless they have already started implementing the technology.

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