HIT Challenges in Rural Areas

Rural hospitals suffer from limited HIT adoption in comparison with the other hospitals. Rural hospitals demand technological assistance most of all, as IT technology can be beneficial for the health care industry. HIT increases the access to the medical care, decreases expenditures for the health care help and improve the quality. HIT becomes an essential source of medicine, which makes rural and city citizens be equal in the area of the health care service. The formation and improvement of the IT infrastructure in the rural areas is important for enhancing the quality of the service. Nevertheless, small rural hospitals and centres in distant regions are limited in HIT aspect. The challenges are related with high costs, capital expenditures, lack of professionals in the rural locations, and issues associated with security complications.

Staff and Scale Challenges

The first essential problem and challenge for implementing HIT in the rural hospitals is the limited scale of the service. The staff of the hospitals is quite small for the intervention of highly developed technologies, especially HIT. Joseph and Molland (2017) also support this claim talking about the problem of communication between the academic surgery departments and rural hospitals. Furthermore, the issue demands specific professionals, which are able to perform tasks of the IT department. The rural hospitals have limited IT departments, which are not able to fulfill all the functions of HIT. Small staff cannot cope with the Electronic Health Records (EHR) or some new software. Thus, the absence of the necessary professionals and limited number of employees are among the main barriers for the newest technologies. This problem is related with the scale challenge. The scale in its full essence; the scale of time, money, the availability, the scale of limitations regarding the software and the personnel, who are sometimes not able to get to the rural area. Another problem is the payment for the performed scale of tasks. The IT workers can get bigger salaries for performing the same job in big cities than in small towns and other rural areas. The technological intervention in the medical sphere is not relevant with the amount of IT professionals available outside the cities.  It is quite uncomfortable for the patients as they must travel far away to get a quality health care assistance, as the rural hospitals are not able to provide the necessary information concerning the surgical assistance (Joseph & Molland, 2017).  This issue is related not only with the scale of the rural medical service but also with IT equipment supply.

Computerization in Rural Areas and Skills

Rural hospitals do not have the necessary amount of the computers and it influences not only the quality of the service but also the possibility of the workers and their IT skills. This challenge was investigated by Hook, Snow and Clark. The professionals in the medicine are not familiar with the basic computer skills and primary competency to use the simplest and commonest software for the health care system (Clark, 2014). This limitation concerns not only the absence of computers and skills but also weak financial donations for this issue. The rural employees face the problems of computer illiteracy and cannot find the necessary assistance, because the governmental budged does not include the study of computer technologies in the health care system (Hook, J., & Snow, J. 2010). Additionally, the introduction of newest technologies and HIT programs can cause the resistance of the personnel who lack the necessary education. A strong HIT in rural areas should follow the sufficient IT education. Thus, the issue of new technologies at workplace will not invoke panic among the workers. These challenges form the vicious circle which is a barrier for technological equipment in rural hospitals. The statistics shows quite alarming situation; 60% of medical workers cannot use electronic records (HER) for providing summaries of care records and more than 90% cannot allow their patients to view records online, transmit, download or do any other operations concerning their records (Clark, 2014). The rural hospitals cannot support online database for conducting their patients’ records because they have poorly motivated employees.

Employee Commitment

The staff of the rural hospitals does not see perspectives and necessity to substitute the system of the current work performance with a more technological. It was assessed by Cresswell, Bates, and Sheikh. The meaningful use of HIT is debatable for the rural workers as they are used to performing their task without computerization. Moreover, they are afraid of certain changes and new technologies intervention. It is related not only to the factor of the distant rural areas but also to some psychological aspects of people leaving far from technological progress. The solution of the problem can involve two the most fundamental factors: new approach to education and sufficient computerization. The employee should be aware about the process of technological health care enhancement, since it can improve their quality of work and even simplify it. The progress should be continually supported and an old software substituted with the newest solutions. The worker will feel the difference and necessity to apply it. Effective implementation is associated with a variety of factors: technical, social, organizational and socio-political (Cresswell, Bates, & Sheikh, 2017). The technical aspect includes the problems of usability, adoption, performance and costs. The users should be informed and convinced in stability of the program, reliability and integration to the enhanced condition of medical service. From the social perspective, the staff must be informed about the level of its benefits and expectations. Furthermore, a more comfortable working process increases the employees’ motivation. In rural areas, the introduction of HIT may help to develop planning, create communication background, improve teamwork and preparation for the further integration of new technologies. Rural hospitals are not related with the clinics and other medical industry sectors. Thus, the weak understanding of the whole process and the fear of the rural hospitals’ employees become an additional barrier for HIT adoption, which can be easily solved with the help of fundamental education and psychological preparation.

The Barrier of Trust and Necessity

Wager, Lee and Glaser believe that the trust issue is one of the most important factors in building the clinical team. Therefore, the adoption of new technologies in rural clinics is even more complicated than the other challenges since the personnel is not ready to trust HIT. Different departments in the clinic must work as a single unit in order to be successful. However, the penetration of new HIT department can bring some disorganization into the working process. Although, HIT system can improve the employees performance; the trust toward such innovation is still debatable. Communication is the way of understanding and trust, while IT technologies can limit the area of communication and decrease its necessity. Although, such conditions can be more effective, useful and comfortable, the rural staff may not trust these innovations. The solution of the issue is still possible, but it can take a long period of time, since education and psychological preparation cannot be sufficient for it. The challenge can be overcome only after some period of time, when the personnel gain some experience and confirms the highest proficiency, effectiveness and reliability of a new system (Wager, Lee & Glaser, 2005). Furthermore, the employees in the rural area may not see the acute necessity to apply the newest technologies.      

