Why Is Healthcare Innovation So Hard in Rural America?

In small towns where the doctor is a neighbor and the hospital is the biggest employer, new ideas like AI and telehealth face a much tougher path to adoption.

Rural critical-access hospitals are struggling, and they're looking at innovative ideas like telehealth and AI to keep the doors open. But what works in the big city won't necessarily work in a small community.

And that's what makes innovation such a hard sell in rural America.

"We're very cautious when the word 'partnership' comes into the conversation," says Susan Gutjahr, HIT Director at Sparta Community Hospital, a 25-bed hospital in Sparta, Illinois, a city of roughly 4,000 residents in the southern part of the state. "We don't want to lose our local connection. That's who we are."

For small hospitals like Sparta, new technology offers the promise of improving care, but it can also rob the organization of its identity—a valuable commodity in rural communities where the hospital is often the biggest employer and the doctor is a neighbor. Hospital leaders looking to keep their hospital afloat have to understand that the promise of innovation doesn't apply equally to every organization.

"What can new technology really bring to us?" asked Gutjahr, who attended the HIMSS 25 conference and exhibition earlier this month in Las Vegas "to physically see everything that I get e-mails about." For hospitals that are often the lifeblood of a rural community, the idea of buying things just to keep up with the big guys isn't always best.

Different Communities, Different Priorities

During a panel on rural healthcare challenges at the ViVE 25 conference this past month in Nashville, Rachelle Schultz, President and CEO of Winona Health, an independent community health system based in southeast Minnesota, said she has to balance new ideas with specific workforce demands.

"Our challenge is to really rethink the work," she said. "It's a very different landscape today. … Our really experienced people have retired, and the incoming people have different expectations," she said.

Schultz said her hospital had to invest in a simulation lab because some of their new hires are ill-prepared for the hospital. Some nursing and allied health programs are cutting out clinical rotations in order to get more students out the door and into health systems, resulting in a new wave of hires that need more training on basic patient care.

"In a lot of cases they've never laid hands on a patient," she said. "This puts a burden on our supervisors and our managers [to use the lab} to reinforce the education and the training."

As a result, she said, there's less money to spend on other technology.

"We need new technology probably more than most folks do," added Ryan Thousand, Fractional Chief Information Officer at Dahl Memorial Healthcare, a critical-access hospital in Ekalaka, Montana that's more than two hours away from the next healthcare facility. "It's something that we really have to be on the innovative edge of, but unfortunately we don't have anyone to feed and water that after we put it in."

Thousand said he has to focus on using whatever he has and "creating that vanilla base layer that allows us to innovate." That means avoiding a new EHR or virtual care platform and focusing on base-line technology just to be connected.

"My IT team could fit in the trunk of a Prius," he said. "And I can't go out and buy that shiny new car. I would love to have Epic Connect. I have Dwight, but he's 65 years old and he drives a tractor every day to my office" just to see a doctor.

Telehealth Is a Bad Thing?

Scott McEachern, CHCIO, Chief Information Officer at Southern Coos Hospital & Health Center in Bandon, Oregon, said they invested heavily in the Epic Community Connect EHR to tackle interoperability challenges. He said it was crucial that his small health system create a platform to try and hold onto patients who, through telehealth, have more options for care.

That struck a chord with Mountain.

"People talk about telehealth like it's the best thing that ever happened; it's the worst thing that ever happened," he said. "They can now get their care from their house [instead of coming] into my facility."

Telehealth may allow small hospitals to connect patients with specialists and services that aren't available in a rural facility, Mountain noted. But it also gives patients an opportunity to see what they can access elsewhere—to the detriment of a small, local hospital that needs those patients to survive.

"Now you're sending them off for that additional care and you're just praying that they come back," he said.

Schultz, whose health system has used a Cerner/Oracle EHR since 1989, said she's encouraged by the integration of AI into the EHR, which would improve what she called "the bane of our existence as providers."

"There is no Amazon-like experience with our current EMR systems," she said.  Adding AI, however, "is what I would consider breakthrough technology."

Mountain was less optimistic.

"AI is not going to work for me right now," he said. "I've got gravel roads. At the end of the day if you bring a blade in that's made for asphalt, it's not going to work. And that's where I'm at. The emerging technologies for us are still the shiny objects that are out there, and we're just trying to get to those less-emerging [technologies]."

Community Comes First

The challenge with bringing in new technology, the panelists said, is that it affects not only the hospital, but the entire community.

"Most of us are the largest employers in our community, so we're critical not only for healthcare but … for the economy of the cities that we're in as well," said Linda Stevenson, Chief Information Officer at Fisher-Titus Medical Center in Norwalk, Ohio.

"In rural areas technology is a force-multiplier when it comes to your economy," Mountain said. "I'm the largest employer in town, and that's not a good thing. For the hospital to be the largest employer in town is kind of scary. So at the end of the day, If I take a job away from somebody and I start bringing in AI, that's all they start talking about. They don't care about the efficiencies."

Mountain suggested attracting new technology like AI into the community, but having it develop in other businesses first, rather than the hospital. The community would see the benefits economically in new and better businesses, and then the hospital could embrace the technology to improve care.

At the end of the day, how a rural community embraces technology is far different than how an urban city looks at innovation.

 "We have kiosks, and we have people who come in who will not use kiosks," noted Schultz, adding that Winona Health doesn't use patient portals because some patients want to call their doctors instead of messaging them online.

 "I think we have to be careful that we're not interrupting what is really a valued relationship that people have with their doctors, their nurses, their therapists, and so forth, and make it too techy," she said. "Because at the heart of it, it is the connection of people."

"We can swing too far if we're not paying attention," she added.

That's what concerns Gutjahr, at Sparta Memorial Hospital. For a rural hospital, a partnership might just mean giving patients new opportunities to seek care elsewhere. With that in mind, she was at the HIMSS conference to look at new technologies and ideas to improve patient engagement and staff retention.

"We need help to hang on to what we have," she said, noting clinicians will come to Sparta to get their foot in the door, then move on to bigger and better paying opportunities. "That's a real challenge.