Use of Epic at a critical access hospital a key for care coordination
An instance of the system typically installed at large integrated systems helps a South Dakota facility share patient data and reduce needless costs.
As a critical access hospital in eastern South Dakota, Madison Regional Health System faces the typical challenges that small rural facilities face.
But the independent organization still has a job to do, which is maintain health services for the residents in its service area, and now more than ever, that means having access to data, and ensuring that it flows where and when it’s needed.
The 22-bed hospital has been able to use a version of the Epic health records system to provide healthcare services onsite and facilitate information sharing with other integrated health systems in its area for referrals.
Using the records system – one typically associated with large health systems operating dozens of provider sites – has enabled it to improve efficiency, offer better care while enabling the organization to keep patients close to home, better attract clinicians to work there and improve care handoffs when needed.
All those benefits are critical in a rural environment, especially as provider organizations face increased financial pressure and seek to maintain high care standards, executives at the independent system say.
The need for records
In addition to acute-care services, Madison Regional also operates a clinic that’s connected with the hospital, an operating room, two labor and delivery suites, among other services. It’s one of the few providers in South Dakota that’s not affiliated with one of the three large integrated delivery systems in the state.
As an independent organization, that can be challenging, says Laura Hoefert, MD, one of six family medicine physicians at the facility, who also serves in an executive role. “We really have to leverage technology because we can be a bit disconnected” as an independent, unaffiliated organization, she says.
The vast majority of Madison Regional’s patients are also getting care elsewhere, either at another facility, from a specialist or through urgent care centers, she says.
Patients’ electronic records typically have been accessed through the Care Everywhere functionality of systems used by the state’s three large integrated delivery systems, or through the state’s health information exchange. But there were challenges – much of the burden for finding patient records fell to clinicians, Hoefert notes. “We had to do that so much that most of us spent a lot of our day finding records.” And if records couldn’t be easily shared or accessed, medical tests often were repeated unnecessarily, a huge additional cost burden and hassle for patients, she added.
Time for a change
About three years ago, Madison Regional learned that its records system provider was retiring the product they were using, and as they considered making a switch, they seriously considered a move to Epic’s records system.
While the Verona, Wis.-based company typically offers products to larger healthcare organizations, Madison Regional decided to work with OCHIN, a nonprofit consultancy based in Portland, Ore., that offers a fully hosted, highly customized instance of Epic practice management and electronic health record (EHR) solutions.
OCHIN Epic now supports more than 2,000 care delivery sites in 38 states, reaching about 7.4 million people, including patients at about a dozen rural hospitals and a growing number of organizations that support Indigenous and tribal communities.
After a long implementation period, Madison Regional went live on the new system in the first quarter of 2025. Executive support for the move was crucial, and staff members, who had become frustrated with workarounds for its legacy EHR system, were in favor of the change as well, Hoefert says.
Achieving benefits
For clinicians, the new system represents significant advantages in saving time, especially in finding patients’ records, Hoefert says. That dovetails into better care for patients, especially in coordinating care for complicated cases across wide-ranging care settings.
One local patient with a complicated malignancy was receiving care in Omaha, but Hoefert was able to access her records to get needed background data for continuing care. “The family knew a lot, but not what I needed to know,” she says. “I had a conversation with her surgeon and was able to coordinate care before she could get down there (to Omaha).” The records system provided “a really easy way to coordinate care for a patient.”
In another case, an obstetrics patient was planning to deliver her baby in Sioux Falls, Iowa, and had been diagnosed with preeclampsia. Hoefert was able to arrange the transfer and electronically send her lab data and other medical information ahead of time, facilitating the transfer and expediting her care.
Having access to obstetric services is especially crucial in rural areas. Data show that one in four rural hospitals has closed obstetric units since 2010, and as of 2022, more than half of rural hospitals offered no obstetric services at all.
“Women in labor are going to show up at our doors no matter what,” notes Teresa Mallett, chief executive officer of Madison Regional. “The question is whether we’re ready for them. We’ve decided the answer will always be yes.”
Easing the transition
Making the switch to the OCHIN-Epic system was supported by the facility’s administration, which is also its clinical staff. It also required a commitment of resources, such as having two full-time equivalents that work as service analysts for the records system, Hoefert says.
Moving to the new system also helped better share patients’ test results, which means tests don’t need to be needlessly duplicated.
Other downstream benefits include better recruitment opportunities. “We were having trouble getting locum tenens staffing, because they didn’t want to work with our (previous) EHR,” she notes. “Now, having Epic is a big recruitment tool. People are excited that we can offer something like that.”
The switch also has resulted in some cost savings. For example, the new system facilitates notes, and clinicians were able to stop using dictation services that they had used with the previous system.
Fred Bazzoli is the Editor in Chief of Health Data Management.