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Health care executive Jason Griffin discusses his article “The digital divide in rural health care.” Jason explains how rural providers in the U.S. face critical infrastructure failures and staffing shortages that threaten their ability to serve communities. He explores why standard one-size-fits-all technological solutions often fail these hospitals and advocates for a collaborative model that prioritizes long-term strategic partnerships over temporary fixes. The conversation highlights the economic importance of keeping rural facilities open and the urgent need to listen to local leaders to bridge the digital gap effectively. Join us to learn how we can build resilient systems that ensure equitable access for everyone.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Jason Griffin. He is a health care executive. Today’s KevinMD article is “The digital divide in rural health care.” Jason, welcome to the show.

Jason Griffin: Thank you, Kevin. Thank you for having me.

Kevin Pho: All right. Before we get into your article, just briefly share your story and journey.

Jason Griffin: I have been working now in health care IT for almost 28 years. I have been in consulting for most of that time. I have been a CISO in an organization and also worked in a lot of different health care organizations. I have always had an affinity for rural health care just because of some family background and where my mom’s side of the family was from.

Over the last 15 years or so, I have really dived into helping to create solutions and collaborations to really drive home more of the and close the digital divide amongst those organizations that just grew exponentially over the last 15 years or so.

Kevin Pho: You talked more about that in your KevinMD article, “The digital divide in rural health care.” Now, for those who didn’t get a chance to read your article, just tell us a little bit about the context and the article itself.

Jason Griffin: That digital divide has come about since just really the modernization of IT and infrastructure has grown so dramatically in the growth of EHRs over the years, and the lack of financial availability of those systems to rural hospitals. There is a workforce gap that has grown constantly. It is hard to recruit in those areas, and it has just created an environment where those folks in those organizations have such a big heart, and they do it for the love of patients, for the love of caring for individuals, but they wear so many hats that oftentimes they are stretched so thin that it is just wearing them out. It is wearing out the organization. The care model has not kept up with, in terms of integration and collaboration among systems, as we have seen in the larger IDNs. So that divide has really just created and grown dramatically.

You couple that with the fact that they are operating on such low margins. They don’t have the capital to invest in that infrastructure. Vendors aren’t really supplying solutions to fit that financial environment. And it is just heartbreaking at times, quite frankly. I can remember having to sit in the car and drive an hour and a half, two hours just so my grandparents can get care when I was young. So that has grown immensely since then.

Kevin Pho: Give us a picture of the types of settings and health care institutions you’re talking about that really illustrates some of those rural health IT shortcomings that you mentioned.

Jason Griffin: Rural America exists. We think about the East Coast, the West Coast, but when you talk about the middle of America, most often there is one hospital within a 200-mile radius of a lot of folks living here in the U.S. Those hospitals operate on negative margins. In fact, 44 percent or more of them operate on a negative margin. The folks that work there are longtime residents of that region, most often, and their families are too, so they know the patients, they know the people. But technology just does not get there.

For instance, just the basic Wi-Fi access just does not get there. We have seen a little bit of that close with some of the satellite opportunities that come into the area. But just imagine being somewhere where you are so many miles away from specialists, from true care that most of us need, you know, cancer care. How far do we have to go just for that? So the setting becomes one that will break your heart because of what you see, but that will give you faith in humanity because of the people that are in those organizations and how much they care and what’s driving them to do better with less.

Kevin Pho: You wrote in your article that sometimes weather events, a simple snowstorm, can sometimes knock out health IT for one of these rural health facilities and really cripple that organization, right?

Jason Griffin: Right. It was tornadoes in rural Arkansas where my family was from. But just think about a snowstorm where now power lines are down, water’s down, and hospitals can’t really function. Generators don’t function for more than a couple of days if they have generators. Patients aren’t able to be moved because of the distance from one hospital to the next. And do they even have the transportation to get them there and to move those folks there?

And even with that, I’m glad you mentioned that. With the way we are seeing weather patterns change over the last 15 years, it has just become even more of a gap. I’m happy that we have been involved with the rural health community nonprofit that we have partnered with, with Microsoft and CDW, and we are now able to provide through Starlink access to Wi-Fi to at least start to close that gap.

I am just excited about where we can go. I think there is the collaboration, community collaboration, vendor collaboration, public sector, private sector is starting to grow and we are starting to see more involvement. So I am hopefully hopeful that even with the investment coming from the Rural Health Transformation Program that hopefully will start funding next year, we can start to improve and modernize the way we deliver care so that it becomes more sustainable in a rural hospital over the next 10 years. It is not just about dumping money. It is about changing and collaborating and integrating.

Kevin Pho: One of the things you mentioned earlier was how difficult it was for recruiting and bringing health IT experts into rural health care areas. So you’re getting situations, as you wrote in your article, that one person may act as the CIO and the IT director simultaneously. During things like downtimes and health IT crises, just tell us about the workforce restraint that really impedes the recovery of anything that happens to the health IT infrastructure in rural areas.

