Rural and community hospitals serve almost 15% of the U.S. population, but only 10% of physicians practice in rural America, according to a report from the Centers for Disease Control and Prevention. Despite their rural setting, these healthcare organizations face the same staffing, security and budgetary challenges as their urban counterparts.

Similarly, rural and community hospitals cannot afford downtime for their electronic health records, an expense estimated at $7,900/minute, and at almost $8,662/minute today for the cost of ransomware attacks.

How can emerging technologies help remote and often under-resourced rural and community hospitals manage these other challenges?

Dr. Mark Pratt is a board-certified emergency medicine physician with more than 18 years of clinical experience. As a clinical informaticist, he serves as the chief medical officer at Altera Digital Health, which aims to bring comprehensive ambulatory, inpatient, emergency, financial, registration and analytic software to healthcare.

Pratt earned his Bachelor of Science in Biochemistry at the University of Tennessee, Knoxville, his Doctor of Medicine at the University of Tennessee Health Science Center, and completed his residency in emergency medicine at the University of Missouri, Kansas City.

We interviewed Pratt to discuss those questions and more affecting the rural and community hospital market.

Q. What are some of the big challenges rural and community hospitals face today?

A. People often forget that rural and community hospitals do many of the same things as large health systems, from the revenue cycle to regulatory reporting. These are still highly complex organizations that share many of the same challenges as big hospitals but with fewer resources.

Achieving and maintaining financial stability is at the top of these organizations' minds today. Rural and community hospitals tend to have more significant percentages of Medicare and Medicaid patients, and we continue to see reimbursements shrink from these programs. While the rise of inflation has slowed since last year, costs remain higher.

This has put many healthcare organizations in a difficult position as they have to find more and more ways to operate at a positive margin.

Staffing shortages are another industry-wide problem with an outsized impact on rural and community hospitals. Particularly within rural settings, it can be extremely challenging to attract and retain qualified talent for both clinical and nonclinical roles.

On the clinical side, specialists may find fewer resources available within a rural community, for example, which might make practicing in a suburban or urban setting more attractive. During the pandemic, there was an increased reliance on contract workers across the board, who tend to be costlier than full-time employees.

Before and since that period, rural and community hospitals have relied on contractors more than larger organizations, which has continued to exacerbate other financial challenges.

A third major challenge that is becoming increasingly difficult as technology becomes more integral to care delivery is the ability of these organizations to maintain their IT systems effectively and efficiently. Keeping up with upgrades can feel like being stuck on a hamster wheel if your IT team is short-staffed, and those thinning margins mean IT teams have to do more with less.

At the same time, cybersecurity threats are growing in frequency and severity; smaller organizations may be more likely targets of bad actors looking to exploit organizations that don't have the resources to recover as quickly, if at all. All these factors threaten the ability of rural and community hospitals to remain independent, which has become increasingly difficult in today's healthcare landscape.

Q. What are some of the emerging technologies rural and community hospitals can use to help overcome the significant challenges?

A. While not necessarily a brand-new innovation, cloud computing is an emerging technology within the healthcare space, and it has great potential to help rural and community hospitals address these challenges. From a financial perspective, cloud-based technologies can offer a lower total cost of ownership than on-premises deployments by reducing an organization's hardware footprint.

The cloud also reduces the amount of maintenance that needs to be performed onsite, which is a significant benefit to organizations struggling to fill staffing gaps within their IT departments. Additionally, the cloud enables access to data anywhere, anytime, giving providers more flexibility for documentation.

For example, using a mobile device, they can complete charting in between seeing patients without being tied to a desktop. Documentation burdens are a top contributor to clinician burnout, which has obvious ramifications for staffing. From a connectivity perspective, giving providers access to all the data they need when they need it is also critical so that providers have a complete picture of the patient for better decision-making.

Containerization is another type of technology expanding in healthcare that can help rural and community hospitals improve IT operations. A container is a fully running environment packaged together in a single file with all the code and everything the code needs to run.

When developers use containers, what they plan to deliver is what is delivered, and it works the same on any machine. With containerization, an organization does not need to buy and maintain hardware or an ideal environment for the software. So, similar to the cloud, containers can help organizations reduce their IT spend and avoid straining understaffed IT teams who can now focus on other tasks instead of trying to keep up with routine maintenance.

