Rural Texas hospitals teamed up to transition from paper records to electronic health records to improve patient care.
Competition is tough in Texas.
And in four small West Texas towns within 25 miles of each other, rivalries are real.
“You’ve heard of ‘Friday Night Lights,’” explains Rick DeFoore, CEO of Stamford Memorial Hospital, referring to a book, film and TV drama about high school football. “Two of these towns are fierce sports rivals, and you would think, ‘So what?’ But I promise you, it affects everything out here.”
Money-saving water agreements have been nixed, and forget about school consolidation. For years, four hospitals in those rural towns were as separate as separate can be.
Then came the American Recovery and Reinvestment Act (ARRA) and incentives for facilities adopting electronic health records (EHR). Forty-five bed Anson General, 25-bed Stamford Memorial, 20-bed Stonewall Memorial and 14-bed Throckmorton County Memorial hospitals were each solely using paper patient files.
“We looked into it, but our hospital was struggling to make ends meet, so the idea of taking on something like that, regardless of incentive, was beyond our reach,” DeFoore remembers. “But the push behind EHR was sharing medical information, so it made sense to have a network of hospitals working on a similar system, because we do share patients in a competitive kind of way and in a cooperative kind of way.”
Just down the road, Nathan Tudor, who was then CEO of Stonewall Memorial, was in a similar position.
“None of us had the luxury of access to capital, but we all wanted to provide a higher quality of care for our patients, and EHR is a tool to help us do that,” says Tudor. “There was a friendly competition amongst us all, but for the betterment of the whole we set the egos aside and came together.”
The hospital CEOs decided collaboration was their best chance at converting to EHR. And the unlikely foursome received a grant from the Texas Department of Rural Affairs to kick start the rural health information exchange.
“Even though we’re at small hospitals, CEOs are used to getting our way, so there was some inevitable jockeying for position,” DeFoore says. “But it was a pretty harmonious team with everybody taking a role that fit them.”
He vetted the web-based provider contract. Ted Matthews, Anson’s then CEO, applied for funds. Tudor took on the role of negotiator. And Randy King, CEO of Throckmorton County Memorial, provided clinical expertise as a former nurse practitioner.
“It was comforting having a group of peers you can call and rely on, because we’re going through the same thing,” Tudor says. “Sure, we were competitors, but there was a level of trust. Nobody was out to one-up anybody on this deal. We knew it wouldn’t be sustainable if we couldn’t count on each other.”
Within six months of teaming up, all four hospitals had begun implementing EHR. Today, two – Stamford and Anson – have received meaningful use incentive checks from ARRA that more than covered their technology investment. According to the Centers for Medicare and Medicaid, only 35 hospitals of any size in the nation have met stage one meaningful use requirements.
“We’re a bunch of overachievers here,” DeFoore says. “We’re very proud that we worked together to achieve this significant milestone for patient care in our communities.”
Throughout the process, networking staffs shared struggles and solutions, and nurses in rival towns traded tips to adapt to the new patient care system.
“That synergy happened naturally as a result of us admins agreeing to work together,” DeFoore says. “We get in a rut of doing things the way we always did, but they were able to capitalize on best practices together and get past the ‘Friday Night Lights’ attitude.”
Still, there were workforce obstacles, he said.
“The IT expertise to manage a system like this is a significant challenge in rural areas,” DeFoore says. “It’s like driving a Lamborghini but living in the country where no one knows how to change the oil on that kind of car.”
But once the West Texas rural health exchange figured it out, word spread.
“At the time no group of independent hospitals had established this kind of collaborative that we know of,” Tudor says. “We were way ahead of the curve. In a rural area, you have to be because you don’t have the resources so you have to do creative thinking on a limited budget to get things done.”
Soon, other rural hospital CEOs were asking to join the EHR partnership. And when Tudor moved five hours away to lead 25-bed Otto Kaiser Memorial Hospital in Kenedy, Texas, he continued the connection. Matthews relocated to become CEO at 52-bed Eastland (Texas) Memorial Hospital and added it to the exchange network too.
“Instead of having four hospitals in one region of Texas, we now have eight, and that gives us strength in potential future negotiations with the vendor and when vying for grant money,” DeFoore says. “This kind of collaboration opens the doors for other opportunities for collaboration and improvement. There’s been far too much competition between small hospitals. This just makes sense.”
DeFoore says he’s noticed community pride in the region in light of the EHR effort.
“In addition to the financial incentive and moving ahead technologically, there’s a morale boost to be on the leading edge of something. I realize how far we have to go, so it’s hard for me to put my feet on my desk and say, ‘Ain’t we great?’” he says. “But it has helped us in recruiting staff. People say, ‘Really? In Stamford?’ There’s bragging rights.”