Cloud-Based EHRs, Telemed Come To Rural ColoradoCloud-Based EHRs, Telemed Come To Rural Colorado

Telemedicine Tools That Are Transforming Healthcare

Rural healthcare providers in Colorado now have access to a trifecta of online services that can help them deliver 21st-century medicine. Via the Colorado Telehealth Network (CTN), which offers secure broadband connectivity, rural clinics and hospitals can use cloud-based electronic health records, obtain remote consults from big-city specialists, and connect online with the Colorado Regional Health Organization (CORHIO), a statewide health information exchange.

Owned by the Colorado Hospital Association and the Colorado Behavioral Health Council, CTN began forming its network in 2010 and got its first 200 members up on the network at the end of last year. Among those members, CTN Program Director Debby Farreau told information Healthcare, are hospitals, healthcare systems, federally qualified health clinics, rural clinics, and behavioral health clinics. While these organizations include a lot of physicians, CTN has not yet reached small private practices, she said.

A $9.5 million grant from the FCC to provide rural broadband service has powered CTN so far. CTN members pay at least 15% of the cost, with larger organizations paying a higher share.

CTN partnered with CORHIO in 2009 to link together providers across the state, with an emphasis on rural providers. Any organization in the state that wishes to connect to CORHIO can do so through CTN, according to Janice Whittleton, director of business development and outreach at CORHIO. In an interview, she explained that if providers don't use the dedicated network, which operates in a "private cloud," they must set up another secure connection to link with the HIE.

CTN has made it easier for rural providers to acquire EHRs and attest to Meaningful Use, Whittleton said. The reason is that the availability of broadband--a new capability in many rural areas--has allowed these providers to purchase cloud-based EHRs. These remotely served EHRs cost less than office-based EHRs and require less onsite maintenance, facilitating adoption by physicians.

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In addition, Whittleton pointed out, it's simpler and cheaper for physicians with cloud-based EHRs to interface their systems with CORHIO. That's because the vendors who maintain the systems can limit their customization and can standardize the interfaces to the HIE. "So the interface charges to the practices tend to be quite a bit less or even free for a cloud-based EHR compared to an EHR that's hosted in the physician practice," she said.

CORHIO, which is also the health IT regional extension center (REC) for Colorado, received a $12.5 million grant to help small primary practices and safety net providers select, implement, and use EHRs to achieve Meaningful Use. To date, Whittleton said, CORHIO has enrolled nearly 2300 providers in its REC--a significant portion of them in rural areas.

"I don't think we'd be seeing the level of success in adoption that we've had in the rural community if the CTN broadband didn't exist," she said. "EHRs would be so much more expensive, and the lack of broadband would have imposed a significant barrier that we'd have to work through."

CTN also facilitated the use of telemedicine, Farreau pointed out. In the past, if a rural hospital had an emergency, it couldn't send a radiology image to a tertiary-care facility to find out whether the patient needed to be transferred. Now, if they're on the network, they can transmit that image instantaneously. Many providers also use CTN for telestroke consultations and other types of consults.

Some CTN members contract with outside teleconferencing firms to do videoconferencing over the network. Later this year, Farreau said, CTN plans to offer its own videoconferencing service.

Also on the roadmap is a vendor-neutral, cloud-based image-sharing service that CTN is developing with CORHIO. This will ensure that wherever a patient presents, his or her test results will be available. That isn't usually the case today, noted Whittleton. When an image is sent from a rural hospital to a metropolitan facility to be read, that helps the ordering physician, "but it doesn't facilitate sharing that image among other providers," Whittleton explained. "So if a patient shows up in another hospital, they have a second or third test run, because the result of the first one isn't available."

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