Third, we are seeing much growth in the automation space, particularly with robotic process automation (RPA), which automates tedious, repetitive tasks. RPA is a software bot that replicates rules-based actions typically performed by a human. There are many functions within the revenue cycle that are particularly well-suited to RPA, such as claims processing and insurance verification.

Many of these organizations need help to hire and retain financial staff with nuanced healthcare experience, making RPA and other AI technologies an attractive alternative. The use of automation is also increasing on the clinical side. For example, hospitals can leverage automation to take the unstructured physician's note and auto-populate the various data points into the structured sections of the EHR, cutting down on time spent documenting and clicking.

Similarly, ambient listening can help clinicians turn their attention from the EHR to the patient during clinical interactions.

Q. What kinds of outcomes do you believe rural and community hospitals can expect from putting these emerging technologies to use?

A. Cloud-based EHRs are easier to implement than on-premises systems as they do not require hospitals to install additional hardware or software. Hospitals rolling out cloud-based systems are unlikely to face the same disruptions to cash flow that they might otherwise incur with an onsite system implementation.

Deploying on the cloud also gives hospitals greater scalability to add users or service lines more freely. From cybersecurity and disaster recovery standpoints, the cloud also offers hospitals a lifeline if an incident occurs.

Whether a hospital is the target of a breach or a system goes down during a natural disaster, cloud-based systems typically have built-in redundancies that on-premises data centers do not. This is another way in which the cloud can reduce disruptions to cash flow and, more importantly, disruptions to patient care.

Leveraging technology with containers can also help rural and community hospitals streamline their IT operations. With containerization, hospitals can make smaller updates that do not require a large team. This also increases the speed of innovation, so hospitals can begin using new features and functionality more quickly.

Containers also reduce downtime because developers can modify individual components without bringing down the entire application. As a result, hospitals can avoid temporarily reverting to paper charts and incurring downtime costs. Plus, containerization offers cybersecurity benefits. A malicious actor may be limited to the container accessed in a breach. The developer could then isolate the breach by terminating the compromised container so the hospital can continue using the EHR or other system.

Within the revenue cycle, automation tools eliminate human error and can work 24 hours a day, seven days a week. By removing errors from something like the claim submission process, hospitals can prevent denials, which delay payment and eat up staff time when corrections must eventually be made.

By working around the clock, bots and other forms of automation can help increase the volume of claims submitted and speed up reimbursement. Offloading some of the more tedious tasks from the human workforce also enables staff members to focus on more complex cases.

On the clinical side, deploying a solution like a virtual scribe or an ambient listening tool can give providers more time back in their day by cutting down on administrative work. Not only do these examples help increase time spent with the patient, but they also reduce one of the key contributors to provider burnout.

The growth of technology in healthcare is a double-edged sword. As hospitals adopt new solutions to solve problems, they often add complexities. We have to find a way to strike a balance between innovation and distractions or disruptions. Automation is one lever we can pull to make advancements without burdening providers.

Q. What advice would you offer CIOs and other health IT leaders at rural and community hospitals when it comes to these challenges and these technologies?

A. Artificial intelligence has become a buzzword in our industry, and people are rightfully excited about the new developments it will enable. That said, it is also easy to get caught up in the hype cycle. I would first encourage hospital leaders interested in AI to figure out their organization's most significant pain points.

Ask yourself and your teams where we can remove repetitive tasks. Where can we reduce the cost of doing business? What could we be doing more efficiently? After identifying these opportunities, you can look at what types of systems in the market can help you address those challenges.

All hospitals, but especially rural and community hospitals, must find the most value out of their IT investments today, and that starts with coming from a place of problem-solving.

For all the technologies mentioned above, it is crucial to ask your potential vendors the right questions. Probe them not only on their technologies, but also the partners they work with. Ask why they chose those partners and what benefits that partnership brings to the customer and end users. Preventing cyberattacks and protecting patient data are table stakes. Make sure the vendors you work with understand that and have the same dedication to privacy and security as your organization does.

Finally, remember that technology adoption does not have to be revolutionary and that an evolutionary approach may be more effective. When resources and funding are limited, incremental change is more manageable and likely to succeed.

Instead of taking a big bang approach, start where you think a new implementation will drive the most impact and grow across the organization. Give your physician champions and other leaders room to weigh in and leave ample time to educate staff members interacting with the technology on any changes.

To elevate healthcare experiences for patients and providers, we must find an achievable, sustainable path to get there.

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Email him: bsiwicki@himss.org
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