Recipient of The Health Data Management Electronic Health Records EHR Game Changer Award

EHR Game Changer Goal: Rural Hospital Connectivity

by Gary Baldwin
MAR 1, 2012

This is the second in a series of profiles of recipients of HDM's EHR Game Changer Awards, created to honor individuals who have been true game changers in the design, advocacy, deployment and development of electronic health records technology.

If anything, Earle Rugg is a testimony to the power of perseverance. Rugg serves as the CEO of the Rural Health IT Corp., Portsmouth, N.H., an I.T. consultancy he helped found in 2003. The group specializes in writing grants that enable critical access hospitals and others to launch technology projects that might otherwise be out of their financial reach. And not every grant proposal Rugg has crafted has succeeded, he cheerily admits.

Like every career, his has had some highs and lows. In the early 2000s, Rugg tried to launch a Web-based EHR software company-only to be upended by the "dot-bomb" implosion. "The product was a prototype," he recalls. "It did not even have a name. But we lost our funding and I had to get a real job."

Rugg landed on firmer ground at Payer Technologies, another health I.T. company he helped form via a partnership with the Blue Cross Blue Shield Association. The company served a small niche of third-party administrators in the Blues group, connecting them to a claims processing network. Then, in 2003, Rugg had an encounter with a critical access hospital CEO that led to the formation of the Rural Health IT Corp. Fred Lord, M.D., a physician Rugg had done some HIPAA consulting with, introduced him to the CEO of Mt. Ascutney Hospital, a 60-bed facility in Windsor, Vt. "The CEO's mother had been sick, and went from the hospital's outpatient to inpatient setting," Rugg recalls. "She had to register three times. The hospital had multiple information systems. I asked, 'wouldn't it be great to get these systems to talk?'"

So Rugg did what would become his stock-in-trade at Rural Health IT Corp.-he applied for a grant from the Agency for Healthcare Research and Quality to equip the hospital with an integration engine. His work paid off, as the hospital won the grant, putting Rugg to work to search for a vendor. "We decided on one that was just getting started," he says. The vendor, Orion Health, has since blossomed into a major data exchange software vendor. Later grants helped the hospital implement and expand the data exchange, which is still running as a joint venture between Mount Ascutney Hospital and Dartmouth-Hitchcock Medical Center, Lebanon, N.H. It's an early example of a cross-state data exchange, Rugg says. "We built a bi-directional flow among the different systems at Mt. Ascutney and a one-way flow to Dartmouth's physician portal. If patients moved from Mount Ascutney to Dartmouth, physicians could access their record through a physician portal."

Rugg then became a fixture on the speaking circuit for the Health Resources and Services Administration, another government agency looking to offer technology grants. He parlayed those lectures into business connections that resulted in a variety of other grant writing proposals, strategic consulting, EHR selection and data exchange development. Rural Health IT Corp. went on to secure a $1.6 million grant for the University of North Dakota to launch a data exchange and a $540,000 data exchange grant for Transylvania Regional Hospital to connect seven clinics in Brevard, N.C. One key to successful grant writing is identifying measurable outcomes and milestones, he says. "The ROI for the grant agency is the information they get back. Was the project successful? What went right, what went wrong, and can it be replicated?"

His orientation has been on the rural poor, Rugg says. "The hospitals that serve them don't have the money to go out and buy systems." More recently, Rural Health IT Corp. has been working with hospitals serving low-income urban populations. "They're no different," Rugg says. "They're medically underserved."

Rugg now is working with Franciscan Health System, Tacoma, Wash., on a project that would link the hospital's EHR directly to the personal health records of its patients. In Rugg's vision, the PHR and EHR could both send and receive data, automatically populating each other with data either entered by the physician or patient.