The rural residents are older than the majority of the urban citizens. Many of them have chronic diseases and are not able to visit the hospital constantly. Therefore, the nurses in rural areas perform outpatient care, visiting people in their homes, where some HIT assistance is useless ("Rural Hospitals", 2017). Therefore, the intervention of new expensive and almost unnecessary technologies is not sufficient for the rural hospitals. Furthermore, this can be quite risky.     

Cyber Security Challenges

Any kind of information should be protected form breakdowns and disorders, as well as virus attacks. National Rural Health Resource Center informs that a cyber-security aspect may be a serious barrier, as the protection of the information demands additional services within the IT department, demanding high expenditures. Moreover, the problem of availability is also related to this issue, since the professionals in the aspect of cyber security are not available in rural hospitals. The solution can be quite complicated for medical workers since the professional must not only understand the source and nature of problem but also discover the methods and ways to asses the risk, protect data and cure the problems ("Cybersecurity Threats in Rural America: How to Protect Your CAH", 2016). Security is not a single technical problem. The rural residents can worry about the technical errors. Despite variety of benefits the HIT service is quite complicated and resource demanding. In case of poor cyber protection and HIT support it can be dangerous to use the system that has a high level of vulnerability. Aside from the expensive HIT system the rural hospitals should take care of the expensive systems of risk management and the business continuity framework.  The solution can be expensive and take a long period of time for the necessary preparations, education and integration the systems into the medical area. The more HIT technologies develop the more risk factors of its collapse arise.  Furthermore, the medical information is more attractive for the cyber-attacks than the information from other areas because of weak security programs. It is necessary to admit that the recovery form the hackers attack is highly expensive. Moreover, it can bring down the system for several days and even months. The local professional may not be competent enough to eliminate the problem. Only a highly trained and educated specialists and skilled professionals can cope with some issues.

For the majority of rural hospitals, the costs for the HIT implementation, support and security are too high. The majority of big city hospitals are within the great hospitals network, which safeguards such issues and assist in any case (Johnson, & Murphy, 2013). The rural hospitals stay alone in the medical care system. Even if the employees understand the benefits of HIT they still can not apply it because of the absence of assistance. The hospitals use some elements of informative technologies such as scheduling, registration and other formal details. However, the modernization of the program proposes the system of medical record program and computerized provider, which is not widely used. The rural hospitals are not able to support such expensive and complicated programs alone. Despite the variety of potential benefits only 8-12% of rural hospitals this technology. The process of adoption is quite slow and risky. Additionally, the system rejects the aspect of leadership and strategic planning.

Ethical Concerns

Rural citizens as well as the urban residents have the right to the medical privacy. HIT systems cannot ensure the users that the system is protected and their online communication will be kept in secret. This ethical conflict was investigated by Fleming. The problem is associated with the highly developed technologies, which became more vulnerable to attacks. The databases can be broken and information can be stolen. The patient must be sure that the information is highly protected and is not available in any case. In addition, the resources of the online health care can be quite harmful for the patients. The residents of the rural areas can use the resources for online consultations instead of direct communication with the physician. Online information cannot be relevant, as only personal visit to the specialist can result to accurate conclusions. Wrong online diagnostic can lead not only to wrong treatment but also to depressive condition of the patient (Fleming, 2009).  Nevertheless, the wide usage of HIT in rural medicine can make it more available and comfortable for the patients in case of its wise and appropriate usage.

The Help from the Government

The problem of poor IT adoption in rural hospitals can be solved with the help of governmental assistance as it demands sufficient financial supply. It includes not only wide computerization of distant locations but sufficient education courses for local specialists. The governmental participation should be fundamental and include high perspectives for the IT professionals and cyber security experts, who are ready to work in the rural arrears. The expenditures and costs for the security service should also be considered and controlled by the federal financial assurance. The aspects of the patients’ data safety and quality of rural health care should also be addressed by the government. The introduction of the new technologies should be gradual and slow in order to eliminate personnel resistance, prepare the staff and make the process less painful. Although the HIT intervention is associated with the working process improvement, the newest technologies are not as important for the rural areas as for the big cities (Ward, 2009). Some highly expensive programs may not be in great request, as the residents prefer communication with proficient nurse to the online treatment.

Conclusion

Thus, the rural hospitals cannot apply the HIT resources because of the variety of technical, financial and social challenges. The biggest problem is the scale of the hospital, as the majority of rural health care centres are quite small for integral and professional programs, which demand highly developed department and a considerable number of employees. In general, the problem demands additional financial, technological and human resources, which are not available in the rural area. Moreover, the computerization, education and skills of the local medical workers are not sufficient for the HIT programming. This programming is complicated not only in its implementation but also in the care and protection, as it demands expensive and highly developed cyber security system. The rural centres of medical assistance may face the problems of attack, while the cyber-security professionals are not available in distant areas. Aside form all the technical and financial issues, the HIT can threaten ethical aspects. It may result to problems in the private data collection, protection, and may lead to stressful situations. Despite all the lacks and problems, the computerization and IT standardization of rural areas is important for the betterment of health care services and can be performed with the help of fundamental governmental efforts.