North Country Healthcare: Mastering the Terrain

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Healthcare systems in rural areas face a host of barriers to technology. In northern Arizona, North Country HealthCare is creating a roadmap for them to follow.

For the 20% of American citizens who live in rural communities, access to healthcare can be a challenge. In the intermountain West, where ruggedly beautiful land features have come to symbolize much of our country’s grandeur, topography adds to those difficulties — particularly when it comes to reliable connectivity and broadband access.

Along the I-40 corridor in northern Arizona, from Show Low on the state’s eastern edge to Lake Havasu City on the western border, and from Flagstaff north to the Grand Canyon, a dozen communities depend on North Country HealthCare for high quality, comprehensive medical services.

Each year, North Country cares for approximately 50,000 unique patients in northern Arizona, providing family medicine, behavioral health, OB/GYN, dentistry, physical therapy, telehealth, and pharmacy services through a network of strategically located primary care offices in medically underserved areas.

The federally qualified community health center operates 16 facilities across the width of the state and is the only system to serve Grand Canyon communities and the U.S. Park Service. At present, North Country is embarking on a journey that may be as rigorous as scaling the canyon’s steepest face: linking their providers and patients with digital technology.

North Country must stabilize and modernize their tech infrastructure before making investments in automation and other innovations, but unlike healthcare organizations in more densely populated and geographically accessible regions, they are hamstrung by limited broadband access. “Our staff is excited about the possibilities of technology, but we find ourselves uniquely unable to explore all of them because of technology foundation limitations,” Jon Smith, North Country’s CIO, told BOSS.

Although T-1 transmission lines are still widely used throughout the country because of their reliability, the telecommunications company that provides them in the Grand Canyon has been planning to remove them as part of their own infrastructure modernization efforts. Smith directly advocated against the plan, stressing North Country’s importance as the only source for healthcare for that community and the National Park Service. His efforts succeeded in pushing the telecom’s plans out for a year, but they still have plans to remove the lines, and don’t intend to bring more bandwidth into the canyon.

To ensure that the organization has ample broadband, Smith is using software-defined wide area networking (SD WAN) to add secondary 4G connections to the canyon that will provide redundancy and aggregated bandwidth. “We can’t get fiber and we can’t get any more T-1 lines, so we have to rely on cellular technology,” he said. “We’re doing that at all of our locations because as we’ve started modernizing and moving things to the cloud, we have a higher reliance on the internet and we need it to be fast enough, and to always be available.”

Expanding into new opportunities

North Country has grown rapidly in recent years, outstretching the tech footprint that worked for their smaller size. Before implementing innovations such as RPA, existing data must be cleaned and managed, which requires significant manual work. “We’re starting with the IT department. The goal is to tie into our HR system and make traditional changes with various applications, whether it’s account creation, permissions, groupings, assignments of other applications and services,” Smith explained, noting that while IT may not be the business owner of a particular department in the system, it has a critical role in its success that needs to be valued as such.

“You can get to that value-added perspective so you’re not ripping and replacing software every few years by breaking down organizational walls and showing that you’re not trying to tell people how to do their jobs. You’re just trying to get them to think about things differently, consider security, and so on.”

Effective change management has been key in moving the process forward throughout the network, particularly from the electronic health record (EHR) system standpoint. “We’ve been able to put in good QC, and work with all of our stakeholders to develop a workflow, ensure that proper testing is occurring, and ample training is available to staff as we change. We’ve seen tremendous growth in our EHR, and it’s working.” A strategic shift to the cloud is near completion as well. The entire system’s infrastructure has been moved to Azure, and a virtual desktop system is in place that significantly enhances security.

One persistent challenge is the distributed nature of the system itself, which makes getting fast, on-premises technology help such as replacing equipment a painful process. “We have a small staff

and we are hundreds of miles apart, and they have to get hotel rooms and drive across the state just to service a clinic,” he said. “It’s not as efficient for us as it would be for a health center in a more condensed geographic location.”

Building a culture of security awareness is an ongoing component of the transformation. “We’ve been able to implement a lot of initiatives that have been welcomed by the organization and leadership, but their success ultimately depends on the end user. We have to be vocal, present, and strategic in our approach to securing our staff buy-in to security awareness, and make it a relatable experience,” he said.

“When staff know that you really care about them and their personal life just as much as you do about the security of the organization, it really bridges that gap and helps them buy into the process and the positive impact it’s going to have on their day-to-day.”

Smith pointed out that while North Country may be unique in some of the technological challenges they face, such as rurality and the impact of limited broadband access, the implications of rapid growth are affecting community health centers across the nation. “Through the strategic partnerships between key leaders and the CIO, we are swiftly right-sizing technology and positioning ourselves to be more and more innovative in the future while maintaining costs,” he concluded.