Jason Griffin: Yeah. You’re single-threaded. Imagine that CIO and that CISO. His or her family is also in that area dealing with whatever downtime and can he or she even get to their office? It is a scenario where you have one to two individuals that you are going to have to rely on to be the recovery team, not only the incident response team but the recovery team ensuring that the continuity of the organization continues.

And that’s just it. Every day, and remember they are already operating on negative margins, every day that they are down, that loss of revenue is something you can’t recover. That is just lost revenue for that organization. And those folks will. We have plans. There are plans in place. There are some folks doing it. There is Superman, Superwoman and they are going to come through. But that is not sustainable. How often can we go through that level of return from those one to two individuals? And that is what is concerning, and I hope that is what we fix going forward.

Kevin Pho: So you briefly alluded to some potential solutions going forward. You mentioned Starlink and other satellite-based technological solutions. So go more into detail in terms of what kind of options we have to help that rural IT infrastructure.

Jason Griffin: Well, I think Starlink was a great start. Microsoft kicked us off last year in conjunction with the White House and some other areas where they were offering free security assessments, free security tools. Starlink stepped up to do the same. We as Nordic are looking at solutions that are going to meet the market where we need to meet them in terms of financial capabilities and price points and delivery models.

Our whole goal is to not just upgrade infrastructure, but upgrade the ability and the integration of how that care is delivered. Sometimes it may not need to be infrastructure. Sometimes we can just look at a collaboration of data and the sharing of data in a different way that allows that. But for us, there are going to be tools around disaster recovery and business continuity. I think we are bringing the cybersecurity tools and managing partners and third-party risk management.

Infrastructure modernization is something we are looking at. How do we improve the access to the EHR and to data and put it in the right place at the right time? Telehealth is going to be huge. Just being able to remotely manage and see those patients and not always require those patients to have to drive that a hundred miles to come to a hospital, if we can get the infrastructure in place to support that, then those programs will, in and of itself, help us move the needle in terms of the level of support available to those areas.

Kevin Pho: And just contrast what you’re talking about with a traditional vendor relationship.

Jason Griffin: Most vendors build their solutions at a scale that is for the larger IDN-type of hospitals and environments. Those hospitals are able and can afford and have the budget to spend those dollars, but that is not always the case. So what we are looking to do, and it is not those vendors’ fault, I mean they are obviously revenue-generating businesses and organizations and they have a model for their solution, but we want to try to identify ways to just bring that down to a price point and have vendors support us in that to relieve some of that financial pressure on those organizations.

Kevin Pho: Tell us in terms of going forward, you mentioned that rural hospitals are already working on negative margins. What other solutions do we have, maybe from a policy standpoint, that can help these rural health care facilities going forward? Especially from a health IT standpoint, and there’s just so many aspects to that, and we mentioned a few today and you threw in of course cybersecurity as well. So tell us from a policy standpoint, what more can we do to help these rural clinicians?

Jason Griffin: We can create more of a collaboration amongst private sector, public sector; start to share data more in our HIEs, our health information exchange; create a robust infrastructure for organizations to share that data. Our revenue cycle process for those, or I mean, think about operating on AR days where if you’re getting paid, if the claim is accepted, it may be 90 to 120 days before you receive payment. And the cuts in Medicaid could affect that that we are seeing possibly come in the next five years or so and how those are going to be affected.

There is not one silver bullet that is going to fix all of this. It is going to be a collaboration amongst many types of organizations and entities. We have got to fix the revenue cycle piece. We have got to modernize the care model. We have got to integrate these systems and data and put data in the clinician’s hands at the right time. So often because we have disparate systems, we end up forcing the clinician to be the integration point, and they end up having to manage multiple systems and multiple levels of data, and it is just inefficient.

If we can help to solve that problem and create solutions, realizing those solutions aren’t multi-billion dollar generating type solutions. However, they are solutions that are going to, one, improve the overall health of our population, which in turn takes some of the strain off of our health care system, improves cost across the board for everyone.

Kevin Pho: We are talking to Jason Griffin. He is a health care executive. Today’s KevinMD article is “The digital divide in rural health care.” Jason, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jason Griffin: Just be thankful for and recognize what is happening right now in health care. I implore people, everyone, just to be aware of what your state is doing. They have all made applications to be a part of the Rural Health Transformation Program. Talk to your congressmen and senators and really understand and be thankful for, if you are in those rural areas, those local hospitals, realize what those folks are up against and what they are doing. That will hopefully drive some of us to stay home and be a part of the fix. Not necessarily when we go to school and go off, we go to the big city, but there is a lot of need and a lot of value in us supporting those smaller hospitals and growing there. So I would just say that just be aware. Please, we need to bring more awareness to this because we are headed down a path where if we don’t change soon, it could be catastrophic for us. Too many of these hospitals are closing and we want to stop that process.

Kevin Pho: Jason, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Jason Griffin: Thank you, Kevin. Take care.