A rural New York health system focuses on the vulnerable

At the HIMSS Global Health Conference & Exhibition, where thousands of attendees came to Las Vegas to see the latest technology, Julie Demaree offered a snapshot of the challenges of serving rural communities in New York state.

Demaree is the vice president and chief technology and digital innovation officer of St. Mary’s Healthcare, based in Amsterdam, New York.

“We have food in every doctor's office,” she says. “We have something called Annie's Closet, which clothes pregnant moms and their babies. We are taking care of patients in our offices.”

Many community members are struggling to buy groceries. “Food Insecurity is a really big problem,” Demaree says.

While plenty of Americans in cities and suburban communities also face food insecurity, those in rural areas face hurdles to get resources for help.

“You have to get to that food pantry, safe housing, heating assistance,” she says.

Rising gas and oil prices are going to pose more hardships, and Demaree says that means some may end up cutting back on their prescriptions.

“The medications always go first,” she says. “Is it food, or is it heat, or is it medication? The medications go.”

‘We are the lifeline’

St. Mary’s may be a small, rural system, but Demaree says it is “a mission-driven organization.”

Health systems in rural areas are hoping to get some assistance from the federal Rural Health Transformation Program, a five-year, $50 billion effort aimed at expanding access in rural communities.

Hospital leaders say that the money will do some good and welcome the assistance. But they also say it doesn’t change the fact that Medicaid spending is slated to be cut by about $1 trillion over the next decade. KFF, which examines health policy, estimates that Medicaid spending in rural areas will decline by $137 billion over 10 years.

Like other hospital leaders, Demaree says rural health systems need ongoing support from the federal government.

“St Mary's has a very strong mission to support the poor, the vulnerable,” Demaree says. “We are screening everyone for social determinants of health, but we identify needs, and there just aren't resources in our area to meet those needs. That's the kind of help we need in rural America. We need people to help our patients. We are the lifeline.”

“We are trying to provide great medical care. We are trying to ensure that they have access to the services they need. We are trying to grow the services that we think we can perform well, and, of course, be fiscally responsible, so we're here for years to come. We want to be here for the long haul,” she says.

With the rural health program, the federal government is directing money to states, which will distribute the aid. While hopeful for some assistance from the rural health program, Demaree says New York is planning to use funding to support areas such as telehealth and cybersecurity, which are areas where St. Mary’s has already made investments.

“What we need is an investment of cash to replace our aging infrastructure, which is what keeps me up at night,” she says.

Demaree says it’s difficult for rural systems to pay for infrastructure improvements. And it’s not easy to raise money for such efforts, which aren’t as enticing as asking donors to help pay for new buildings or new surgical equipment that could attract more doctors.

“It's a lot harder to get money for something that doesn't bring business but is essential to your strategy, which is the stability of your system,” she says. “And that's really what we need right now. And I think that that's probably true of a lot of hospitals across the nation.”

‘Move outside the box’

The system is using technology to expand its services to the community. In the coming school year, St. Mary’s is establishing telehealth services with local schools to help kids who may not easily have access to primary care doctors. St. Mary’s is also working with a pharmacy to deliver medication to the school if needed.

“We certainly are trying to move outside the box,” she said.

By offering virtual care appointments, St. Mary’s can coordinate with primary care doctors and also reach those kids who may not have a physician they see regularly. The telehealth service can also provide a little extra assistance for kids who need it.

“Perhaps a child has an asthma exacerbation, for example, and needs follow up in a few days,” Demaree says. “If we can keep that child in school for that asthma exacerbation follow up, then not only are they more likely to be compliant with care for follow up, they also don't have to miss school. And again, a lot of kids are missing school because they have to go to the doctor, but a lot of kids just aren't getting the doctor because they can't get there. So if we're able to kind of take that care to them, we think that that will help serve our patients and families better.”

St. Mary’s is also using technology to improve medication safety. At HIMSS, Demaree and others from St. Mary’s gave a presentation on its success in improving safety in medication orders.

The health system has set up computerized entries for prescriptions, along with an alert system to warn of potential problems with medication, including allergies or drugs that cause problems when mixed with other medications.

Demaree says it’s part of an effort to bolster patient safety and earn an “A’ in the Leapfrog Group’s hospital safety grades. Currently, St. Mary’s has a “B” and is looking to do better.

St. Mary’s has managed to adjust the system so that it offers alerts to problems, but doesn’t lead to incessant warnings.

“You don't want to have too many alerts, because that causes alert fatigue,” she says. The system worked to “really fine tune those alerts so that our clinicians are getting the right information at the right time without being overwhelmed. If you just get noise all day long, you start ignoring it right … If you just have pop-ups all day long in your EMR, you can also have alert fatigue, and then they have no value anymore.”

Demaree says the system is focused on improving safety and, hopefully, getting an “A” from The Leapfrog Group.

“It represents safe, quality care, and we're showing that you can do it in a small hospital,” she says.